non painful migraine????

[Barb1951]

I"m very concerned about a friend who just wrote to me about a phenomenon she experienced. I was hoping you might shed some light on it.
She has had breast cancer for five years...not getting better...and is on several chemo drugs, etc....
She just told me that last night she experienced what appeared to be HUGE floaters , almost like chevrons and lace, and a partial blindness in PART of her left eye. It came and went and the whole thing lasted about 20 minutes, causing her great anxiety. She was so drained she had to lie down each time.  At the end, her head got really 'hot', things got 'black' momentarily and she was exhausted.  Her eye doctor found nothing wrong, but suggested it was 'non painful migraine'.  Never heard of it.  
Might it be medication related?  Also, I would not share this with her, but I'm more concerned that it might be the cancer spreading to the brain..and it's scaring me to death.  Do you have any ideas?

[John C Hagan III, MD, FACS, FAAO]

In my opinion there is no need to go into treatment of something you probably don't have. The cause of all migraines including eye migraines (ophthalmic migraine) is incompletely understood. It was felt for many may years to be a constriction of blood vessels in the brain (causing aura) followed by dilation of the same vessels causing the pain (if any).  More recent research indicates there may be abnormalities of electrical pathways in the brain during a migraine. As I said we don't know for sure.  Ophthalmic migraine is generally not serious except in women that smoke, take birthcontrol pills or estrogens, have high blood pressure and/or a family history of stroke at an early age. Smoking is probably the worse risk factor. In these groups there is some risk of permanent damage to the peripheral vision and/or a stroke of the brain.

JCH III MD Eye Physician & Surgeon

[Barb1951]

and what can cause an 'Ophthalmic Migraine'?  Is IT serious on it's own?

[Barb1951]

Thank you for your insights.   Not good news, but the facts often aren't today.  Tell me, what are the treatments for the disorders you mentioned.....TIA and Inflammatory disease.??.....and Cerebral Metastatic cancer???

[John C Hagan III, MD, FACS, FAAO]

There are a number of things that might have caused your friends symptoms and some of them are quite serious. You friend should see a eye physician (MD  ophthalmologist). If she saw a non physician limited eye care provider (optometrist) she needs to see an ophthalmologist as soon as possible.

Ophthalmic Migraine or Eye Migraine may or may not have headache associated with it. It is however a diagnosis of exclusion. That is to say you have to rule out the other serious causes before labeling it ophthalmic migraine.

Possible causes include transient ischemic attack (TIAs) due to disorders of the heart, brain or cerebral blood vessels,  inflammatory disease of the lining of the arteries of the head (giant cell or temporal arteritis). It is possible that cerebral metastatic cancer could cause this.  A reaction to the medication would be unusual.

Bottom line her oncologist needs to know about this immediately, and she needs to see an ophthalmologist ASAP.

JCH III MD  Eye Physician and Surgeon