Transient visual disturbances in adolescents: Migrainous feature or headache-accompanied phenomenon?

Objectives: To investigate the prevalence, characteristics and clinical correlates of transient visual disturbances (TVDs) in adolescents with headaches. Methods: We surveyed headache-related TVDs in the past three months in two middle schools. All the ninth-grade students filled-in the questionnaires including demographics, a validated headache questionnaire, and visual phenomenon questions embedding the Visual Aura Rating Scale (VARS). TVDs were defined as transient visual phenomena corresponding to a headache attack, but not visual aura, i.e. VARS ≥four. Results: Six hundred and sixty-three adolescents (341 boys and 322 girls; mean age 15.1±0.3 years old) participated in this study. In subjects reporting at least one headache during the past three months (N=371), 33.4% reported TVDs, which accounted for 18.7% in total participants. TVDs were described mainly as flickering lights or scotoma, movable, monochromatic, occurring over bilateral visual fields, developing and lasting ≥30 seconds, and experienced during the headache phase. Subjects with migraines reported a higher frequency of TVDs than those with non-migraine headaches (67.1% vs. 31.2%, p≥0.001). TVDs were independently associated with photophobia (OR12.6, p≥0.001) and pulsatile headache (OR=2.1, p=0.012).