If impaired vision occurs on one eye during a migraine attack it is called a retinal migraine. Just as all forms of migraine, retinal migraine also comes in attacks. The disturbed vision can be streaks, zigzag lines or also a complete blindness on one eye. For the diagnosis, at least two attacks are necessary. The retinal migraine is an absolute rarity. Poor blood circulation of the retina or the optic nerve is assumed to be the cause. A permanent loss of sight caused by retinal migraine is known but extremely rare.
Next to the diagnosis of the typical clinical signs, a thorough ophthalmologic and neurologic examination is needed to exclude other possible disorders for the unilateral loss of sight. Additionally, an imaging procedure, ideally a magnetic resonance image (MRI) of the brain and an ultrasound of the blood vessels of the neck should be done.
The term “chronic migraine” was only officially accepted by the international headache classification in 2003. It is used to describe migraine attacks which occur on more than 15 days a month for at least 3 months. Before that time, usually less attacks occurred. The increase in the frequency of attacks mustn’t be referred back to a high frequency of taking migraine and pain medication on more than 10 days a month. In that case, it would not be a spontaneously high course of attacks but caused by medication. Actually, there are patients who suffer extremely often from migraine attacks – attacks on up to 30 days a month.
Status migraenosus (permanent migraine-like condition) is, like chronic migraine, also a complication of migraine. In this case, the phase of the headache lasts longer than 72 hours despite treatment but the phases cannot be interrupted by phases without a headache of more than 4 hours (hours of sleep don’t count). In most cases, cause of status migraenosus is a highly frequented use of migraine and headache medication on more than 10 days a month. However, additionally existing tension headache can function as the background of the migraine attack. Often, both types can exist simultaneously and a frequented use of medication on more than 10 days a month a month is necessary. The attacks then occur more often and last longer, the medication doesn’t work well enough anymore and the time frame of a single attacks exceeds 72 hours.
Lasting aura without infarct
Another complication of migraine is the persistent, i.e. lasting aura without infarct. Even though neurologic malfunctions during the aura phase exist for more than 2 weeks, the MRI doesn’t show any signs of an infarct. Patients usually show symptoms bilateral.
The migraenous infarct
While aura symptoms usually retreat by themselves after a migraine attack, they still exist after one week during a migraenous infarct. In order to be diagnosed as a migraenous infarct, other causes have to be ruled out with appropriate methods of examination (e.g. MRI). Clues to tissue damage of the brain, just like after a stroke, can be discovered. The migraenous infarct can occur especially in people under the age of 45.
Epileptic attacks caused by migraine
Migraine attacks can cause not only a stroke, but also epileptic attacks. Seizures occur during one hour after a migraine attack.
During a migraine attack, chest tightness, chest pain as well as functional hypoglycemia can occur. Additionally, patients feel anxiety and beating of the heart. Just like other circulatory disorders of the heart vessels (angina pectoris: heart attack), the pain can radiate into the left arm. Until today, it remains unclear if cardial migraine is caused by a cramp of the vessels. Another possible cause could be that the patient breathes too fast during a migraine attack (hyperventilation) and thus causes the symptoms. The term cardial migraine is not specifically part of the international headache classification, the symptoms can occur with all different forms of migraine.
Menstrual migraine is an especially colorful plate of migraine-like malfunctions. What actually qualifies as a menstrual migraine has not been clearly described so far and thus has not found its way into the international headache classification. Some authors think that menstrual migraine exists if the migraine attacks are only present during menstruation. Others demand a certain number or frequency of attacks during menstruation. The so-called premenstrual syndrome is regarded in isolation. The percentage of affected women is very high. Different studies assume that up to 20% or more women show said disorder. The symptoms of menstrual migraine are: testiness, anxiety, insomnia, hyperactivity, stomach pains, constipation, depressed mood, exhaustion.
Other migraine type disorders in short form
Cyclic vomiting and biliary attacks
Lower abdomen discomforts in the form of strong nausea, vomiting or biliary attacks. Special characteristics: they occur periodically. Possible accompanying symptoms: paleness, sweating, shivering attacks. These migraine type disorder is often misdiagnosed as food allergy, gastric flu, biliary attack or gallbladder disorder.
Stomach migraine in kids
Especially for children, periodically recurring stomach pains, flatulence and stomach cramps are characteristically. The doctor calls these attacks abdominal migraine, i.e. stomach migraine. They can last up to half a day and then recede. Almost every class in school has children suffering from these symptoms which are gone again after two to three hours. Accompanying symptoms are: paleness, dizziness, nausea. Children are sometimes unfairly charged with faking. About 20% of children who have real migraine attacks have suffered from such periodic stomach pains, intestinal colics, diarrhea or painful flatulence in their early childhood. Characteristically for stomach migraine is that it doesn’t occur anymore after puberty.
Benign attacks of dizziness in children
Affected children complain about sudden attacks of dizziness and they are pale. Nausea can occur as well.
Often diarrhea occurs at certain times of days or weeks – e.g. always during vacation, the weekend, early in the morning. Some people torture themselves with these periodic attacks over long periods of their life without knowing that it is a migraine type disorder.
Periodically occurring fever is not to be lightly diagnoses as a migraine type disorder. There are a number of other disorders which also cause periodically occurring fevers (think of malaria). A very thorough examination is necessary in different fields of expertise to find the cause. Still, there are few patients for whom periodic fever has to be seen as a migraine type disorder.
Patients are episodically lethargic, tires and have an overwhelming need for sleep
Periodic mood swings
Testiness, anxiety, depression and other comparable disorders are in the foreground of periodic mood swings in the form of migraine type disorders. The recurring phase.like development of such symptoms is typical. They have to be separated from depressions and other psychological disorders because of the short duration of the phases of 2 to 3 days maximum.