Acute monocular oligemia in a patient with migraine with aura demonstrated using OCT-angiography: A case report

Abstract

Introduction: Migraine is one of the most common causes of transient visual loss. Optical coherence tomography angiography (OCTA) provides fast and non-invasive imaging of the retinal vessels. We report the first case of monocular retinal oligemia demonstrated using OCTA during a migraine attack with aura. Case description: A 27-year-old man with a previous history of migraine with visual aura was seen in the emergency room due to acute left hemicranial pain with positive visual symptoms in his right eye. The patient reported a blue stain in his right eye. Optical coherence tomography angiography (OCT-A) showed an extensive area of hypoperfusion in the macular region of his right eye. Forty-eight hours later visual symptoms had improved and the OCT-A showed a significant reduction in the area of hypoperfusion. Seven days later the patient was asymptomatic and retinal perfusion had returned to normal values. Conclusion: Monocular involvement suggests that these retinal vascular changes are independent from cerebral vascular changes, supporting the hypothesis of selective retinal ganglion cell layer spreading depression as the possible cause of some cases of retinal migraine.

Reduction in retinal microvascular perfusion during migraine attacks

“…There have also been two case reports that have showed reduction of ocular vascularity and VAD during a migraine attack. 61,63 Both these case studies looked at transient changes during an attack in a single individual participant; however, the observations in these case reports are in line with the reduction of perfusion that we find in our study.…”

“…The difference between these results and ours could be due to multiple differences in study design including evaluation of a MO group only, no interictal baseline scan, the use of 6 × 6‐mm scans, which may have lower resolution, as well as not using the VFI measure, which is thought to be more sensitive to perfusion differences. There have also been two case reports that have showed reduction of ocular vascularity and VAD during a migraine attack 61,63 . Both these case studies looked at transient changes during an attack in a single individual participant; however, the observations in these case reports are in line with the reduction of perfusion that we find in our study.…”

“…To date there have been limited studies evaluating the macular microvasculature using OCTA in the interictal [38][39][40][41][54][55][56][57][58][59][60] and especially the ictal [61][62][63] phase of migraine. Our study examined both the interictal and ictal phase in a cohort of participants with high-frequency MA and MO, enabling investigation of the effect of a migraine attack on retinal vasculature and blood flow while accounting for the interictal baseline.…”

Using optical coherence tomography and optical coherence tomography angiography to delineate neurovascular homeostasis in migraine: a review

“…Aura migraineurs had decreased deep foveal VD ipsilateral to headache during prodromal aura, improving 3 hours post-aura ( Kızıltunç and Atilla, 2020 ). In one study, investigators found that aura migraineurs had right-eye macular hypoperfusion during the right aura but left hemicranial pain, resolving within a week after resolution of pain and aura ( González-Martín-Moro et al, 2023 ). Aura migraineurs had thinner maculae after 6 months post-attack ( Cunha et al, 2008 ).…”

The effect of pharmacologic treatment of migraine on retinal vasculature

“…I read with great interest the case report by González-Martín-Moro et al 1 which described monocular superficial plexus oligemia detected using OCTA in a patient with migraine with aura. The authors hypothesised that this oligemia was likely secondary to primary retinal spreading depression phenomena.…”