TY - JOUR
T1 - Migraine with binocular blindness
T2 - A clinic-based study
AU - Rozen, Todd D.
N1 - Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2011
Y1 - 2011
N2 - Objective.â To describe the syndrome of migraine with binocular blindness. Background.â Rarely do migraine patients complain of losing vision in both eyes during an attack of headache. There are no large clinic-based studies looking at the prevalence of binocular blindness in migraine sufferers and no information about patient demographics, neuroimaging, and laboratory testing. Methods.â Over a 14-month time period, 383 new patients with a diagnosis of migraine were seen at the Geisinger Headache Center. All patients were asked if they ever experienced an episode of complete bilateral blindness along with their headaches. Those with a positive history had coagulopathy testing as well as brain magnetic resonance imaging and magnetic resonance angiography of the intracranial circulation. Results.â A total of 6 patients or only 1.6% of the new migraine patients had episodes of binocular blindness with their headaches. All were female and each had a history of migraine for at least 3 years. Five patients had a diagnosis of migraine without aura, while one had a diagnosis of basilar-type migraine. In all patients the blindness episodes occurred in isolation during a migraine headache. In all but one patient the blindness was instantaneous and not a slow evolution. In 2 patients the blindness episode only occurred 1 time; in 3 patients episodes occurred more than once but were rare, while 1 patient had blindness with 50% of her headaches. In regard to duration, in 2 patients blindness lasted only several seconds, 2 patients between 2 and 10 minutes, 1 patient 30 minutes and 1 patient 60-120 minutes. Neuroimaging was normal in all. Three patients had a history of smoking and 3 never smoked. Coagulopathy testing was abnormal in all patients. Two patients were homozygous for methylenetetrahydrofolate reductase (MTHFR) 677TT polymorphism, but both had normal homocysteine levels; 3 patients were heterozygous for MTHFR 677CT polymorphism and 1 had elevated homocysteine levels and 1 patient had a positive lupus anticoagulant (had the most frequent episodes of blindness). Conclusion.â Binocular blindness with migraine headache is a very rare occurrence at least in a headache specialty clinic population. It is a female-predominant event and occurs mostly in migraine patients who do not have a history of aura. Blindness episodes can be very brief or prolonged and many do not fit the typical duration of a migraine aura. They are typically infrequent events and may occur only 1 time without recurrence. Migraine with binocular blindness may reflect an underlying clotting disorder. A possible etiology outside of a coagulopathy-related event is retinal spreading depression.
AB - Objective.â To describe the syndrome of migraine with binocular blindness. Background.â Rarely do migraine patients complain of losing vision in both eyes during an attack of headache. There are no large clinic-based studies looking at the prevalence of binocular blindness in migraine sufferers and no information about patient demographics, neuroimaging, and laboratory testing. Methods.â Over a 14-month time period, 383 new patients with a diagnosis of migraine were seen at the Geisinger Headache Center. All patients were asked if they ever experienced an episode of complete bilateral blindness along with their headaches. Those with a positive history had coagulopathy testing as well as brain magnetic resonance imaging and magnetic resonance angiography of the intracranial circulation. Results.â A total of 6 patients or only 1.6% of the new migraine patients had episodes of binocular blindness with their headaches. All were female and each had a history of migraine for at least 3 years. Five patients had a diagnosis of migraine without aura, while one had a diagnosis of basilar-type migraine. In all patients the blindness episodes occurred in isolation during a migraine headache. In all but one patient the blindness was instantaneous and not a slow evolution. In 2 patients the blindness episode only occurred 1 time; in 3 patients episodes occurred more than once but were rare, while 1 patient had blindness with 50% of her headaches. In regard to duration, in 2 patients blindness lasted only several seconds, 2 patients between 2 and 10 minutes, 1 patient 30 minutes and 1 patient 60-120 minutes. Neuroimaging was normal in all. Three patients had a history of smoking and 3 never smoked. Coagulopathy testing was abnormal in all patients. Two patients were homozygous for methylenetetrahydrofolate reductase (MTHFR) 677TT polymorphism, but both had normal homocysteine levels; 3 patients were heterozygous for MTHFR 677CT polymorphism and 1 had elevated homocysteine levels and 1 patient had a positive lupus anticoagulant (had the most frequent episodes of blindness). Conclusion.â Binocular blindness with migraine headache is a very rare occurrence at least in a headache specialty clinic population. It is a female-predominant event and occurs mostly in migraine patients who do not have a history of aura. Blindness episodes can be very brief or prolonged and many do not fit the typical duration of a migraine aura. They are typically infrequent events and may occur only 1 time without recurrence. Migraine with binocular blindness may reflect an underlying clotting disorder. A possible etiology outside of a coagulopathy-related event is retinal spreading depression.
KW - binocular blindness
KW - coagulopathy
KW - migraine
KW - retinal spreading depression
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U2 - 10.1111/j.1526-4610.2011.01968.x
DO - 10.1111/j.1526-4610.2011.01968.x
M3 - Article
C2 - 21812773
AN - SCOPUS:81255136081
SN - 0017-8748
VL - 51
SP - 1529
EP - 1536
JO - Headache
JF - Headache
IS - 10
ER -