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The danger of ignoring a migraine

Department of Neurology, Hurstwood Park Neurological Centre, Haywards Heath, Sussex, UK

Correspondence to:
Correspondence:
Dr Nin Bajaj;
narinderbajaj@compuserve.com

Submitted 16 November 2000
Accepted 15 February 2001

Keywords: migraine; reversible posterior leukoencephalopathy syndrome; hypertensive retinopathy; headache; Behçet's syndrome; dural sinus thrombosis; alveolitis; nitrofurantoin; adverse drug reactions; interstitial lung disease

A 31 year old man was referred with prolonged loss of vision after a typical migraine attack. His usual migraine attacks consisted of a left sided headache preceded by nausea and vomiting and a visual aura of coloured and flashing lights in both visual fields. Visual loss after his migraines could last up to one hour.

The frequency of his headaches had markedly increased eight months before presentation and these were relieved with a combination of pizotifen and naratriptan. Three weeks before presentation, he suffered a typical migraine but noticed that the visual loss after the migraine persisted as a "hole" in the vision of the left eye. Two weeks later he developed a similar scotoma in the field of the right eye with distortion of vision in that eye such that straight lines appeared wavy. He had no other relevant past medical history.

On examination, his visual acuity . . . [Full text of this article]