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Opthalmic Migraine?
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Opthalmic Migraine?

I finally got to see my ophthamologist about the weird jittery vision eye event that I had back on May 17.  They were going to do a quick exam, and they didn't even have a copy of the letter I hand delivered last week telling about the event in detail, and how my vision continues to be blurry and occasionally jittery still.  I had brought another copy, and made sure the tech read it.  I explained it to her.  I gave her a copy of my latest brain MRI results.  I brought the CD of my MRI.

They did a very thorough exam; my eyes are still dialated, so this is hard to type.  They even did a short color test.

The ophthamologist said that my optic nerves look very healthy, though he noted a small area of inflammation that he said was a normal variation, though he didn't note it when I saw him in April.  

His diagnosis was an opthalmic migraine, though I tried to explain to him that what he was describing to me was not what I had experienced.  I looked it up when I got home, and it doesn't sound or look like what I experienced, though since it's so non-threatening I'd be glad if that's all it was.  The description says that it starts small and takes over the entire field of vision.  Mine was a sudden alteration of my entire field of vision, no jagged lines, just like the electrical impulses were all out of whack.  I don't know how else to describe it.  No headache, which is normal with the opthalmic migraine, so maybe I just had a variation.

He said if I was worried about me vision, he would schedule me for another visual field test.  I demurred, thinking insurance and that I had one before the event, but he strongly suggested that I have it done, and told his assistant how to code it so that it is medically neccessary, so I'll go in for another VFT.

I requested his chart notes; he seemed to not want to worry me, and I would prefer to see all his thoughts on my appointment.  He stressed several times how important it is for me to get in to see my MS specialist as soon as possible, and that he would fax her his notes even though they hadn't scheduled me yet.

This kind of migraine is caused by a vasospasm behind the eye, apparently.  It shouldn't have caused the extreme fatigue afterwords that lasted for a couple of days; well the really extreme part was over in around 24 hours.  I don't know what to think.  Hope it's a one time thing and won't continue happening because of one of those little lesions in my brain setting off a vasospasm.  It was weird.  

Once again, a doctor visit with more questions than answers.  Actually, that's not fair, my optic nerves still lool pretty healthy.  I want to keep them that way!

Any thoughts on the matter?  Any experience with this diagnosis?  


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230625 tn?1216764664
All of my migraines have been "optical migraines" or a "migraine with aura".   I'm not sure if this is the same as an "Ophthalmic Migraine" or not.

I would get an aura ahead of the headache (you can have the vision stuff with out the headache from what I was told).   My vision would be like looking through a kaleidoscope, but the visual distorsion can differ from person to person.    

The vision stuff would last a time before the headache.   I got to where I knew if the visual distortion was happening, I'd quickly pop some Ibuprophen and would be able to avert the headache.  It took a few migraines before I figured that out though.

I would get fatigued, but that was from the headache and it didn't last a couple of days.  

My ophthal says my optic nerves are healthy and normal.   I get Vision Field tests every 6 months since I have Pigment Dispersion Syndrome (non-MS related).   They have all been normal, as well as my VEP.

Did you have a VEP done?

Most of my migraines were awhile ago, but I had my last about 5 years ago.   Sorry, I can't recall whether the entire visual field was affected at once.  I believe it was a gradual thing and didn't alter my entire field of vision at once.

Just like the type of visual distortion can differ from person to person, maybe if it's gradual or all at once can differ as well??

Sorry, I can't be of more advice, but wanted to let you know my experiences with the migraines.

I'm glad they did a thorough exam on you.  Ugh... I hate getting my eyes dilated!!   Good call on getting a repeat VFT.   Like I said above, I get them every 6 months for the PDS and my insurance has been covering them with no problem.  If there is a medical necessity, I think it should be ok.

Take care, Pat :)
429326 tn?1282331954
Good Morning

Just wanted to let you know what I have experienced,  (NO MS DX)

it started with what they told me was an optho-migraine with out the headache
it looked like someone had thrown a baseball thru a window, lines all jagged, but it was in color, it happened maybe 5 - 6 times over 2-3months and it would take about 15mins to go away, but i never had a headache.
During those months I was having other neuro issue too. But no one could explain or find anything wrong with me.

since then (yr and half ago) I have had several bouts of pain in the same eye, along with flashes of light and new just the other day a black spot and a couple flashes of light in my other eye. then stabbing pain in bad eye.

they have told me I have a partial posterior vitreous detachment, but he also noted a possible CNS lesion on the report. I guess with all my other symptoms going on at the same time I have eye problems. But I have given up on the optho, will get my new mri thursday, hope they see something.

good luck, and hope that doesnt cause you to much trouble.

