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Headaches in optometric practice part 1 – migraine

In the first in a series examining the assessment and management of the many, varied forms of headache that present in practice, optometrist Kirit Patel looks at the cases of some patients with migraine

The term migraine is used to describe a variety of primary headache conditions where there is recurrent moderate to severe headaches, often associated with a variety of autonomic-related symptoms. These include a visual aura and, because of this, optometrists are often consulted about migraine. Here are three cases seen where the underlying cause of the migraine was quite distinct.

Case 1: Acephalgic (silent) migraine

A 42-year-old myopic male (RG) had been experiencing ‘streaking of brake lights’ and a ghosting effect in the vertical plane when driving. This was noticeably worse at night, and becoming so intense that he had recently had to stop driving on a trip to Paris and ask his wife to take over. Following on from this visual sensation, he succumbed to a feeling of ‘very tired eyes.’ He admitted to being ‘a stressed individual’ and he believed the symptoms may be generated by stress mechanisms and bright lights.

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