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Migraine is a severe and common primary headache disorder, characterized by pain as well as a plethora of non-painful symptoms. Among these, visual phenomena have long been known to be associated with migraine, to the point where they can constitute a hallmark of the disease itself. In this review we focus on two key visual disorders that are direc...
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Migraine is the comorbidity most frequently associated with visual snow syndrome (VSS), but the prevalence of VSS in patients with migraine (PWM) has not been studied. Our objective was to evaluate the frequency of VSS in PWM and to analyze if symptoms of VSS happened in a permanent or episodic manner (eVSS) in this population.
We conducted a multi...
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... In addition, comorbid migraine has been associated with a more severe Extended author information available on the last page of the article course of VSS, in terms of the number of visual symptoms [5,6,11]. Other comorbidities associated with VSS include fibromyalgia, depression, and anxiety, which are also more common in patients with migraine without VSS [1,9,12]. ...
... Current diagnostic criteria for VSS include the persistence of visual snow in a continuous way and for at least 3 months. Recently, visual snow has been described in an episodic manner, during migraine attacks or before the onset of a persistent VSS [12]. ...
Migraine is the comorbidity most frequently associated with visual snow syndrome (VSS), but the prevalence of VSS in patients with migraine (PWM) has not been studied. Our objective was to evaluate the frequency of VSS in PWM and to analyze if symptoms of VSS happened in a permanent or episodic manner (eVSS) in this population.
We conducted a multicenter observational cross-sectional study. PWM was recruited from headache units, and a survey about the presence of visual snow symptoms was administered. The frequency and characteristics of patients that met current VSS criteria were analyzed. Demographic and clinical features of patients with VSS, eVSS, and PWM with no visual snow were compared.
A total of 217 PWM were included. Seventeen patients (7.8%) met the VSS criteria. VSS patients had visual aura more frequently (58.8% vs. 31%; p = 0.019) and a higher MIDAS score (96.6 vs. 47.7; p = 0.014). Fifty-eight PWM (26.7%) showed visual snow and associated features in an episodic way and were classified as eVSS. Patients with VSS showed a tendency towards a higher frequency of visual symptoms than patients with eVSS (p > 0.05). No statistically significant differences in sociodemographic characteristics and comorbid conditions were found between VSS and eVSS.
The prevalence of VSS in PWM may be higher than that described for the general population. Some PWM may present similar visual symptoms to patients with VSS but in an episodic manner. Our study reinforces the observation that the clinical spectrum of visual snow is likely to be broader than previously described.
... The symptoms of aura migraine include the gradual appearance of visual, speech, and other central nervous-related signs. A migraine with an aura lasts an hour 8 . , mainly appearances in migraines without aura have unilateral, pulsating, moderate to severe pain, annoying by or causing to avoid of daily physical activity. ...
Migraine headache, a prevalent and intricate neurovascular disease, presents significant challenges in its clinical identification. Existing techniques that use subjective pain intensity measures are insufficiently accurate to make a reliable diagnosis. Even though headaches are a common condition with poor diagnostic specificity, they have a significant negative influence on the brain, body, and general human function. In this era of deeply intertwined health and technology, machine learning (ML) has emerged as a crucial force in transforming every aspect of healthcare, utilizing advanced facilities ML has shown groundbreaking achievements related to developing classification and automatic predictors. With this, deep learning models, in particular, have proven effective in solving complex problems spanning computer vision and data analytics. Consequently, the integration of ML in healthcare has become vital, especially in developing countries where limited medical resources and lack of awareness prevail, the urgent need to forecast and categorize migraines using artificial intelligence (AI) becomes even more crucial. By training these models on a publicly available dataset, with and without data augmentation. This study focuses on leveraging state-of-the-art ML algorithms, including support vector machine (SVM), K-nearest neighbors (KNN), random forest (RF), decision tree (DST), and deep neural networks (DNN), to predict and classify various types of migraines. The proposed models with data augmentations were trained to classify seven various types of migraine. The proposed models with data augmentations were trained to classify seven various types of migraine. The revealed results show that DNN, SVM, KNN, DST, and RF achieved an accuracy of 99.66%, 94.60%, 97.10%, 88.20%, and 98.50% respectively with data augmentation highlighting the transformative potential of AI in enhancing migraine diagnosis.
