Neuropatia óptica isquémica associada a enxaqueca

Neuropatia óptica isquémica associada a enxaqueca


Marco Aurélio Lana,
Reginaldo M. Mattos Júnior


Arquivos Brasileiros de Oftalmologia

versão impressa ISSN 0004-2749versão On-line ISSN 1678-2925

Arq. Bras. Oftalmol. vol.61 no.3 São Paulo jun. 1998



To describe the epidemiological and clinical features of patients with ischemic optic neuropathy (ION) associated with migraine.


Patients with ION associated with migraine examined during a 17-year period were reviewed retrospectively. The patients underwent a complete ophthalmological evaluation and appropriate laboratory investigations to rule out other diagnoses. ION was considered secondary to migraine when occurring in patients with a long history of migraine including some transient monocular visual blurring, loss of vision occurring during a migraine attack, and other possible causes being ruled out by appropriate tests.


Out of 446 ION patients, 18 (4.3%) were considered due to migraine. There were 14 women and 4 men with ages ranging from li to 53 years (mean 31.4). In two patients bilateral involvement occurred. Among the unilateral cases the right eye was involved in li patients and the left in 5. Visual acuity ranged from 20/20 to NLP. Visual field abnormalities were found in all patients in whom the test was feasib!e, there being predominance of altitudinal and arcuate defects. Optic disc edema was found in 1O eyes (50%), optic disc pallor in 9 (45%), and normal fundus in 1 (5%). In. 6 patients (30%) structural changes of the optic disc could be detected.


Migraine may cause ION. Its diagnosis should be considered in patients with a history of migraine-associated transient visual loss and when other etiologies of the visual loss are ruled out by appropriate investigations.

Keywords: Ischemic optic neuropathy; Migraine


1 Arnold AC, Badr MA, Hepler RS. Fluorescein angiography in nonischemic optic edema. Arch Ophthalmol 1996;114:293-8.
2 Arnold AC, Hepler RS. Fluorescein angiography in acute nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol 1994;117:222-30.
3 Boghen DR, Glaser JS. Ischaemic optic neuropathy. The clinical profile and natural history. Brain 1975;98:689-708.
4 Burde RM. Optic disk factors for nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol 1993;116:759-64.
5 Burger SK, Saul RF, Selhorst JB, Thurston SE. Transient monocular blindness caused by vasospasm. N Engl J Med 1991;325:870-3.
6 Bussone G, LaMantia L, Botardi A, Parati EA, Frediani F, Testa D. Complicated migraine in AS hemoglobinopathy. Eur Neurol 1984;23:22-5.
7 Doro S, Lessell S. Cup-disc ratio and ischemic optic neuropathy. Arch Ophthalmol 1985;103:1143-4.
8 Feit R, Tomsak RL, Ellenberger CJR. Structural factors in the pathogenesis of ischemic optic neuropathy. Am J Ophthalmol 1984;98:105-8.
9 Galezowski X. Ophthalmic megrin: An affection of the vasomotor nerves of the retina and retinal centre which may end in a thrombosis. Lancet 1882;1:176-7.
10 Hayreh SS. Anterior ischemic optic neuropathy. Berlin: Springer-Verlag 1975;145 p.
11 Headache classification committee of the International Headache Society. Classification and diagnostic criteia for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988;8:1-96.
12 Hupp SL, Kline LB, Corbett JJ. Visual disturbances in migraine. Surv Ophthalmol 1989;33:221-36.
13 Hupp SL, Kline LB, Corbett JJ. Complicated migraine and vision. Headache Quartely 1990;1:146-51.
14 Kaiser HJ, Flammer J, Gasser P. Ocular vasospasm in children. Neuro-ophthalmol 1993;13:263-7.
15 Kalendovsky Z, Austin JH. "Complicated migraine": its association with increased platelet aggregabiity and abnormal plasma coagulation factors. Headache 1975;15:18-35.
16 Lana-Peixoto MA. Estudo comparativo do perfil clinico das formas arteritica e não arteritica da neuropatia óptica isquémica anterior. Tese de Doutoramento, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, 1993.
17 Lana-Peixoto MA. A etiologia da neuropatia óptica isquémica anterior: estudo de 328 casos e revisão da literatura. Rev Bras Oftalmol 1994;53:497-506.
18 Lana-Peixoto MA, Barbosa AS. Anterior ischemic optic neuropathy in a child with AS haemoglobinopathy and migraine. Br J Ophtalmol 1998;82:199-200.
19 Lee GL, Brazis PW, Miller NR. Posterior ischemic optic neuropathy associated with migraine. Headache 1996;36:506-9.
20 O'Sullivan F, Rossor M, Elston JS. Amaurosis fugax in young people. Br J Ophthalmol 1992;76:660-2.
21 Osuntokun O, Osuntokun BO. Ophthalmoplegic migraine and hemoglobinopathy in Nigerians. Am J Ophthalmol 1972;74:451-5.
22 Piper HF. Passagere Sehstörungen, betont dutch mangelnde Krankheits-bewaltigung. Klin Mbl Augenheilk 1991;199:209-13.
23 Rizzo JF III, Lessell S. Optic neuritis and ischemic optic neuropathy. Overlapping clinical profiles. Arch Ophthalmol 1991;1 09:1668-72.
24 Winterkorn JM, Kupersmith MJ, Wirtschafter JD, Forman S. Brief report: treatment of vasospastic amaurosis fugax with calcium-channel blockers. N Engl J Med 1991;323:870-3.