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This article is from the Vision and Eye
Care FAQ, by grants@research.canon.com.au (Grant Sayer) with
numerous contributions by others.
5.9.2 Classification of migraine:
I. Common migraine. The comprises about 80% of those with migraines. It is
the typical "sick headache" possibly with mood changes. The headache can
be localized or generalized. It may last for hours to days.
II.Classical migraine. The triad of aura, headache, nausea+/-vomiting, and
a feeling of "being out of sorts". It is typically of shorter duration
than the common migraine. The aura may be any sort of neurologic
deficit but of course the ones we see are usaully visual. The visual
aura usually starts near fixation and expands to the periphery then
dissappears to be followed by the headache. The aura may be jagged,
coloured lines, "grey blotches" or "missing patches" or many other type
of visual disturbance. Classical migraine account for about 10% of migraines.
III. Complicated migaine (expanded below)
1.Cerebral
2.Ophthalmoplegic
3.Retinal (or ocular, see below)
4.basilar
5.other
IV. Cluster headaches SEVERE episodic unilateral head or facial pain,
nasal stuffiness, +/-ipsilateral Horners, lacrimation.
Complicated migraine expanded:
1. Cerebral
This is a headache which may be severe and focal neurologic signs which last
longer than the headache. This is the hallmark of the complicated migraine
in which the neurologic deficit may even be permanent. For example, there
can be permanent visual field defects.
2. Ophthalmoplegic migraine
The patient is usually young (less than 30, usually less than 20). There is
a severe unilateral headache. As_the_headache_clears, one or more ocular
muscles on the side of the headache become paretic and may take days or
weeks to recover their function. As you can appreciate, the first time this
happens, the patient is subjected to a lot of investigations including
angiograms as this is mimicing such things as aneurysm, tumour and other
very bad things. If the ophthalmoplegia recurs, the sequence of events and
the previously negative tests are reassuring.
3. Retinal migraine (ocular migraine)
The patient is typically under 40 and suddenly loses a portion (retinal) or
all (ocular) of the visual field in one eye. There is rarely headache.
Never, according to some experts. The differentiation between retinal and
ocular migraine is how much of the visual field is affected. In other
words, what vessel has been affected. If it is distal to the bifurcation at
the optic nerve head, it is retinal. If it involves the central retinal
artery, all of the vision is lost and it can be called ocular migraine. Note
too, that there are seldom if ever flashing lights with this form of
migrain. Again, the vision recovers (ususally, sometimes permanent) in 20
to 45 minutes. With ocular migraine there can be retinal hemorrhages,
vitreous hemorrhages. macular edema, ischemic swelling of the optic nerve.
4. Basilar migraine
Mimics vertebrobasilar attacks. Bilateral blurred vision, vertigo, ataxia,
nausea, incoordination, loss of balance, speech difficulties.
5. Other
There is a host of symptom-complexes which fit the criteria for migraine.
Sudden, episodic, self-limited, lasting 30-45 minutes. These can be chest
pains, vomiting, neurologic symptoms and many others. These are sometimes
called migraine equivalents.
The most common migraine type problem that I see in my practice is that of a
person who may or may not have previously had migraine diagnosed who has a
15-30 minute episode of visual disturbance, often quite classically starting
off small near fixation and expanding to fill a hemifield. When the
probable diagnosis is explained to the patient, the response is almost
invariably "Oh, but it can't be migraine, I don't have a headache!"
Remember, if it walks like a duck and quacks like a duck, it's probably
migraine.
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