Retroorbital pain and autonomic dysfunctions in patients with migraine

Institute of Neurology and Neurosurgery, Department of Ophthalmology Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground. A part of migraine patients complain of unilateral or bilateral ocular pain during migraine access, which may be associated with some vegetative disorders: ptosis, mydriasis, conjunctival congestion, photo and phonophobia, lacrimation, unvoluntary periorbital muscle contractions, nasal hypersecretion. It is important to analyze the frequency of ocular pain in patients with migraine, laterality, character and their association with other autonomic manifestations. Material and methods: 91 patients with migraine (9.9% men, 90.1% women), out of them 51.6% with chronic migraine, 34.1% with episodic migraine and 14.3% with rare episodic migraine. Patients’ age was 18-63 years. The study included only patients with migraine without other associated neurological or ocular pathology. Ophthalmologic examination included assessment of visual acuity, perimetry, intraocular pressure measurement in migraine crisis and lucid period (air-push N 10-21 mm Hg), ophthalmoscopy, biomicroscopy, refractometry if necessary. Results: According to the statistical analysis of data, 48.4% patients had bilateral ocular pain during migraine attack; 26.3% unilateral headache and eye pain, 25.3% did not experience pain during the migraine attack. By the type of eye pain 34.1% had non-pulsating retro-orbital pain; 18.7% –pulsating retroorbital pain; 22% - had superficial eye pain. During the migraine attack 18.7% of migraine patients had unilateral conjunctival congestion, ipsilateral of headache; 33% bilateral congestion and congestion absent in 48.4% patients. Unilateral lacrimation – 11.4%, bilateral lacrimation in – 25.6%. Photophobia between attacks of migraine accounted for 38.6% of patients. Unilateral ptosis – 8.4% during the attack, bilateral ptosis – 10.8%. Periorbital muscle tics during the migraine attacks were observed in 42.2% patients. We found a statistically significant correlation (P <0.001) between the type of eye pain and intraocular pressure values measured during the migraine attacks and between them. Conclusions: Migraine attacks are often associated with different character of ocular pain, autonomic disorders and with increasing of intraocular pressure

Retrobulbar pain in migraine – differential diagnosis with other pathologies

Department of Ophthalmology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: Some migraine patients complain of ocular pain during migraine crisis. Eye pain can be unilateral or bilateral, independent of the location of headache and is distinguished by the character and intensity of pain. Sensory innervation of the eye and periocular region is provided by the I branch of the trigeminal nerve. Recurrent branches of V nerve innervate the dura mater encefali, intracranial venous sinuses and cerebral vessels. This explains why in extraophthalmic pathologies, headache may radiate into the eye and orbit, and in ocular disease may radiate in different areas of the head and face. Retrobulbar pain may be associated with some types of primary headache, optic nerve pathology, pathology of the eyeball itself or tumor, endocrine or vascular damages of orbit. There is a wide range of neurological diseases with secondary pain to orbital region , periorbital and retrobulbar region, conditional pain related to organic brain pathology. Eyes pain may be a sign of suffering from orbital apex, inflammatory origin in optic neuritis, myositis or Graves-Basedow disease. Sometimes retrobulbar pain is a sign of the presence of an intracerebral aneurysm or fistula carotidcavernous onset, while short pain, is a sign of a neuralgic pain. Ophthalmologist has the first obligation to detail the circumstances of the occurrence of pain, or its association with other symptoms, of which the most common are decreased visual acuity, ocular congestion and/or presence tearing or conjunctival secretions. Conclusion: To differentiate migraine eye pain origin and organic origin it is necessary to know some features of their manifestation

