Migraine without pain can still mean trouble
By Graciela Gutierrez
A surprising number of patients with migraines don’t experience any pain but instead suffer from visual disturbances that drive them to seek the help of an ophthalmologist.
An estimated 20 percent of migraine sufferers experience migraines without a headache, according to a Baylor College of Medicine ophthalmologist.
"People are usually surprised they can be diagnosed with migraines without ever having a headache," said Rod Foroozan, M.D., assistant professor of ophthalmology at BCM. "Most people are used to understanding a migraine to mean pain."
Visual symptoms
Some common symptoms of migraine without headache that affect sight are transient loss of vision, blind spots, flashing light or shadowy spots and double vision.
"It's not uncommon for me to see one or two people a week with visual problems related to migraines," Foroozan said. "If it's strictly a migraine issue rather than an eye problem, we'll refer them to a neurologist."
Migraines without headaches are not directly related to the eyes. Instead, the migraine activity occurs in the visual cortex of the brain located in the back of the skull.
Identify problem
Many factors can contribute to migraine, some serious and some less so. For example, in some rare cases a prolonged migraine, with or without headache, can cause a stroke. Foroozan said it is important to identify the actual problem.
One way doctors rule out sight problems is by giving a visual field test. It is a computer-based test that displays lights in different parts of the field of vision while the eye is focused on a target. When the patient sees a flash of light, he or she hits the buzzer. This lets the doctor know what areas of the eye detect the light.
Foroozan said once the correct diagnosis is given, the proper treatment can be determined to help prevent or minimize migraine side effects.
