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'Visual snow' - a disorder distinct from persistent migraine aura.

Christoph J Schankin1, Farooq H Maniyar, Kathleen B Digre

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Brain : a Journal of Neurology
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PubMed
Summary

Visual snow is a distinct visual disorder characterized by persistent dots, often accompanied by other visual symptoms and migraine. This study defines its unique phenotype, differentiating it from migraine aura.

Keywords:
flashbackmigrainepersistent migraine aurapositive persistent visual disturbancevisual snow

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Area of Science:

  • Neuro-ophthalmology
  • Clinical neurology
  • Visual neuroscience

Background:

  • Visual snow (VS) is a condition where patients perceive continuous tiny dots across their entire visual field.
  • VS is often comorbid with migraine, leading to differential diagnoses like persistent migraine aura or psychogenic disorders.
  • Ophthalmological, neurological, and radiological studies in VS patients are typically normal.

Purpose of the Study:

  • To characterize the phenotype of visual snow.
  • To identify associated visual symptoms and comorbidities.
  • To establish visual snow as a distinct clinical disorder.

Main Methods:

  • A three-step approach including chart review, an internet survey of 275 subjects, and a prospective telephone interview of 142 patients.
  • Systematic identification of additional visual symptoms and comorbidities.
  • Analysis of patient demographics, symptom onset, and clinical history.

Main Results:

  • 22 patients with VS were identified; 15 had additional visual symptoms, and 20 had comorbid migraine.
  • An internet survey revealed eight additional visual symptoms in over 33% of subjects, including palinopsia, entoptic phenomena, photophobia, and nyctalopia.
  • In 142 interviewed patients, 78 had confirmed VS with normal ophthalmological exams; 72 reported at least three additional visual symptoms. Mean age of onset was 21 ± 9 years. Migraine (59%) and anxiety/depression were common comorbidities.

Conclusions:

  • Visual snow is a unique visual disturbance, clinically distinct from migraine aura, and can be disabling.
  • Migraine is a common comorbidity, but standard migraine treatments are often ineffective.
  • Visual snow should be recognized as a distinct disorder requiring further systematic research into its clinical features, biology, and treatment.