Visual disturbances in migraine – differential diagnosis with other pathologies

Department of Ophtalmology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground. Sudden visual loss is a common complaint with variable presentations among patients of different ages. Some patients describe their symptoms as a gradually descending gray-black curtain or as blurring, fogging, or dimming of vision. Symptoms usually last a few minutes but can persist for hours. Variation in frequency ranges from a single episode to many episodes per day; recurrences may continue for years but more frequently occur over seconds to hours. It does not necessarily have to be a complete loss of vision. It could be a partial loss of vision, or a blurring of the visual field. In other cases, the vision loss may appear as a gray splotch that blocks sight. Visual aura in migraine is the most common type of aura, often presenting as a fortification spectrum, a zigzag figure near the point of fixation that may gradually spread right or left and assume a laterally convex shape with an angulated scintillating edge leaving variable degrees of absolute or relative scotoma in its wake. Many different causes of sudden visual loss are recognized; however, the most common reason for painless sudden visual loss is ischemia. Ischemia, often via mechanical obstruction, can affect any aspect of the visual system. Those who develop ischemia of the eye often have other evidence of atherosclerotic disease, such as coronary artery disease and peripheral vascular disease, which increases their susceptibility to ischemic events in other parts of the body. Conclusions. Sudden vision loss is a common complaint in eye care practices. Often, such a situation requires urgent attention

Efficiency of application topical timolol 0.5% prevented migraine attacks

Institute for Neurology and Neurosurgery, Department of Ophtalmology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: Migraine is a chronic neurological disorder characterized by recurrent episodes of headache and associated symptoms that last 4-72 hours. It is a disease with genetic substrate, very common, debilitating and costly, with a considerable socioeconomic impact, recorded mainly in the most productive period of life between 25 and 55 years. Migraine is often associated with photophobia, phonophobia, vertigo, sometimes vomiting, fatigue. For the treatment of migraine attacks are recommended NSAIDS, triptans, ergot preparations. For preventive treatment are recommended β-adrenergic blockers, calcium channel inhibitors, serotonin antagonists, tranquilizers, antidepressants. Typically, most of such pharmaceuticals are administered orally. Since most of migraine attacks are accompanied with a retro-orbital pain, the efficacy and safety of topical Timolol 0.5% on blockage of β-adrenergic receptors for preventing migraine headaches are assessed. Beta-blockers are awell-known prophylactic treatment for migraine; however, treatment by the ocular route has not been widely considered. Timolol maleate eye drops 0.5% have been prescribed as a prophylactic treatment against migraine headaches, according to reports with success in terms of the prophylactic effect of such treatment. Conclusion: This article presents cases from the literature that illustrate the resolution of a visual field defect, ophtalmoplegia and another simptoms associated with migraine possibly due to administration of a topical beta-blocker. This novel method of treatment may have a place in the management of migraine. Timolol maleate eye drop is an effictive, well-tolerated, safe, and easy-to-use prophylactic antimigraine medication

Ophthalmic manifestations of chronic migraine

Department of Ophthalmology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Institute for Neurology and Neurosurgery, Chisinau, the Republic of MoldovaBackground: Migraine is a common disorder and its pathogenesis remains still unclear. Several hypotheses about the mechanisms involved in the pathogenesis of migraine have been proposed, but the issue is still far from being fully clarified. Neurovascular system remains one of the most important mechanisms involved in the pathogenesis of migraine and it could be possible that hypo-perfusion might involve other areas besides brain, including the retina. This is, for example, of particular interest in a form of migraine, the retinal migraine, which has been associated with hypo-perfusion and vasoconstriction of the retinal vasculature. Although vasoconstriction of cerebral and retinal vessels is a transient phenomenon, the chronic nature of the migraine might cause permanent structural abnormalities of the brain and also of the retina. On this basis, a few studies have evaluated whether retina is involved in migraine patients. Migraine is divided into two major subtypes: migraine without aura and migraine with aura. Migraine without aura is characterized by at least five attacks of recurrent headache lasting somewhere from 4 to 72 h. The other major subtype is migraine with aura, characterized by recurrent attacks of reversible focal neurological symptoms that usually develop gradually over 5-20 min and last for less than 60 min. If aura-like phenomenon is persistent, and ophtalmic deaseases are excluded, an examination through neurovisualization is recommended (MRI, CT). Conclusions: Although the vasospasm of cerebral and retro-bulbar blood vesselsis a transient phenomenon, the chronic nature of the disease might be a risk factor for structural abnormalities of the brain and perhaps the retin