MIGRAINE AND YOUR VISION
By David Mallory, M.D.
The visual symptoms of migraine have been described since
the time of Hippocrates, who wrote: "He seemed to see
something shining before him like a light... a violent pain
supervened in the right temple, then in all the head and
The previous estimates of 10 percent of the population
suffering from migraine are probably markedly
underestimated. Recent studies suggest that the rate may be
as high as 34 percent in women age 15 to 20 and 22 percent
in men age 21 to 34. Migraine is much less common in
children but studies indicate that 5 to 6 percent of
children between the ages of 7 and 15 have migraine.
In classic migraine there are first visual symptoms, called
the "aura." The aura can appear as sparkles, flashes of
color or heat waves. A migraine attack can also begin with a
small central blind spot that builds up and expands with
zigzag lines and lasts for 20 to 30 minutes. The migraine
aura is caused by constriction of blood vessels in the
brain. In 13 percent of people with migraine, the attack
stops there without development of any headache at all.
Classically, following the aura a severe headache, which in
two-thirds of people is limited to one side of the head,
occurs. The headache is usually accompanied by nausea or
vomiting and lasts for two to three hours to several days.
The person may need to retire to a dark room because their
eyes are more light-sensitive.
Migraine attacks can occur as frequently as several times a
day to only three or four times in a person's lifetime. It
is quite variable. There may be only the headache or only
the visual aspect. The visual symptoms may even be simply a
loss of vision in one eye or even a complete inability to
move the eyes, which occurs temporarily after the headache.
Many people can identify a particular trigger to their
migraine, such as chocolate, cheese or alcohol. Stress,
smoking, high blood pressure and birth control pills can be
the cause, and these can be handled. The most promising new
medication to treat an acute attack of migraine, sumatriptan
(Imitrex), has previously been available only as an
injection that can be self-administered. It has just been
approved by the FDA in pill form. Fifty to 65 percent of
headaches are relieved within two hours by the oral form and
80 to 90 percent with the injection. The headache may
however re-occur, and use of this medication is
contraindicated in people who have heart disease or
uncontrolled high blood pressure.
David Mallory, M.D. is a cataract, intraocular lens and
laser surgery specialist at the Southwest Eye Clinic.