Case studies of the migraine aura in the blind or partially sighted.

Abstract

Visual Aura symptoms are particularly intriguing when manifesting in the severely visually impaired. Presented here are eight case reports of the migraine aura experienced by those who are blind or partially sighted. The migraine aura consists of fully reversible neurological symptoms that typically precede the migraine headache by approximately 30 min. The symptoms are commonly visual and include the classic fortification spectra, seeing flashing lights, stars or phosphenes, or experiencing distortions of the visual scene. Non-visual aura symptoms can also be experienced, including pins and needles or numbness on the face and/or limbs, allodynia, speech difficulties, auditory disturbances and distortions of the sense of smell and/or taste. Both visual and non-visual aura symptoms were assessed using an on-line questionnaire. All participants experienced visual symptoms associated with their headache. Six experienced non-visual aura symptoms, which is a higher proportion than usually found when people without visual loss are questioned. Migraine triggers were also assessed. Glare and stress were the most frequently endorsed (by six out of eight), followed by flickering lights, tiredness and hormonal factors (five out of eight). The relative weight or balance of activity in visual, somatosensory and motor cortices is suggested as a possible explanation for the higher rate of non-visual aura symptoms in those who are blind or partially sighted.