Retinalny migraine — the separate type of a paroksizmalny migrenozny headache differing in existence of passing visual violations in the form of monocular single/multiple losses under review or a total blindness on one eye. Duration of violations of sight which is not exceeding 1 h Retinalnaya migraine is characteristic it is diagnosed on the basis of clinical criteria and recorded by the doctor or the patient of episodes of violations under review. Additional researches (EEG, an oftalmoskopiya, UZDG, MRT, etc.) are directed to an exception of other pathology which can also be the cause of defects of the visual field. Treatment consists in selection of optimum medicine, an exception of influence of provocative factors, normalization of a way of life.
Retinalny migraine — a paroksizmalny tsefalgiya (headache) which attacks are followed by tranzitorny visual frustration in the form of defect of a field of vision or a total blindness (amavroz). The blind spot in the visual field carries the name of scotoma and can have various localization and a form. In the International classification of a tsefalgiya about 18 types of migraine are allocated. Among them retinalny migraine is one of the most rare forms. It meets in the isolated look a little, its paroxysms are more often are combined with the attacks of oftalmichesky or simple migraine. Prevalence of pathology is poorly studied in a type of lack of its controlled screening. Retinalny migraine is of practical interest to experts in the field of neurology and ophthalmology.
Reasons of retinalny migraine
Developing of retinalny migraine is associated with a temporary spasm of the central artery of a retina. Some researchers assign the leading role in pathogenesis of a similar spasm to serotonin — biogenous amine which emission from platelets is observed at the beginning of the migrenozny attack. Owing to a spasm the ischemia of a certain site of a retina leading to loss by it of ability to perceive light irritations develops tranzitorny (i.e. reversible). Scotoma is as a result formed. At ischemia of several sites of a retina scotoma has multiple character, and at defeat practically of all area of a retina is observed . Taking into account an etiopatogenez of visual frustration retinalny migraine also carries the name setchatochny.
The triggers starting the migrenozny attack are very individual. Distinguish overcooling, a stress, physical overfatigue, a sleep debt, change of meteoconditions, touch hyper stimulation from them (noise, an unpleasant smell, flickering light and so forth), the use of separate foodstuff (a celery, chocolate, a citrus, nuts, cheese, red wine, etc.); at women — periods, reception of hormonal contraceptives. Researchers note that not the last place in genesis of migrenozny paroxysms in general and retinalny migraine in particular is occupied by the increased irritability, discontent, irascibility. Besides, the family nature of migraine observed at most of patients suggests an idea of inheritance of a certain predisposition to this pathology.
Symptoms of retinalny migraine
Clinically retinalny form of migraine is shown by the hemicrany attacks (pains in one half of the head) which is combined with the violation of visual function lasting not longer than 1 hour in the form of formation of one or multiple scotomas or a total blindness. Disorders of sight can precede a hemicrany, at the same time they arise not earlier than in 1 hour prior to emergence of a headache. In others, more rare, cases retinalny migraine is characterized by the visual violations appearing after the beginning of a tsefalgiya. Scotomas and are always observed gomolateralno. i.e. on the same party, as a headache.
Retinalny migraine can begin with emergence of one scotoma, then there is a set of defects of the visual field which, merging, can lead to a total blindness on one eye. Often the attack is followed by feeling of pressure upon an eyeball from within, subfebrilitety, nausea, giperesteziy (hypersensibility) to various external irritants (light, a sound, a smell).
Retinalny migraine differs in the small duration of the attacks. Important clinical criterion is the complete recovery of visual function not longer, than in 1 hour after the beginning of violations, and lack of similar problems with sight during the period between paroxysms.
Diagnosis of retinalny migraine
Basis for verification of the diagnosis "retinalny migraine" are clinical criteria and an exception of other possible reasons of similar visual frustration. At diagnosis the neurologist defines compliance of symptomatology to the following diagnostic criteria:
- existence not less than 2 paroxysms of the headache answering to criteria of the migraine developing not later than in 1 hour or during sight violations. The last have passing character and no more than 1 hour proceed. Disorders of sight have to be confirmed or the patient by the image in the drawing of the arising visual impairment, or the doctor examining the patient in the period of a paroxysm.
- lack of pathological changes at ophthalmologic inspection during the period between the attacks of migraine
- lack of other reasons of the arising visual frustration.
The neurologic status of the patient within norm. The inspection at the ophthalmologist including visual acuity definition, perimetry, an oftalmoskopiya in the mezhpristupny period does not reveal deviations, in the period of a paroxysm defines existence of one or multiple defects under review, gomolateralny a headache. For the purpose of an exception of other pathology (aneurism of vessels of a brain, an intracerebral tumor, neuropathy of an optic nerve, a retinopathy, TIA or an ischemic stroke, distsirkulyatorny encephalopathy) EEG, an ekhoentsefalografiya, REG, UZDG of eye vessels, brain MRT, the scanning retina tomography is carried out.
Difdiagnostika of retinalny and oftalmichesky migraine
Unfortunately, clinical physicians sometimes confuse the concept "retinalny migraine" to migraine oftalmichesky. In too time it is 2 absolutely different forms of migraine. Retinalny migraine develops owing to a retina artery spasm, and oftalmichesky — owing to tranzitorny ischemia of structures of bark of an occipital share of a brain. Distinctive feature is the monocular type of violations at a retinalny form of migraine and binocular at oftalmichesky.
Oftalmichesky migraine is classical migraine with aura. It is characterized by the bigger duration of a paroxysm, emergence of meningealny, all-brain and vegetative manifestations. Visual frustration at it are expressed as molniyepodobny flashes, the sparkling points, light zigzags or spheres. Defects in visual fields are observed in the form of a gemianopsiya or narrowing of fields of vision.
Treatment of retinalny migraine
Today doctors do not own an effective and unambiguous method of treatment of migraine. Depending on features of the patient, frequency and weight of paroxysms retinalny migraine is the indication to purpose of resolvents (a naproksen, diclofenac, an ibuprofen), the combined analgetics, narcotic analgetics (a tramadol, fentanyl), antikonvulsant (valproat, carbamazepine, a topiramat), serotonin agonists (a rizatriptan, a sumatriptan, an eletriptan), ergot medicines (ergotamine, dihydroergotamine), beta (propranolol, a metoprolol), antidepressants (a milnatsipran, an amitriptillin, a venlafaksin), antiemetic (a domperidona, a metoklopramida).
As a rule, the most suitable for knocking over of the attack of retinalny migraine medicine is selected by practical consideration. The treatment method during the mezhparoksizmalny period having the proved efficiency does not exist yet. According to researches more than 70% of patients remain are not satisfied with results of therapy.
Forecast and prevention
The forecast of migraine in respect of recovery doubtful. However patients who use own efforts for a victory over migraine (exclude influence of trigger factors, including change own negative reactions to more benevolent behavior), often achieve success. Besides, with age retinalny migraine loses the frequency and intensity.
Preventive measures have mainly secondary character and consist in the prevention of the next migrenozny paroxysm. It is possible to distinguish avoiding of provocative factors, observance of the adequate labor, food and psycho-emotional mode from them. If the patient did not manage to avoid influence of the potential trigger (for example, there was a stressful situation or visual hyper stimulation), application of methods of a relaxation, preventive reception of in advance picked up medicine will help to avoid the attack of retinalny migraine to it.