Visual Symptoms With Migraine
One of the most common neurologic phenomena noted prior to or in the early stages of a migraine headache are scintillating scotoma. These are flashing, scintillating usually yellowish lights in the visual field. They generally last from a few minutes up to 40 minutes, and resolve about the time the migraine headache starts to get severe.
Some patients who use medications like Imitrex or other similar tryptan medications can take these medications when they notice the visual scotoma and abort the migraine prior to the headache. For these patients the prodromal aura is an advantage.
Many other neurologic phenomena can precede migraine headache also. Some of the less common visual symptoms can be tunnel vision and complete or partial blindness on one side of the vision, called homonomous hemianopsia. It’s usually apparent that these are migraine headache related if they precede a severe, one-sided, pounding headache and resolve as the headache comes on there is little doubt. If there is doubt, evaluation for other causes is important.
Neurologic symptoms prior to a migraine are not limited to visual symptoms. Numbness or weakness of one part of the body is fairly common. Complete paralysis or one side of the body is called hemiplegic migraine, and is potentially much more serious. This needs neurologic evaluation and treatment.
Migraine headache management has progressed greatly in recent years. Now we have effective medications to abort migraines early in their course that work in many patients. If migraines are frequent and severe we have preventative treatments that also work for most patients.
Still a small minority of patients struggle with recurrent refractory migraines, and there is lots of progress yet to achieve.