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Migraine and the Eyes

Scintillating Scotoma

Migraine is an extremely common type of headache that can be chronic and recurrent. Migraine often involves the visual centers of the brain. It is most likely caused by a "vasospasm" or blood vessel constriction in the brain. They tend to be more common in women, and can change throughout life. Often they are on one side of the head rather than more spread out, and they are associated with nausea, vomiting, light sensitivity, and sound sensitivity. A "classic" migraine typically has vision involvement. It will start off with some visual changes that are characteristically a scintillating scotoma as shown in the image above. I have suffered from migraines in the past and the image is not perfect, but it approximates the sensation. It can also look like you are looking through water or a heat wave. It is usually in both eyes, but may be worse on one side. It will usually correspond to the same side of both eyes so it will often seem like it is only on one side, but I recommend my patients cover each eye to verify that it is bilateral. The blurry area will usually start off small and grow over several minutes and then begin to recede. The visual changes usually last around 10 to 20 minutes and are followed by a headache in classic migraine. The majority of migraines do not have this "aura," and may just have the headache. Migraines are often associated with changes in hormones, and the character of the migraine often changes after menopause with the headache improving, but the visual symptoms worsening. Vision changes may be the only finding and the patient may not have a headache. These changes are often called ocular migraine or ophthalmic migraine. If it is the first episode of this condition, I recommend that the effected person be seen by an ophthalmologist or eye doctor to rule out other conditions that can sometimes masquerade as a migraine. Although more rare, strokes, transient ischemic attacks, increased pressure in the brain, and high blood pressure can sometimes manifest with similar findings. If you are in Georgetown, Central Texas, Waco or the Austin area, you can schedule an appointment with Dr. Aaker to better diagnose this condition by calling 512-686-1224.

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