Most cases appear in young patients in the first decade of life. Approach any adult with symptoms resembling an ophthalmoloplegic migraine cautiously. Signs include abrupt and severe onset, progressive worsening, consistently one-sided, associated optic nerve edema, fever, and pain that intensifies with positional changes, exertion, straining or coughing. Some signs may indicate a pathology other than a migraine:
You need to work in reverse with these patients and rule out other possible causes before diagnosing the patient with a migraine, says Leonard Messner, O.D., vice president for patient care services at Illinois College of Optometry in Chicago. Use caution if you suspect one of the latter three types. Patients will often present with a painful pupil. These generally occur in children and usually involve a third-nerve palsy. These patients will most likely present with transient visual disturbances and possibly branch or central retinal vein occlusion. This is a vasospastic event limited to the eye. Patients with this type of migraine present with neurologic or visual complaints but no headache. These patients experience the headache associated with a classic migraine but without the visual disturbances. Migraine without aura, also called the common migraine. Neurologic symptoms include aphasia (defect or loss of power of expresion), vertigo, alexia (inability to understand written language) and neuropsychological symptoms. Shimmering or wave-like photopsias, fortification scotomas or other distortions typically start paracentrally and expand across the periphery in a hemifacial pattern. Migraine auras usually occur between five and 60 minutes before onset. Associated symptoms include photophobia, sonophobia, nausea and with severe pain, vomiting. These patients typically experience a unilateral, throbbing headache with moderate to severe pain and gradual onset. Migraine with aura, also called the classic migraine. Migraines fall into five types, as outlined by the IHS: Blaustein also notes women are three times as likely as men to experience true migraines. Also determine the age of onset, nutritional regimen and family history. Ask patients about the location, frequency, duration and type of pain associated with the headache. Blaustein of Pennsylvania College of Optometry. It is imperative that O.D.s be able to distinguish which headaches have a simple vs. Patients may not realize this, though, so they describe their headaches as migraines. Migraine headaches are characterized by a specific group of signs and symptoms.
Since an abundant number of headache symptoms may have visual disturbances, or are located within surrounding ocular tissue, optometrists will frequently be confronted by patients complaining of this, says optometrist Michelle Caputo of Bascom Palmer Eye Institute in Miami. According to the International Headache Society (IHS), close to 90% of the population has experienced some form of headache. How can I determine the etiology of the headache?Ī. Many patients present complaining of migraine headaches, but often have not been diagnosed.
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