The effect of duration post-migraine on visual electrophysiology and visual field performance in people with migraine

Abstract

Dysfunction on clinical tests of vision is common in between migraine attacks; however, the nature of the defect varies between individuals and can change with time. People with migraine show markers of both retinal and/or cortical dysfunction. Abnormal visual field sensitivity does not predict abnormality on electrophysiological testing.

Progressing Scintillating Scotoma Captured on Automated Visual Field Testing

“…A recent report that assessed the effect of migraine on pattern electroretinogram and visual evoked response demonstrated that migraineurs with visual field deficits have electrophysiologic markers of both retinal and cortical dysfunction after a migraine. 4 Given our patient's subjective bilateral scintillating scotoma, the origin of his field defect was most likely cortical. Although the subtle perimetric abnormality in the right eye is merely suggestive of visual field loss, it is not definitive.…”

Clinical impact of migraine for the management of glaucoma patients

“…SAP has identified visual field defects in 20e60% of migraine sufferers in between their attacks ( Fig. 1) (De Natale et al, 1993;Dersu et al, 2013;Lewis et al, 1989;McKendrick et al, 2000;Nguyen et al, 2014;Nizankowska et al, 1997). Visual field sensitivity can also be mapped by kinetic perimetry using a similar achromatic but moving target.…”

“…When studies have specifically compared people with migraine to age-matched non-headache controls, substantial numbers of subtle visual field defects (20e50% of migraine participants) are identified (Drummond and Anderson, 1992;McKendrick et al, 2000;Nguyen et al, 2014). While these visual field deficits may not be classified as abnormal using standard clinical criteria based on the perimeter's global indices, this may partially reflect the contamination of the commercial normative dataset with people who have migraine.…”

“…Reliability indices (fixation loss, false positive rate, false negative rate) of all visual field test results are required to meet standard clinical criteria to be included. Moreover, several studies have explicitly ensured that migraine participants are not tested when unwell and are not medicated at the time of testing to minimise possible effects of migraine or migraine medications on concentration or fatigue Badcock, 2004a, 2004b;McKendrick et al, 2002;McKendrick et al 2000;Nguyen et al, 2014).…”

“…Certain perimetric techniques are customised to bias the assessment of specific precortical visual pathways, such as the fast-flickering luminancepedestal targets of temporal modulation perimetry (TMP), or flicker perimetry, that preferentially test the magnocellular pathway (Vingrys et al, 1994), or the blue-on-yellow stimuli of shortwavelength automated perimetry (SWAP), which preferentially tests the koniocellular pathway (Sample and Weinreb, 1990). Both TMP Badcock, 2004a, 2004b;McKendrick et al, 2000;Nguyen et al, 2014) and SWAP (McKendrick et al, 2002;Nguyen et al, 2014;Yenice et al, 2006;Yucel et al, 2005) have identified visual field defects in up to 50% of migraine cohorts. Note that these findings should not be interpreted as evidence for migraine producing a selective loss of one type of processing pathway, as dysfunction in both the magnocellular and parvocellular pathways has been demonstrated in people with migraine using perceptual stimuli designed to assess these channels separately (McKendrick and Badcock, 2003;McKendrick and Sampson, 2009).…”