Visual symptoms in the migraine syndrome

Abstract

Visual symptoms occurred in 41 percent of a selected group of migrainous children diagnosed at The Hospital for Sick Children, Toronto, between 1959 and 1971. The records of 100 migrainous children experiencing visual phenomena were reviewed. Sixty-seven were reexamined and separate verbal and graphic accounts of their symptoms obtained. The phenomena were classified by type of dominant visuals into three categories as follows: 1. Binocular visual impairment and scotomas (77 patients). Transient blindness, blurring of vision, and varied scotomas were most common. Vertigo, ataxia, and, less commonly, diplopia and impaired consciousness were associated with visual symptoms. 2. Distortions and hallucinations (16 patients). Micropsia and macropsia were the most common phenomena. Inversion, alterations in the perception of motion, and elaborate hallucinations were seen less often. 3. Uniocular visual impairment and scotomas (7 patients). The visual impairment and scotomas are similar to those of patients in the first category except that the visual field of only one eye is affected. Pain may occur in the ipsilateral eye. The symptoms of patients in the three categories can be attributed to disturbances maximal in the territory of the basilar (posterior cerebral), middle cerebral, and ophthalmic arteries, respectively. The visual phenomena varied. Although diverse, they were remarkably constant for a given individual. Visual symptoms in association with paroxysmal headache and nausea, positive heredity, and normal neurologic examination are strong evidence for the diagnosis of migraine, thus reducing the need for more elaborate neurologic study. © 1973 American Academy of Neurology.