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 neck..."

    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.