What is migraine?
Migraine is a common cause of headache that affects 10% of the population. Migraine may also cause unusual visual symptoms that occur with or without a headache.
What causes migraine?
The cause of migraine is unknown, but heredity may play a role. Many people with migraines have family members who also have had migraine. Migraine may be caused by abnormal episodes of blood vessel constriction within the brain. A number of events may trigger a migraine (ref): emotional stress, hunger, lack of sleep, hormonal changes (puberty, menopause, and hormone pills), bright lights, loud noises, a change in altitude or weather conditions, exercise, and certain foods (including caffeine, chocolate, alcohol, and red wine). Sometimes eye problems can worsen or bring on migraine. Such problems include improper eyeglasses, eye dryness, double vision, past eye injury or eye surgery. There is evidence that links migraine with a defect in the wall of the upper chamber of the heart (patent foramen ovale). It has been theorized that small particles (e.g. platelet-thrombin emboli) may originate in the venous circulation and pass through the defect in the heart wall into the arterial circulation and on to the brain. This might explain small defects in the brain sometimes seen on MRI scans in patients with migraine.
What are the symptoms of a migraine?
Migraine is associated with a great number of symptoms. Hours or days before a migraine episode occurs, subtle symptoms may be noticed. These symptoms include depression, fluid retention, and stomach disturbances. Visual symptoms can occur before a headache or be the sole symptom of a migraine. These visual symptoms occur without warning when the vision is impaired just off to the side of central vision. A jagged light (“like cracked glass”), which appears to shimmer or repeatedly flash, borders the area of impaired vision. The jagged light causes a missing area of vision and gradually works away from the center to the peripheral vision, taking on a C shape over a period of 15 to 30 minutes. It sometimes is described as heat waves, bubbles, tunnel vision, or a kaleidoscope, and it may be silver and white or in color. Objects may appear too small or too big (This is called the Alice in Wonderland Syndrome). In middle-aged patients a brief loss of vision may occur in one eye resembling a stroke-like symptom. It usually involves both eyes but may appear more prominently in one eye. In younger patients, nausea and a throbbing headache often follow the light flashes. In older patients, the visual symptoms may occur without headaches. Keep in mind that there are many types and causes of flashing lights.
Migraine may also cause other symptoms that do not involve the eyes. Such symptoms include tingling of the face and hands, weakness, or trouble with speech. If this occurs, it may be helpful to call a neurologist for consultation.
The headache may be described as a deep, penetrating pain or a painful stretching sensation. The headache often begins on one side of the head, but it may spread over the entire head. It may be throbbing nor non-throbbing.
What treatment is available?
Making the correct diagnosis is the most important step. Light flashes may be caused by other problems such as retinal detachment. Therefore the eye doctor is often called on to make this important distinction. If migraine symptoms occur infrequently, no treatment is needed. Establishing regular sleep, meal, and exercise programs may help. Riboflavin and magnesium supplements may be of benefit as well. Prescription medication is available if headaches are severe or frequent. They are usually prescribed by a neurologist.
If there is any significant change in symptoms or if permanent loss of function occurs, please contact your doctor without delay. In rare instances, a brain aneurysm or tumor may cause unusual light flashes and headache. Your doctor will decide whether further examination or testing is required.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
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