Headaches & Vision

Migraine visual aura around the leaning tower of Pisa

Migraines and

the visual system

Migraine visual aura | Glossary of terms

These descriptions are for informational purposes only and should not be used as a sole basis for diagnosis. Practitioners should conduct a comprehensive clinical evaluation, ensuring that other migraine features are present (ICHD 3) before attributing symptoms to migraines with visual auras. If these symptoms occur for the first time, appropriate investigations should be conducted to exclude neurological or ophthalmic causes.

Approximately 30% of patients with migraines experience auras (Rasmussen.1992). Visual auras are the most common type of migraine aura, occurring in over 90% of patients with migraine with aura (Viana. 2017). Visual auras are not only common but are also the most multifaceted, with patients reporting a range of different and often complex visual disturbances. There is no consensus on terminology used and can be confusing for non-headache specialists. These descriptions may assist community practitioners in effectively questioning patients about migraine visual auras and for descriptions in referral letter to specialists.

The list describes the different types of visual auras and the relative frequencies within the patients that experience visual auras. It is adapted from a systematic review published in The Journal of Headache and Pain (Viana.2019).

Aura Term , Descriptions and Frequency

  • Flickering Lights 12 - 91%

    Bright lights that flicker and are dynamic

  • Zigzag lines 24 - 81%

    Jagged or zig zag lines

  • Scotoma 23 - 77%

    Single blind area

  • Phosphenes 19 - 70%

    Small bright dots

  • Foggy/blurred vision or dimness 25 - 54%

    Blurry vision or general dimness to vision

  • Scotomata 32%

    Several blind spots / black areas

  • Tunnel vision 4 - 27%

    Blindness in whole periphery

  • Heat waves/water oil 8 - 24%

    Like looking through heat waves, water or oil

  • Hemianopia 6 - 24%

    Blindness of half a visual field

  • Corona phenomena 2 - 18%

    An extra edge on objects

  • Visual snow 7%

    Diffuse, mobile, continuous tiny dots present throughout visual field. Present in all conditions of illumination even with the eyes closed. Dots remain individual and do not clump (Schankin.2014)

  • Oscillopsia 2 - 4%

    Movement of stationery objects

  • Micropsia 2 - 4%

    Objects appear smaller or more distant than they are

  • Macropsia 1 - 3%

    Objects appear larger or closer than they are

  • Complex hallucinations 1 - 3%

    Visual perceptions of something that is not present (e.g objects, animals or persons)

References

  1. Viana, M., Tronvik, E.A., Do, T.P. et al. Clinical features of visual migraine aura: a systematic review. J Headache Pain 2019;20: 64.

  2. Viana M, Sances G, Linde M.et al.Clinical features of migraine aura: results from a prospective diary-aided study. Cephalalgia 2017;37(10):979–989

  3. Rasmussen BK, Olesen J. Migraine with aura and migraine without aura: an epidemiological study. Cephalalgia 1992; 12: 221–228; discussion 186.

  4. https://ichd-3.org/1-migraine/1-2-migraine-with-aura/

  5. Schankin CJ, Maniyar FH, Digre KB, Goadsby PJ. Visual snow--a disorder distinct from persistent migraine aura. Brain. 2014;137(Pt 5):1419-1428