A 29-year-old woman presented for evaluation of visual phenomena. Her family history is positive for complex migraines in her mother and sisters. Her first migrainous symptom occurred at age 20 when she noted that the “words on [the] page went circular.” This lasted 15 minutes without any accompanying headache. She did well until 3 years ago when a variety of visual phenomena developed, especially in the winter, that lasted anywhere from 10 minutes to longer if untreated. Her symptoms included seeing shimmering lights or lines on the snow or in the sky (Figure, A and C) and shimmering “orbs” in the sky (Figure, D). These occurred mostly in sunlight and sometimes caused anxiety and vomiting, but they also occurred when it was not sunny. She also developed symptoms with her eyes closed such as a burst of flashing lights. These symptoms could be aborted with sumatriptin succinate (Imitrex). She was given a diagnosis of acephalgic and visual migraines. Later in her course she did develop unilateral retro-orbital headaches and dull diffuse headaches with or without accompanying visual auras. More recently she developed transient slurred speech after seeing a burst of purple/pink dots that moved slowly down her field of vision (Figure, B). During another episode, she developed subjective right-sided weakness and a tingling sensation with bright flashing lights in her vision and was evaluated in the emergency department. She has undergone numerous evaluations, including ophthalmologic examinations and magnetic resonance imaging of the brain, the findings from all of which were normal. She works as a computer graphics designer and uses digital editing software to render these images. These images are reminiscent of a latter-day Hildegard von Bingen1 whose “celestial visions” depicted in manuscripts may well have been migraine auras.
Kesari S. Digital Rendition of Visual Migraines. Arch Neurol. 2004;61(9):1464-1465. doi:10.1001/archneur.61.9.1464