Neuro-Ophthalmic
Migraine Aura
Also known as: migraine aura, ocular migraine, visual migraine, scintillating scotoma, shimmering zig zag vision, expanding shimmering pattern
Filed as: Routine
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
A cortical visual disturbance that builds and travels over several minutes before resolving, typically shimmering, zig-zag or scintillating and affecting the same side in both eyes. Headache may follow or may be absent entirely. The positive, spreading, self-resolving character is what distinguishes it from vascular visual loss, and an episode that is one-eyed or persistent is a different problem needing prompt assessment.
Recognition
Symptoms: what patients report
- Transient bilateral or homonymous visual phenomenon, often shimmering, zig-zag, coloured, or scintillating.
- Expanding scotoma or crescent pattern that gradually spreads over about 5-30 minutes and resolves.
- Headache may follow, but aura can occur without headache.
Signs: what the examination shows
- Retinal examination is expected to be normal if symptoms have fully resolved.
- Positive visual phenomena are more typical than a dark curtain or dense floater shower.
What OptoGuide™ covers for migraine aura
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Ophthalmologic Manifestations of Migraines — EyeWiki
- Migraine Visual Aura — NANOS
- The Neuro-Ophthalmology Survival Guide (Pane, Miller & Burdon) — standard reference text
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.