By Brian M. Grosberg, M.D.
Assistant Professor of Neurology, Albert Einstein College of Medicine, and Director of the Inpatient Headache Program, Montefiore Headache Center, Bronx, NY
A 42-year-old woman with migraine was referred by her eye doctor to a headache clinic because she was having recurrent episodes of visual loss in one eye. Her migraine headaches were severe, pulsating and left-sided. Associated features included nausea, vomiting and increased sensitivity to lights, sounds and odors. Her headaches occurred approximately six times monthly and lasted 24 to 72 hours.
One-third of her headaches began with transient spells of visual loss in the left eye consisting of black spots and flashing lights. The visual phenomena always began in the outer edge of the woman’s left eye and expanded to engulf the entire eye within a few minutes. Alternately covering each eye during an attack and comparing their views confirmed that the visual disturbances were confined to the left eye. Complete visual loss in the left eye lasted for five minutes, then fully resolved, and was followed immediately by a migraine headache.
The woman’s general medical and neurological examinations were normal, as were repeated eye examinations by several ophthalmologists. Other tests, which included an MRI of the brain, ultrasound examination of the carotid arteries, echocardiography and extensive blood testing, were within normal limits. The patient was treated with a gradually escalated dose of nortriptyline, a medication used for headache prevention. The episodes of visual loss completely stopped and the woman experienced a significant reduction in headaches (down to one per month). Continue Reading