Late onset visual migraines with no headache?

Ears, nose and throat
1

Sorry to hijack this forum with a non-vestibular problem, but I suspect there's more expertise here than on the migraine forum.

I'm a 73-year-old female, good general health, fairly active, good lifestyle, BMI 24, BP borderline-high but monitored by my GP.

I have no history whatever of classic migraines - i.e. the type with an aura.

This afternoon, while preparing an email, I suddenly noticed a small scotoma in the centre of my visual field, whichever eye I looked through. Not so much a blind spot, more a tiny grey circular spot which it was difficult to see through. It covered about 2mm of text on my screen.

I downloaded an Amsler grid and tested my eyes. Left eye normal, but on the right eye the little blurry spot obscured a couple of mm of the grid just to the right of the central spot. I quit the computer, went off to do something else, to change the focal length.

The grey blurry central spot got bigger over the next 5 minutes - affecting both eyes equally. Then it started changing into a cluster of jagged black lines which appeared to be rotating, still in the centre of my visual field and getting rapidly bigger. It was partly obscuring my central vision though I could kind of see through it.

Shortly afterwards the cluster of jagged lines assumed a half-moon shape and started slowly moving off to the right of centre. It eventually formed a complete semi-circle around the right of my visual field, and looked as if it was rippling, like water. As it moved over to the right, I regained normal central vision but started losing vision in the right field. All this continued to affect both eyes.

It eventually disappeared off the right-hand edge of my visual field, leaving me with normal (for me) vision. The entire episode lasted about 40 minutes.

I had no other symptoms during this episode, apart from feeling a bit panicky. (It was the first time anything like this had ever happened to me.) I grinned at myself in the mirror a couple of times, to check for facial weakness, but there was none.

I checked my sight on the Amsler grid again after the end of the attack - everything OK. This happened five hours ago and I haven't developed a headache or any other symptoms since then.

Would this be a visual migraine? And is it normal for these to start so late in life with no antecedents?

2

Just to add that these weren't the classic "floaters" of old age. I get these occasionally and know what they look like. Also my eyes were fully tested seven months ago, including retinal photography, and all was fine.

3

I think you should go to a good eye doctor.

4

The consultant I saw for visual migraines told me the oldest patient he had for first onset was 90.

5

Thank you Anne - that's very reassuring. I was a bit concerned when this came out of the blue! Can I just ask whether you ever get the visual effects without a headache?

6

If,you googe Moorfields NHS uk,,eye,conditons there's  a,whole,bunch of different ones to click on which will describe symptoms. They are in London Uk and very reknowned.  You can get Migraine Associated Vertigo with no headache , but as you dont mention dizziness of any kind i doubt you have that per se.

7

Thank you Gillian. No, I don't believe it's vestibular in origin either. I only posted here because I suspected I might get more information than over on the migraine site (which has proved to be the case so far).

I did, of course, have the two-month attack of BPPV that I posted about on here earlier this year, but I know there's no connection as the BPPV was completely cured by an Epley manoeuvre 4 months ago.

I've now done a bit more research and have discovered that it's not all that rare for these visual migraines to start out of the blue in old age, and that in the elderly visual migraines are more likely to occur without headache than in young people. However, I see there's a possible link with TIAs, so I think I'll still touch base with my GP when he gets back from his hols at the end of this month. There's a dodgy locum standing in at the moment, so I won't bother with him.

I've also withdrawn €50 (£40) in cash, which I'll keep handy in case I get a worse attack, or any worrying neurological symptoms. That'll pay the taxi to A&E at a very good university hospital on the other side of town if necessary. Under our health service we can present at any hospital or doctor we want, anywhere in the country - no catchment areas. But if you call an ambulance they have to take you to the nearest suitable place, and I don't want to get carted off to either of my flea-pit local hospitals!

And how are you? How are you getting on with the exercises now?

8

Hi Lily, yes my vision goes wonky as i I am unable to focus my eyes properly, everything looks blurred and my perception of distance is affected.I don't get a headache which is why they are called 'silent' migraines but sometimes I do get a thumping/pounding sensation in my ears.Overall I am much improved but stil have bouts of imbalance especially going down stairs and into light and dark areas. When it was at its worst I was crawling around on the floor as couldn't stand up. But at that time I also was suffering with BPPV and the two combined to make things worse. At the moment I don't have BPPV but I was having recurring bouts of it every few weeks and the epley manouvre didn't work for me. Eventually the crystals within the ear canal  dissolve on their own and for me that can take about 6 weeks.  It is my left ear that is affected with BPPV and could be due to a head injury on that side many years ago I was told by ENT

9

Sorry to hear that your BPPV keeps coming back. I was lucky with mine this last time round, as it was fixed in minutes with the Epley manoeuvre after about two months. That was four months ago and I've been fine since then. I was less fortunate the first time I got it, 25 years ago, when there was less knowledge about the Epley. As far as I recall, it took about a year for the crystals to dissolve spontaneously.

It sounds as if you have some other vestibular problem going on as well. I really feel for anyone who has permanent vertigo, having had the two BPPV experiences.

Fortunately I don't have any eye problems - apart from yesterday's incident plus dry eyes due to an autoimmune condition. I didn't have any focussing problems yesterday. What I experienced fits exactly with the description of scintillating scotoma. My heart was certainly pounding during the episode, but that was only because I was initially a bit freaked out by it!

I feel completely reassured now but I still think I'll touch base with my regular GP when he gets back from his holidays at the end of this month.

I hope your condition continues to improve.