Eye migraine – migraine with aura in the form of the passing visual violations which can arise against the background of a headache or at its absence. It is clinically shown by feeling of blinking, loss of sites of a field of vision, emergence of phosphene, fotopsiya and scintillating scotomas. Diagnostics is based on data of the anamnesis, objective survey, an oftalmoskopiya, perimetry, MRT and angiography of vessels of a brain. Symptomatic treatment consists in purpose of analgetics and NPVS, carrying out periostalny and intra bone blockade in trigger points. Preventive therapy during the mezhpristupny period includes purpose of nootrop, miorelaksant and antidepressants.
Eye migraine, or vibrating scotoma – the disease which is shown loss of the image in certain sites of a field of vision and specific visual aura in the absence of organic changes of eyes. The first descriptions of eye migraine were presented by Hubert Airey to H_H a century. The disease develops at young age against the background of lability of the autonomic nervous system more often. Vibrating scotoma is more widespread among female representatives and people whose work is connected with long visual loading. Genetic predisposition is characteristic of a disease. The tendency to spontaneous short-term remission is observed. Development of complications is not characteristic, at height of attacks sight loss is possible.
Reasons of eye migraine
The neurologic dysfunction caused by violation of operation of the visual analyzer is the cornerstone of eye migraine. The main etiologichesky factor of a retinalny form of a disease is the regionarny decrease in a tone of a back brain artery leading to temporary ischemia of a retina. Oftalmoplegichesky migraine arises when squeezing ІІІ pairs of cranial nerves an expanded venous kavernozny sine or a carotid. Hereditary tendency to development of eye migraine is noted, the mechanism of inheritance is not installed.
The Pristupoobrazny nature of a disease is connected with vasomotorial dysfunction. Emergence of attacks is promoted by violation of the mode of a dream and wakefulness, change of climatic zone, an emotional overstrain, a hormonal imbalance, a long hypoxia or stay in the room with a flickering light source. Specific predictors are anomalies of a structure of vessels of a brain (arterial aneurisms and malformation) leading to violation of blood supply of a thalamus and occipital area. In the pubertatny period clinical displays of this pathology connect with the raised loads of nervous system, high growth rate and development of an organism.
Symptoms of eye migraine
The central or paracentral scotomas of the different size and configuration, and also loss of certain sites of a field of vision are characteristic of a retinalny form of a disease. The tendency to combination of defects of the visual field with the subsequent total decrease in visual acuity is observed. A specific symptom – emergence of phosphene in peripheral departments of blind area. Blinking before eyes testifies to temporary ischemia of vessels of a retina after which the headache in a frontal lobe with transition to an eye-socket develops. Character of a pain syndrome pulsing. Pain develops from the opposite side in relation to a zone of insufficient blood circulation. Retinalny migraine on average lasts of 30 minutes till 2 o'clock, duration of visual aura makes 10-20 minutes. At height of an attack development of nausea with the subsequent vomiting, subjective feeling of increase in VGD and increase in sensitivity to external irritants is possible. All functions of sight are restored within 1 hour.
Specific displays of oftalmoplegichesky migraine (Möbius's disease) are temporary an upper eyelid, an anizokoriya and . Development of an ekzotropiya of paralytic genesis is possible. At the movement of eyeballs there is a diplopiya. This form of a disease is more often diagnosed for children. Attacks can proceed within 1-2 and more weeks. Besides, visual symptoms can also arise at the associated bazilyarny migraine. Characteristics of pathology are bilateral defeat and , the defeats of a trunk of a brain which are combined with a clinical picture.
The visual aura at migraine with aura is presented by the fotopsiya and scintillating scotomas inclined to progressing up to a gomonimny gemianopsiya. Patients describe aura as emergence of zigzags, flashes of a lightning or sparks. Visual edge of elements flickering, helicoid. The first symptoms of pathology are small spots with the paracentral localization which extend further in peripheral departments of a field of vision. Sites of a sparkling are replaced by loss of parts of the visual field. Visual violations develop for 4 minutes and are completely leveled within 1 hour. Just before an attack the period of imaginary wellbeing which average duration makes about 60 minutes is possible. The heavy course of a disease can lead to ophthalmologic hallucinatory disorders, paresteziya of hands, the person or language. The diffusion depression of bark in combination with a local oligemiya is characteristic of this form.
