Abstract:To investigate the relevance of lacking or diminished visual input on the expression of migraine, we evaluated its prevalence and clinical features in a population of visually impaired subjects. Between September 1999 and April 2000, 203 visually impaired subjects with a headache inventory were surveyed. Those with headache were assessed according to IHS criteria for the presence of migraine. Migraineurs had their symptoms further detailed through an interview and a headache diary. Of the 104 subjects reportin… Show more
“…Our case and the one described by Kowacs et al 6 in a small sightless population contrast the rarity of this phenomenon in ordinary migraine, indicating that acoustic aura may be significantly more common among blind subjects. Speculatively, if the lack of vision result in the overactivation of cortical areas related to hearing, this could favor an auditory aura in this population.…”
Migraine is a neurological disorder that frequently involves cortical paroxysmal dysfunction expressed as aura 1 . The most frequent type of aura is visual, sometimes experienced as fortification spectra, known as teichopsia. This typical zigzag, horseshoe-shaped expanding bright perception, usually perceived as complex interlacing lines named "chevaux de frises" by Gowers, followed by a bean-shaped loss of visual acuity, strongly suggests the involvement of visual processing areas. Clinical, experimental, and neuroimaging evidence demonstrates that cortical spreading depression (CSD) is the phenomenon underlying the pathophysiology of bizarre visual perceptions among migraineurs. Computerized models simulating a CSD wave passing through cortical area V1 convincingly reproduce the teichopsia pattern 2 .The cortical function is deeply dependent on neuronal input. Depriving the cortex of its natural input may influence the cerebral function and change the cortical maps both locally and distantly 3 . In blind individuals, the occipital cortex is critical for tactile Braille reading 4 . The visual cortex is pivotal in the pathophysiology of the migraine aura, the objective of the present study was to investigate whether the phenotype of migraine-related visual phenomena would change in amaurotic patients.
AbstrActMigraine is a central nervous system disorder frequently expressed with paroxysmal visual dysfunctions. Objective: To test the hypothesis that a normal visual input is vital for migrainous aura and photophobia. Methods: We studied the migraine-related visual disturbances in 8 sightless migraineurs identified among 200 visually impaired subjects. Results: The main findings were visual aura and photophobia disappearance along with the development of blindness, abnormal aura [too short, colorful (e.g., blue or fire-like), auditory in nature, or different in shape (round forms)], and the lack of photophobia. Conclusions: We propose that the aura duration should be accepted as shorter in visually impaired subjects. The changes in the aura phenotype observed in our patients may be a result of cerebral plasticity induced by visual impairment and/or the lack of a visual input per se. Integrity of visual pathways plays a key role in migraine visual aura and photophobia.Keywords: migraine with aura, subnormal vision, blindness, visual aura, photophobia resumo A enxaqueca é doença neurológica frequentemente associada a anormalidades visuais transitórias. Objetivo: Testar a hipótese de que a visão normal é importante para o fenótipo da aura e da fotofobia. Métodos: Estudamos 8 enxaquecosos deficientes visuais identificados em uma população de 200 indivíduos com visão subnormal. Resultados: Os principais achados foram: o desaparecimento da aura visual e da fotofobia com o início da cegueira; a ocorrência de aura atípica -muito curta, colorida (p. ex. azul, ou cor de fogo) auditiva ou diferente na forma (arredondadas); e a ausência de fotofobia. Conclusões: Propomos que a duração da aura possa ser admitida como mais cur...
“…Our case and the one described by Kowacs et al 6 in a small sightless population contrast the rarity of this phenomenon in ordinary migraine, indicating that acoustic aura may be significantly more common among blind subjects. Speculatively, if the lack of vision result in the overactivation of cortical areas related to hearing, this could favor an auditory aura in this population.…”
Migraine is a neurological disorder that frequently involves cortical paroxysmal dysfunction expressed as aura 1 . The most frequent type of aura is visual, sometimes experienced as fortification spectra, known as teichopsia. This typical zigzag, horseshoe-shaped expanding bright perception, usually perceived as complex interlacing lines named "chevaux de frises" by Gowers, followed by a bean-shaped loss of visual acuity, strongly suggests the involvement of visual processing areas. Clinical, experimental, and neuroimaging evidence demonstrates that cortical spreading depression (CSD) is the phenomenon underlying the pathophysiology of bizarre visual perceptions among migraineurs. Computerized models simulating a CSD wave passing through cortical area V1 convincingly reproduce the teichopsia pattern 2 .The cortical function is deeply dependent on neuronal input. Depriving the cortex of its natural input may influence the cerebral function and change the cortical maps both locally and distantly 3 . In blind individuals, the occipital cortex is critical for tactile Braille reading 4 . The visual cortex is pivotal in the pathophysiology of the migraine aura, the objective of the present study was to investigate whether the phenotype of migraine-related visual phenomena would change in amaurotic patients.
