Scintillating Scotoma

(Migraine Scotoma)

A scotoma is a “blind spot” in front of the vision. The visual phenomenon of scintillating scotoma usually appears like a “twinkling shadow” or “zig zag pattern” before the eyes. While every experience is a little different, the most common symptoms are “black spot” or “twinkling blur” appearing before the eyes. It is often straight ahead so it interferes with clear vision. This blur usually shifts a little to the side as it gradually enlarges and becomes “wavy” or “zig zag” or “jagged flashing light”. Finally, it disappears. In most cases the total time from appearance to disappearance is about twenty minutes. Many think the spots or waves are in front of one eye only, but they usually are seen in front of both eyes.

After this experience, most people feel normal again. Others lose their appetite, become nauseated, or vomit; some people notice numbness or tingling or a one sided pounding headache [which may last for hours or days] and usually follows the scotoma. This is called migraine headache, and may be quite severe. Most people who have the pounding headache feel worse around bright lights or loud noises, and are often most comfortable staying in bed with the shades closed. If you do not have the headache, you are very fortunate!

Migraine is actually a common, harmless, peculiar disorder of the nervous system, which results from changes in the blood circulation in the brain. These changes in circulation produce all the symptoms. It usually runs in families, and seems to be more common in women. The cause is usually some kind of stress: fatigue, or nervous tension, or food allergy which releases certain chemicals in the body. After some time [which explains why the episodes are not always promptly following the stress] these chemicals produce changes in the muscles of the blood vessels that supply the oxygen to the back of the brain where we actually “see”. They most often occur in people who are intelligent and hard working. Patients are often a little too hard driving and “perfectionistic” and may be pushing themselves too hard.

The first step involves the muscles of the blood vessels tightening into spasm and the blood flow slows. This causes a “short circuiting” across the back (or seeing part) of the brain. It takes about twenty minutes for this disturbance to across the visual area and this corresponds to the time most patients see the “twinkling spots” before their eyes. Usually, the electrical disturbance stops at the end of the visual area, but if it progresses, numbness and tingling may arise in the face, arms, or legs. Nausea or vomiting may occur.

Next, the blood vessel muscles relax abruptly, which allows the vessels to stretch and dilate, producing the pulsating (“pounding”) headache, usually only on one side of the head. If the muscles relax more slowly, the headache does not occur.

The first and best treatment is to understand your symptoms and relax and be interested in your condition. By paying attention to what seems to be the causes of the episodes, you may be able to avoid some of them. For example, some patients have migraine episodes whenever they eat certain foods (sugar, MSG, and wheat products). Some persons have episodes only on Mondays, or when they are angry, or when viewing certain visual patterns. Women have more symptoms when pregnant or while taking birth control pills. If you have recurrences, say, every month, you may find it helpful to keep a diary of the time of the day, duration, and associated activities in order to analyze the frequency and causes.

Most people find that migraine episodes are troublesome for several years, and then become less frequent with the passage of time.

Medication is available to try to ease the headache episode which follow the scotoma. Often this works, but the medicine must be taken quickly at the first hint of an attack or it will do little good. Other medicine is used as a preventative for those unfortunates who have very frequent headache episodes. But 99% of migraine patients need no medicine.

While every thing seems perfectly normal at this time, you should advise me or your family physician if you notice any change in your own usual pattern or frequency of symptoms. Occasionally, we find it necessary to “escalate” our investigation through the use of special neurological consultations, xrays, etc.

And Please Finally Remember: you eyes are fine you are not losing your vision. The worst thing you can do is worry the best is to “be gentle with yourself”.

Foods and Drugs containing Caffeine

  • Cocoa and chocolate
  • Coffee
  • Tea
  • OT OTC Drugs: Anacin, Excedrin, No-Doz, Vanquish, Vivarin
  • Px Drugs: Darvon, Esgic, Fioricet, Fiorinal, Norgesic, Supac, Synalgos
  • Soft Drinks: 7-Up, Pepsi, Dr. Pepper, Fresca, GingerAle, Root Beer, Mountain Dew, Tab