Headache specialists use the International Classification of Headache Disorders (ICHD-3) to diagnose different types of migraine. If your doctor is not a headache specialist, he or she may offer you a descriptive diagnosis instead.
Unfortunately, most doctors do not have the appropriate training to diagnose such a rare type of migraine. Patients and doctors alike use descriptive terms to describe all kinds of visual disturbances associated with migraine. Many patients have been told they have “ocular” or “ophthalmic” migraine when there is no such diagnosis. To make matters worse, doctors do not refer to a standard set of criteria when using these terms.
Possible diagnoses:
- Ancephalgic migraine – a migraine attack without headache
- Migraine with aura – a migraine attack preceded by a sensory aura
- Persistent aura without infarction – migraine with aura in which one of the aura symptoms lasts ≥ 1 week
- Migrainous infarction – migraine attack with a prolonged aura >60 minutes resulting in ischemic infarction
A true Retinal Migraine is diagnosed when symptoms match the ICHD-3 criteria.
Retinal migraine
Description:
Repeated attacks of monocular visual disturbance, including scintillations, scotomata, or blindness, associated with migraine headache.
Diagnostic criteria:
- At least two attacks fulfilling criteria B and C
- Aura consisting of fully reversible monocular positive and/or negative visual phenomena (e.g. scintillations, scotomata or blindness) confirmed during an attack by either or both of the following:
- clinical visual field examination
- the patient’s drawing (made after clear instruction)of a monocular field defect
- At least two of the following three characteristics
- the aura spreads gradually over _5 minutes
- aura symptoms last 5-60 minutes
- the aura is accompanied, or followed within 60 minutes, by headache
- Not better accounted for by another ICHD-3 diagnosis, and other causes of amaurosis fugax [loss of vision in one eye] have been excluded.
Sources:
- Friedman, Deborah I. MD, MPH (2011), Visual disturbances: related to migraine or not, American Headache Society Center for Headache Education, 2011, retrieved online at https://www.achenet.org/news/visual_disturbances_related_to_migraine_or_not/
- Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalgia. 2013; 33(9) 650.
- Robert, Teri (2006), Retinal Migraine – The Basics, American Headache Society Center for Headache Education, June 1, 2012, retrieved online at https://www.achenet.org/resources/retinal_migraine__the_basics/