Visual Snow—Persistent Positive Visual Phenomenon Distinct from Migraine Aura

Schankin, Christoph; Goadsby, Peter J.

doi:10.1007/s11916-015-0497-9

Cited by 37 publications

(36 citation statements)

References 20 publications

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“…In particular, VS patients who have comorbid migraine present an increased chance of having non-entoptic visual symptoms. Further, some cases of VS has been reported to start with an aura episode (18).…”

Section: Visual Snowmentioning

confidence: 99%

“…Visual snow (VS) is a common comorbidity of migraine, with which it may share some pathophysiological mechanisms (18,19). In addition to describing the limited neuroimaging literature available for VS, we will proceed to present distinct hypotheses for putative pathophysiological mechanisms underlying visual snow, hoping to elucidate the neurobiology of the disorder and provide insight for future studies attempting its investigation.…”

Section: Introductionmentioning

confidence: 99%

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Imaging the Visual Network in the Migraine Spectrum

et al. 2019

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The involvement of the visual network in migraine pathophysiology has been well-known for more than a century. Not only is the aura phenomenon linked to cortical alterations primarily localized in the visual cortex; but also migraine without aura has shown distinct dysfunction of visual processing in several studies in the past. Further, the study of photophobia, a hallmark migraine symptom, has allowed unraveling of distinct connections that link retinal pathways to the trigeminovascular system. Finally, visual snow, a recently recognized neurological disorder characterized by a continuous visual disturbance, is highly comorbid with migraine and possibly shares with it some common pathophysiological mechanisms. Here, we review the most relevant neuroimaging literature to date, considering studies that have either attempted to investigate the visual network or have indirectly shown visual processing dysfunctions in migraine. We do this by taking into account the broader spectrum of migrainous biology, thus analyzing migraine both with and without aura, focusing on light sensitivity as the most relevant visual symptom in migraine, and finally analyzing the visual snow syndrome. We also present possible hypotheses on the underlying pathophysiology of visual snow, for which very little is currently known.

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Section: Visual Snowmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Imaging the Visual Network in the Migraine Spectrum

et al. 2019

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“…Patients with "visual snow" describe continuous static-like flickering dots across the visual field which they often describe as resembling the static on an analog television. 74,75 Additional visual symptoms described by these patients sometimes include afterimages and trail phenomena (palinopsia), sensitivity to bright light (photophobia), and increased awareness of normal entoptic phenomena. This condition is often grouped among the persistent visual phenomena in migraine, although it is most likely a unique entity distinct from persistent migraine aura or status migrainosis.…”

Section: Visual Snowmentioning

confidence: 99%

“…This condition is often grouped among the persistent visual phenomena in migraine, although it is most likely a unique entity distinct from persistent migraine aura or status migrainosis. 74 A set of diagnostic criteria for visual snow syndrome (VSS) now appears in the ICHD-3 classification, 2 with a modification that has been suggested to provide a clearer definition of entopic phenomena (►Table 1). 76…”

Section: Visual Snowmentioning

confidence: 99%

Migraine Aura: Pathophysiology, Mimics, and Treatment Options

et al. 2019

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Recent insights into the clinical presentation and pathophysiology of migraine aura have paved the way for new treatments for this common but frequently debilitating condition. Marked efflux of cellular potassium and glutamate contributes to the cortical spreading depression that forms the electrophysiological basis of migraine aura phenomena. Secondary vascular perturbations also contribute to the various symptoms of a migraine attack. Calcitonin gene-related peptide (CGRP) plays a key role in many of these steps, and a growing class of CGRP-antagonists have emerged as a novel, efficacious preventative therapy. It is still not fully understood why a preponderance of migraine aura symptoms is visual, and this issue is an active area of research. In addition, the pathophysiological changes responsible for visual snow syndrome are under investigation. Before diagnosing a patient with migraine aura, it is important to consider the differential diagnosis of transient visual phenomena, with attention to clinical features that may suggest conditions such as retinal disorders, transient ischemic attack, or occipital epilepsy.

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“…It is, therefore, conceivable that healthy subjects do not see these manifestations due to an active suppression system that might be located in the supplementary visual cortex. This suggests that the lingual gyrus might play an important role in this system . Whether this area is of particular relevance for VS or only for one or more of the additional symptoms such as photophobia needs to be determined.…”

Section: Visual Snow (Vs)mentioning

confidence: 99%

Persistent and Repetitive Visual Disturbances in Migraine: A Review

2016

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Visual disturbances in migraineurs, such as visual aura, are typically episodic, that is, associated with the headache attack, and overlaid by head pain and other symptoms that impact the patient. In some patients, however, visual symptoms are dominant due to frequency (migraine aura status), duration (persistent migraine aura and other persistent positive visual phenomena), or complexity (visual snow syndrome). These syndromes are more rare and challenging to classify in clinical practice resulting in a lack of systematic studies on pathophysiology and treatment. We aim at describing clinical features and pathophysiological concepts of typical migraine aura with a focus on cortical spreading depression and differentiation from non‐typical migraine aura. Additionally, we discuss nomenclature and the specifics of migraine aura status, persistent migraine aura, persistent positive visual phenomena, visual snow, and other migrainous visual disturbances. The term migraine with prolonged aura might be a useful bridge between typical aura and persistent aura. Further studies would be necessary to assess whether a return of the classification category eventually helps diagnosing or treating patients more effectively. A practical approach is presented to help the treating physician to assign the correct diagnosis and to choose a medication for treatment that has been successful in case reports of these rare but disabling conditions.

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Visual Snow—Persistent Positive Visual Phenomenon Distinct from Migraine Aura

Cited by 37 publications

References 20 publications

Imaging the Visual Network in the Migraine Spectrum

Imaging the Visual Network in the Migraine Spectrum

Migraine Aura: Pathophysiology, Mimics, and Treatment Options

Persistent and Repetitive Visual Disturbances in Migraine: A Review

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