1.2.4 Retinal migraine

Repeated attacks of monocular visual disturbance, including scintillations, scotomata or blindness, associated with migraine headache.

Diagnostic criteria:
A. At least two attacks fulfilling criteria B and C
B. Aura consisting of fully reversible monocular positive and/or negative visual phenomena (eg, scintillations, scotomata or blindness) confirmed during an attack by either or both of the following:

    1. clinical visual field examination
    2. the patient’s drawing (made after clear instruction) of a monocular field defect

C. At least two of the following three characteristics

    1. the aura spreads gradually over ≥5 min
    2. aura symptoms last 5-60 min
    3. the aura is accompanied, or followed within 60 min, by headache

D. Not better accounted for by another ICHD-3 diagnosis, and other causes of amaurosis fugax have been excluded.

Some patients who complain of monocular visual disturbance in fact have hemianopia. Some cases without headache have been reported, but migraine as the underlying aetiology cannot be ascertained.

1.2.4 Retinal migraine is an extremely rare cause of transient monocular visual loss. Cases of permanent monocular visual loss associated with migraine have been described. Appropriate investigations are required to exclude other causes of transient monocular blindness.