... The most common symptom of migraine aura is visual aura. It is present in 98-99% of aura cases [34]. These data highlight the need to include both optic snow syndrome and visual aura in the differential diagnosis of transient visual disturbances. ...
... However, patients with missed stroke are most often initially misdiagnosed as having migraine. In particular, transient ischaemic attacks can be difficult to exclude in patients whose aura is abrupt or of unusual duration [34,35]. ...
... Some patients refer to the visual symptoms as zigzags, bubbles, or clouds. In this self-described dynamic visual phenomenon, the small flickering dots can be mostly black and white (grey on a black background or black and grey on a white background), but they can also be transparent or coloured [22,34,37,47,48]. The first description in the literature comes from 1995 [49]. ...
Visual snow syndrome (VSS) is a rarely diagnosed neurological phenomenon. It is a visual disorder characterised by the presence of numerous white, black, or translucent dots in the visual field, resembling the ‘snow’ of an analogue TV set experiencing reception interference. According to The International Classification of Headache Disorders, 3rd edition, visual snow is defined as a pattern of continuous small dots across the visual field lasting >3 months and accompanied by at least two of the following four additional symptoms: palinopsia, increased entoptic phenomena, photophobia, and nyctalopia. These complaints are not consistent with a typical migraine with visual aura and cannot be better explained by another disorder. The authors present the case of a 39-year-old woman who was diagnosed with VSS. The symptoms appeared after a migraine attack and had not alleviated. The patient reported a sensation of constant ‘TV screen snow’. A neurological examination found no signs of focal damage to the nervous system. The results of the ophthalmological examination, MRI of the brain with contrast, MRI of the eye sockets, and EEG were normal. VSS is a phenomenon that is still not fully understood, different from migraine aura and associated with a number of additional symptoms. VSS is very difficult to treat. In this case, a lot of drugs were used without improvement. Further research must be conducted to determine the best treatment options for these patients.
... Its primary etiology is concussion [1]. While VSS has received considerable attention regarding its defining characteristics and diagnostic criteria [2,3], the area of treatment has been relatively neglected [4], and it has not been promising thus far. For example, medications have had minimal success (∼20%), and in many cases (up to 35%) have exacerbated the primary symptom of visual snow [4]. ...
... While VSS has received considerable attention regarding its defining characteristics and diagnostic criteria [2,3], the area of treatment has been relatively neglected [4], and it has not been promising thus far. For example, medications have had minimal success (∼20%), and in many cases (up to 35%) have exacerbated the primary symptom of visual snow [4]. In this editorial update [5], recent advances in the neuro-optometric treatment approach to VSS will be considered in patients with concussion and other neurological events. ...
... Emphasis should be placed on neuro-ophthalmology conditions because although the VSS is primary in the majority of cases, it occasionally can be secondary to other disorders. Possible secondary causes of VSS were presented by E. Barral et al. [10]. When the onset is rapid, the differential diagnosis should include bilateral optic neuropathies, e.g., methanol intoxication, ischemia, Leber optic neuropathy, and folate/vitamin B12 deficiency. ...
... Asking patients about taking recreational drugs may be sensitive. However, it is vital in distinguishing VS from another condition of the visual snow spectrum, hallucinogen persisting perception disorder (HPDD), which may resemble VSS but has a different initiation mechanism [10]. The patient should tell the practitioner if VS is continuous or episodic and if they can recollect a specific event that preceded the onset. ...
... Careful care is required for patients with a history of migraine, particularly with aura, both visual and non-visual. In migraineurs, VS can be present episodically as a part of the aura, and so it is imperative not to confuse these two different conditions [10]. ...
