Acephalgic retinal migraine: A 6-year follow-up case report and literature review

Retinal migraine is a rare cause of transient monocular visual loss that presents a significant diagnostic challenge and necessitates the careful exclusion of alternative etiologies. This case report describes the 6-year clinical course of a rare, headache-free variant of retinal migraine.

A 42-year-old male experienced recurrent transient monocular visual loss episodes 2 to 3 times per year, affecting either eye, without any associated headache. Each episode involved stereotypical visual symptoms starting with photopsia, followed by an expanding altitudinal visual field defect.

Extensive investigations, including neuroimaging, vascular studies, blood work, and ophthalmological examinations, returned normal results. After years of investigations and excluding other etiologies, a diagnosis of retinal migraine was established based on the International Classification of Headache Disorders 3rd edition criteria.

The patient opted for low-dose aspirin to decrease the risk of permanent visual loss.

The patient continued to experience similar visual episodes without any change in frequency, severity, or characteristics.

Retinal migraine may occur without headache, consistent with current International Classification of Headache Disorders 3rd edition criteria. Careful history-taking remains a cornerstone of accurate diagnosis, and time can serve as an invaluable diagnostic tool. Finally, a patient-centered approach is essential, particularly when evidence-based management options are limited.