3. • 視覚前兆は後頭葉由来であり, 同名の障害を来すことが多い
– 片側眼障害ならば網膜症や眼球, 神経, 血管の問題を疑うべき.
– 片側の眼症状を来す片頭痛を “Retinal migraine”と呼び, 稀な病態.
通常若年で片頭痛の既往がある患者で生じることがある.
– 陽性症状は片頭痛の前兆らしいが,
陰性症状のみの場合はTIAを示唆する所見.
3
Cleveland Clinic Journal of Medicine 2005;72:529-534
Visual symptoms of migraine aura
vs transient ischemic attack (TIA)
FEATURE MIGRAINE AURA TIA
Duration 15–30 minutes 3–10 minutes
Quality Dynamic, bright, multicolored Static, dark
Forms geometric patterns Dimming of vision
T A B L E 2
MIGRAINE AURA KUNKEL
9. • 国内におけるtypical migraine aura without headacheの頻度.
– 関東地方の6箇所の眼科において, 1914名にアンケート調査を施行.
1063名(55.5%)より回答あり, TAWHの頻度を調査したstudy
患者は眼科を受診した患者群.
• アウトカム
– ID migraine screener testで片頭痛と診断されたのは81名.
TAWHの診断criteria満たしたのは35名(3.2%)であった.
9
Cephalalgia 2010;30(8) 962–967
found that the ID migraine test was positive in 86% of patients diagnosed with
episodic migraine and 83% with chronic migraine [13]. Sensitivity and specificity,
respectively, ranged between 80–88% and 74–76% among the three clinic settings,
supporting the value of this simple screener in different clinical settings.
Practical pointer
Migraine is an intermittent, disabling, recurring headache condition associ-
ated with sensitivity to stimulation (like lights, noise, and odors) and often
nausea.
Box 2 ID Migraine Screener (based on Lipton et al. [12])
Instruct patients to answer the following three questions about their
headaches:
1. Over the last 3 months, have you limited your activities on at least 1 day
because of your headaches?
2. Do lights bother you when you have a headache?
3. Do you get sick to your stomach or nauseated with your headache?
Patients answering “yes” to at least two of these questions probably have
migraine