Objective:
Visual snow (VS) is a rare clinical entity in neuro-ophthalmology. It is described as the presence of flickering dots affecting the whole visual field, often compared by patients to snow or pixelated television static. Importantly, it can be an alarming symptom for many patients, lowering their quality of life. Our purpose is to increase awareness of this disease, because many healthcare professionals have difficulty identifying symptoms as the nature of the condition is subjective. In this review, we aimed to describe the updates in the etiology and treatment of visual snow. We searched for articles in English, presenting original data and published after December 2019. Different studies show inconsistent data. Neuroimaging studies found, among other things, hypermetabolism of the lingual gyrus, increased gray matter in different brain areas, and altered connectivity in visual pathways. However, these findings were not present in all patients. According to the literature, among the most effective drugs is lamotrigine. Unfortunately, it also carries a risk of worsening the symptoms. It is crucial to remember that VS can be worsened or induced by alcohol, recreational drugs, and certain medication. In terms of treatment, nonpharmacological approaches such as color filters and repetitive Transcranial Magnetic Stimulation were also used.
Interpretation:
Further studies are needed to understand the nature of VS fully. Even though the pathophysiology and effective treatment of the condition remains unknown, expanding the knowledge about visual snow can impact the comfort of patients.
... The visual snow itself can, however, manifest episodically, and either remain as an ictal disorder or later evolve into the classic form of VSS [12][13][14]. In these cases visual snow should carefully be distinguished from visual aura or other visual phenomena associated with migraine [15]. In a large retrospective, single-centre, case series of two hundred and fortyeight cases of visual snow, 15% of patients reported transient symptoms as part of their typical migraine aura [12]. ...
... Such cases range from retinitis pigmentosa [23], to rod-cone dystrophy [21], autoimmune/ paraneoplasic retinopathy such as glycine receptor antibody syndrome [24], uveitis, macular atrophy, central serous retinopathy and vitreous detachment [12]. In certain cases where less common causes are suspected, particularly with sudden symptom onset, then further testing for conditions such as bilateral optic neuropathies, methanol intoxication, ischemia, Leber Hereditary Optic Neuropathy, and vitamin deficiencies should be pursued, Neurological causes such as idiopathic intracranial hypertension, prion disease and other structural lesions of the posterior visual pathway should also be considered [12,15]. ...
Visual snow syndrome is a neurological condition characterized by ongoing prominent phenomena described consistently as tiny dots moving across the entire visual field, often associated with complex visual symptoms. These can take the form of afterimages, entoptic phenomena, nyctalopia and light sensitivity. Although some of these symptoms can be benign, they can nonetheless become significantly impactful for many who experience them, particularly in cases that have a sudden and abrupt start. As visual snow syndrome becomes increasingly recognized in clinical practice we begin to learn about its typical presentation and underlying pathophysiology. Treatment of visual snow, however, still proves quite challenging, and efforts need to be focused on unravelling the biological mechanisms of the syndrome. This endeavour has characterized the most recent research on visual snow, mostly involving neuroimaging, neurophysiological and neurobehavioral studies aimed at understanding its underlying neural signature. Another important aspect of the syndrome, which will likely prove critical in deepening our understanding of visual snow, is represented by the intricate biological and historical connexion with migraine. This narrative review focused on visual snow syndrome will explore its clinical, pathophysiological and treatment aspects in detail.
Los profesionales de la salud visual, están sujetos a escuchar diversos fenómenos entópicos y manifestaciones visuales que implican un cuidado y estudio concreto; incluso en entidades poco conocidas, siendo una de ellas la Palinopsia. De tal forma, en la presente investigación se aborda lo necesario a esta condición; la Palinopsia refiere a una alteración visual por lesiones cerebrales, siendo tomada como indicio o prevalencia patológica según dependa el caso.
Migraine is an extremely disabling, common neurological disorder characterized by a complex neurobiology, involving a series of central and peripheral nervous system areas and networks. A growing increase in the understanding of migraine pathophysiology in recent years has facilitated translation of that knowledge into novel treatments, which are currently becoming available to patients in many parts of the world and are substantially changing the clinical approach to the disease. In the first part of this review, we will provide an up to date overview of migraine pathophysiology by analyzing the anatomy and function of the main regions involved in the disease, focusing on how these give rise to the plethora of symptoms characterizing the attacks and overall disease. The second part of the paper will discuss the novel therapeutic agents that have emerged for the treatment of migraine, including molecules targeting calcitonin gene-related peptide (gepants and monoclonal antibodies), serotonin 5-HT1F receptor agonists (ditans) and non-invasive neuromodulation, as well as providing a brief overview of new evidence for classic migraine treatments.