AbstrActMigraine is a central nervous system disorder frequently expressed with paroxysmal visual dysfunctions. Objective: To test the hypothesis that a normal visual input is vital for migrainous aura and photophobia. Methods: We studied the migraine-related visual disturbances in 8 sightless migraineurs identified among 200 visually impaired subjects. Results: The main findings were visual aura and photophobia disappearance along with the development of blindness, abnormal aura [too short, colorful (e.g., blue or fire-like), auditory in nature, or different in shape (round forms)], and the lack of photophobia. Conclusions: We propose that the aura duration should be accepted as shorter in visually impaired subjects. The changes in the aura phenotype observed in our patients may be a result of cerebral plasticity induced by visual impairment and/or the lack of a visual input per se. Integrity of visual pathways plays a key role in migraine visual aura and photophobia.Keywords: migraine with aura, subnormal vision, blindness, visual aura, photophobia resumo A enxaqueca é doença neurológica frequentemente associada a anormalidades visuais transitórias. Objetivo: Testar a hipótese de que a visão normal é importante para o fenótipo da aura e da fotofobia. Métodos: Estudamos 8 enxaquecosos deficientes visuais identificados em uma população de 200 indivíduos com visão subnormal. Resultados: Os principais achados foram: o desaparecimento da aura visual e da fotofobia com o início da cegueira; a ocorrência de aura atípica -muito curta, colorida (p. ex. azul, ou cor de fogo) auditiva ou diferente na forma (arredondadas); e a ausência de fotofobia. Conclusões: Propomos que a duração da aura possa ser admitida como mais cur...
“…A community‐based study has challenged the relevance of the occipital cortex in migraine since the prevalence of migraine in blind individuals is similar to the one experienced by the general population . However, migraine attacks were found to be more severe in blind migraineurs than in visually normal individuals, a fact that proposes a relationship of the occipital lobe with the modulation of the headache …”
Section: The Visual System and Migraine: Clinical Aspectsmentioning
This paper achieved its goals of addressing and condensing information on the pathophysiology of the visual aspects of migraine and its clinical aspects, especially with regards to therapy, making it useful not only for those unfamiliar to the theme but to experienced physicians as well.
“…The changes in aura phenotype observed in our patients may be the result of both cerebral plasticity induced by the visual impairment and/or the lack of visual input per se. Integrity of visual pathways plays a key role in migraine visual aura and photophobia. Comments: These Rio de Janerio RJ, Brazil neurologist/headache researchers contribute 8 sightless subjects' migraine‐related visual disturbances to an otherwise very limited literature 1,2 . As best as I can determine, these 8 subjects add to the previous 6 sightless aura subjects and 5 visually impaired reported 1,2 .…”
mentioning
confidence: 99%
“…Integrity of visual pathways plays a key role in migraine visual aura and photophobia. Comments: These Rio de Janerio RJ, Brazil neurologist/headache researchers contribute 8 sightless subjects' migraine‐related visual disturbances to an otherwise very limited literature 1,2 . As best as I can determine, these 8 subjects add to the previous 6 sightless aura subjects and 5 visually impaired reported 1,2 . In this study of 200 visually impaired subjects, 191 remained after exclusion for various consent reasons, 64 remained after subjects had to meet criteria for congenital or acquired amaurosis by the International Classification of Diseases (tenth edition) and 23 remained after meeting International Classification of Headache Disorders 2004 (ICHD‐II) criteria for migraine without aura, typical aura with migrainous headache, typical aura with nonmigrainous headache, typical aura without headache, probable migraine without aura, and probable migraine with aura, present for at least 1 year prior to the interview with 8 remaining with migraine with aura with exclusion of subjects with any other form of migraine or headache type.…”
mentioning
confidence: 99%
“…Comments: These Rio de Janerio RJ, Brazil neurologist/headache researchers contribute 8 sightless subjects' migraine‐related visual disturbances to an otherwise very limited literature 1,2 . As best as I can determine, these 8 subjects add to the previous 6 sightless aura subjects and 5 visually impaired reported 1,2 .…”
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