Visual violations at bazilyarny migraine arise in the pubertatny period more often. Clinically the disease is shown by flashes of bright light which lead to development of a temporary blindness and are followed by vegetative frustration. Are more characteristic of girls phono - and photophobia. At children's age emergence of "Alice's syndrome" at which the visual aura in the form of ophthalmologic illusions appears is possible. Patients note lengthening, shortening or change of color of objects. Vegetative, or "panic", migraine is characterized by dacryagogue and darkening before eyes. In most cases symptoms are preceded by visual aura.
Diagnosis of eye migraine
For diagnosis "eye migraine" use data of the anamnesis, survey of forward departments of eyes, assessment of volume of movements and reaction of pupils. The oftalmoskopiya, perimetry, MRT of a brain and an angiography are among tool diagnostic techniques. The listed maloinformativna researches, but their carrying out is necessary for an exception of organic pathology of an organ of vision and establishment of an etiology of a disease.
At poll of patients with eye migraine quite often it is possible to reveal hereditary predisposition, contact with certain triggers and the repeating attacks in the anamnesis. At survey conjunctiva hyperaemia, expansion of pupils and an anizokoriya can be observed. In some cases the volume of movements of eyes is a little limited, manifestations of a nistagm are not characteristic. The difference in the diameter of pupils more than 0,9 mm speaks about a pathological anizokoriya. Reaction to light often sluggish. It is not recommended to conduct a research during the migrenozny attack because of possible strengthening of clinical manifestations.
At height of an attack the spasm of arteries of a retina which in the subsequent is replaced by expansion of veins of an eye bottom is defined by an oftalmoskopiya method. Data of perimetry indicate narrowing of fields of vision on the party of defeat. MRT of a brain and an angiography allow to reveal anomalies of a back brain artery (aneurism, a malformation, pathological branching) and bark ischemia in a zone of its blood supply. In the prodromalny period brain hypostasis is possible. The long course of a disease can lead to formation of small sites of a heart attack and an atrophy of substance of a brain, expansion of ventricles and subarakhnoidalny space. It is possible to establish a migraine form only on the basis of specific clinical manifestations in the presence of 5 and more attacks in the anamnesis. Differential diagnosis of oftalmoplegichesky migraine is carried out with an incomplete form of a syndrome of the top orbital crack.
Treatment of eye migraine
Tactics of treatment of eye migraine consists in knocking over of attacks and the migrenozny status. Therapy is carried out both in sharp, and in mezhpristupny the periods. It is recommended to stop a sharp headache by means of analgetics and nonsteroid resolvents (NPVS). Injections of aspirin are expedient not later than in 2 hours from the moment of development of the first manifestations. The tableted forms (paracetamol, indometacin) are shown at the easy course of a disease. It is recommended to accept the combined analgetics at heavy attacks. At the migrenozny status it is necessary to hospitalize immediately the patient for performing intensive therapy. It is necessary to enter system glucocorticosteroids (Prednisolonum) and to begin dehydrational therapy with diuretics (mannitol). Introduction of neuroleptics and a metoklopramid is shown. A highly effective method of elimination of a pain syndrome is carrying out periostalny and intra bone blockade in trigger points.
Treatment during the mezhpristupny period is shown at development more than 2 attacks of eye migraine for one month and low efficiency of conservative therapy. Medicamentous therapy should be selected individually taking into account provocative factors of a disease. Purpose of nootrop (piracetam), miorelaksant (a tolperizon a hydrochloride), antidepressants is most widespread (fluoxetine). It is necessary to draw the attention of patients to need of regular reception of basic medicines at diseases cardiovascular (hypertension) and respiratory system (bronchial asthma, HOBL).
Forecast and prevention of eye migraine
Prevention of eye migraine comes down to normalization of the mode of a dream and wakefulness, the thought-over distribution of working loading. Patients should exclude from a diet products with the high content of a tiramin (tomatoes, milk, red wine, chocolate, a celery, cocoa). Occupations are shown by physiotherapy exercises, terrainkur, swimming. It is necessary to avoid stressful situations, to minimize an emotional overstrain. Non-drug prevention consists in performing massage, hydrotherapy and acupuncture. Alternative option is occupations auto-training and rational psychotherapy. The forecast at eye migraine favorable for life and working capacity. Timely inspection at the ophthalmologist and the neurologist is recommended.