405614 tn?1329147714
I had such a headache after being on the computer while my eyes were dialated that I wasn't good for much for the rest of the day.

Pat, I have had migraines with auras in the past.  Mine are either a flash of blue light (not so bad, usually, or a zig-zaggy line that starts small in my peripheral vision then gets larger, with color and movement, and sometimes takes over my entire field of vision, but usually is mostly in one eye.  Those headaches can be nasty, and I can feel tired afterwards, but nothing like the fatigue I felt in Phoenix.  

angie, What you describe sounds more like the description of what my ophtho said I had experienced, but really doesn't fit what happened to me; I hope it was a one time deal, because I would hate for something like that to happen while I was driving!

I was watching a live basketball game and all at once my entire field of vision was disturbed; I thought afterward that it was like the electrical impulses sending picture to my brain were misfiring.  Everything was still in view, just jumpy, jittery, extra bright.  Well, I tried again to describe it!  :o)  It lasted 5 or 6 minutes, then the overwhelming fatigue.

I hope that it was a one time deal. Most of my migraines were menstrual, and now I take Premarin around that time, and have rarely had a migraine since.  Maybe that basketball game was just the perfect storm of too much noise, people with nasty cologne, heat, flashing lights, fast-paced basketball, bright soreboards and everything that combined to set off that vasospasm.  

Or maybe the heat caused a pseudo-exacerbation, since I've been having issues with my vision since my acute onset tremors and all that followed.

Oh, in the four months since my regular eye exam, my vision has already changed for the worse a small amount.

angie, I have a bunch of floaters, which I believe are from the vitreous stuff. They mess with my vision.  What you're talking about is like that, but more so?

I insisted that Binyons replace the lenses on my glasses since I don't see through them as well as I did my last pair, but I'm afraid I might just have to get used to the fact that my vision is changing.

I don't think I'll see that ophthamologist again; there are two neuro-ophthomologists at the teaching hospital where I will be seeing a MS specialist, and I thought one of them might be more knowledgeable if I do indeed have MS.

Thanks for your input, and I hope you're enjoying your day.

429326 tn?1282331954
yes , I found a web site that shows a picture of the cracked window thing I saw, it is just the same, but my lines were in color.

I would just like to know how a person never having migraines, never ANY vision problems could just 1 day start having all of this stuff including other neuro problems. Just dont make sense to me. It like my health changed overnite.

1 day driving in the fog I did have what I consider a floater(from viewing that website)
it was a squiggley line, and my eye just kept running with tears.
then the cracked window thing-floater.

the other day I was driving in the rain, not pouring, as the rain hit the windshield the drops looked like they were white and bright, thats the day I got the severve stabbing pain.
then a couple days after my other eye was getting flashes, real quick flashes of light.
then the bad eye had the black spot for just seconds.
then that nite, I think I had a dream about a detachment, in what I hope was a dream I saw lots of lights floating from top to bottom.

did you ever have vision,,floaters or anything else before you started all your other problems?

have a good day
405614 tn?1329147714
I'm sorry, it sounds like you are having a terrible time.  Too bad you don't have the one-time only version of the optho migraine.  Yours sound just like what I read about, too.  

My floaters started in my right eye the day I woke up with acute onset tremors.  I had a defect in the center of my vision in that eye, which faded fairly quickly, but I was left with several floaters, including one that is fairly dark.

When I had my LP and subsequent leakage of CSF that required a blood patch, I developed floaters in my left eye, more of the squiggly and spotty clearer sort.  Lots of them.  It was explained to me that the reduced pressure in the CSF caused some small insults to the vitreous stuff, which caused the floaters, and they may fade.  Ha.

Many years ago, I was concerned because it seemed like I retained after-images of stuff for a long time, so that my vision was distorted by it.  Kind of like when you see a bright flash, and then you have a spot in front of your eyes, but with alot of things.  No one could ever explain that to me; they probably thought I was crazy.  It was probably related to the few migraines I had back then.

I hope your eye symptoms improve soon and that your MRI shows something that can lead to some answers and treatment.  Take good care of yourself.

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