| Identifier |
Migraine_vs_Non_migrainous_presentations_in_Neuro_Ophthalmology |
| Title |
Migraine vs Non-migrainous Presentations in Neuro-Ophthalmology |
| Creator |
Andrew G. Lee, MD; Shravya Pothula |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (SP) Class of 2022, Baylor College of Medicine, Houston, Texas |
| Subject |
Migraines; Neuro-Ophthalmology; Diagnosis |
| Description |
Dr. Lee lectures medical students on migraine vs non-migrainous presentations. |
| Transcript |
So migraine is a very common disorder and millions of people have it. And you can have it with or without the migraine related aura. The typical aura is a fortification aura, typically described as a jagged line with a flashing light, that's a scintillation, it is usually bilateral cutaneous usually lasts about twenty minutes and then the headache follows. It might be characterized by movement across the visual field which is march and buildup so it starts off small and then it gets bigger and bigger and bigger and if you get that history, then a typical migraine headache, moderate to severe and associated phonophobia, nausea vomitting that's pretty much the distinctive presentation of the migraine with aura patient. The further it is away from this patient the more dangerous it is. So if it is unilateral rather than bilateral. Now a migraine can occur in one eye in the old days we'd call it retinal migraine but you really have to meet all the International Headache society criteria for migraine before you call someone with a transient monocular visual loss event retinal migraine and this retinal migraine might be retinal vasospasm in fact is was moved out of the migraine classification in the International Headache Society criteria. If it's not a a jagged line which is the fortification scotoma especially if it's altitiudinal so a curtain coming down, a curtain coming from the side. That curtain altitudinal and respecting horizontal or vertical meridian is very bothersome for being a TIA, a vascular event and not a migraine related event and if the duration is longer than minutes so if it's a permanent loss you do a field and they still have homonymous hemianopsia or they have a field defect, one eye or both eyes. Migraine really shouldn't leave a defect even though migraine can cause a stroke both in your eye and in your brain that's a diagnosis of exclusion. And then a non vascular distribution of march buildup is normally what we see in migraine but if it's a vascular buildup, the curtain coming down following the blood supply of the optic nerve of the retina, so a vascular distribution suggests that we are not dealing with migraine and it might be a TIA. And patients who have this for the first time a transient monocular vision loss for the very first time you really shouldn't be making the diagnosis of migraine in that patient so migraine requires multiple recurrent and stereotyped which means it's the same quality each time episodes and so the further it is from this prototype bilateral stereotyped fortification scotoma scintillation march and buildup 20 minutes the further whatever they're describing is from that whether its unilateral non fortification non scintillating altitudinal, non vascular versus vascular distribution and if they have any other symptoms or a residual field defect you should really not be calling that person migraine. So patients should have a full eye exam and a full visual field, if they have a visual field defect that's probably not migraine because migraine is transient and that's basically the main thing you need to about differentiating migraine from not migraine. |
| Date |
2020-05-27 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6z37cr9 |
| Setname |
ehsl_novel_lee |
| ID |
1561508 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6z37cr9 |
