it is not, therefore, surprising that vivid accounts of migraine accompaniments exist throughout history, since the scintillating scotoma is the most frequently occurring visual symptom in migraine with or without headache.
The classic scintillating scotoma, with march of fortification figures and expansion over time, is characteristic of migraine.
Neurologic Manifestations Associated with Migraines Visual disturbances Scintillating scotoma (fortification spectrum/wavy vision) Heminopia Diplopia Blurred vision Blindness Vertigo Sensory disturbance Face (when around the mouth and hand: chiro-oral) Aphasia Hemiparesis/Hemiplegia Decreased hearing (very uncommon) Decreased level of consciousness (rare) Pupillary abnormalities Mydriasis Theories abound regarding the cause of the migraine phenomenon.
The diagnosis of migraine aura without headache can be entertained if the patient has the major migraine characteristics, including migration of scintillating scotoma, recurrences of similar episodes of 15 to 30 minutes' duration, a history of similar spells with headache, an eventually benign course, and a normal physical, ophthalmologic, and neurologic examination.
Patients using oral contraceptives who develop migraine symptoms have a higher incidence of neurophthalmic sequelae, including cerebral vascular accidents.(10) Any patient with scintillating scotoma who is using an oral contraceptive should be advised to discontinue the medication and to adopt an alternative form of birth control.