TY - JOUR T1 - Are these visual symptoms due to migraine? A guide for general practice JF - British Journal of General Practice JO - Br J Gen Pract SP - 88 LP - 89 DO - 10.3399/bjgp20X708041 VL - 70 IS - 691 AU - Paul Goldsmith Y1 - 2020/02/01 UR - http://bjgp.org/content/70/691/88.abstract N2 - Visual aura occurs in approximately 30% of migraine patients. The challenge for a GP is knowing when visual symptoms are entirely consistent with migraine and when instead there may be another cause requiring urgent investigation or consultation.The most characteristic aura of migraine is an aura that gradually evolves over more than 5 minutes. This evolution reflects the migrating wave of excitation and inhibition across the cortex, most commonly beginning in the visual cortex. The wave travels at 3 mm per minute and the evolution of symptoms reflects this.1The descriptions patients give can be fascinating. One patient may describe ‘funny vision’ for an hour followed by headache — an easy diagnosis, if not illuminating. Whereas one of this author’s more eloquent and analytical patients described the onset as distortions to the left of centre of her vision, then door frames appearing to be on a slant, then the door itself appearing to undulate, as if breathing, then a feeling of certitude of knowledge, of having great mathematical ability, then speech disturbance. This case points to one of the other clues that visual symptoms are migrainous, namely the presence of non-visual symptoms and involvement of multiple vascular territories.The International Headache Society criteria for migraine with aura require at least three of six characteristics, as … ER -