Correspondent Migraine headaches affect 18 percent of women and 6 percent of men, yet only about half of these patients receive an appropriate diagnosis, and many are undertreated. Because of the visual disturbances frequently associated with migraines, these patients often end up in ophthalmologists' offices, presenting diagnostic and therapeutic challenges. To improve care for migraine patients, the U.S. Headache Consortium, a multidisciplinary panel of professional organizations, developed evidence-based clinical guidelines. The practice parameters, which were published last year in Neurology and on the Web, have refocused attention on migraines and the importance of their proper management. Diagnostic Issues Visual symptoms associated with migraine include flashing lights, scintillating scotoma and blind spots.
Patients also tend to have throbbing, hemicranial pain as well as nausea and vomiting.
It's essential to exclude a serious etiology for the headaches, such as a brain tumor or aneurysm. Further evaluation also is indicated if the headache is accompanied by anisocoria, diplopia, papilledema or loss of vision. Ophthalmologists should make certain there are no signs of increased intracranial pressure, said Robert H. Spector, MD, an Atlanta neuro- ophthalmologist. In particular, you want to make sure there is no papilledema or swelling of the optic nerve. Likewise, a visual field test is imperative to rule out an occipital lesion, which may, on rare occasions, produce symptoms indistinguishable from migraine.