Headache with visual symptoms: red flags in the work-up

Irene de Boer, MD, Leiden University Medical Center, Leiden, Netherlands, discusses the work-up approach in patients experiencing headache and visual symptoms. About 1/3 of migraine patients have aura, which frequently manifests as visual symptoms. While migraine with aura is not life threatening, there are other causes of headache with visual symptoms that can be, meaning quick identification is crucial. Dr de Boer outlines some red flags that should be looked out for - new, unexplained neurological deficits; advanced age (50+); abrupt, new headaches, or progressive headaches; and the patient having systemic disorders. All of these can mean additional testing is needed. Imaging is usually used - MRI is preferred, along with CTA/CTV scans to visualize the vessels. Electroencephalograms and ophthalmological examinations are also often used. Whether the visual symptoms are positive (seeing something new) or negative (loss of vision) can also help with differential diagnosis, as well as whether they occur gradually or abruptly. Dr de Boer highlights the broad range of conditions that can cause these symptoms, including psychiatric and systemic disorders, and ophthalmological issues, emphasizing the need for a range of tests to reach a diagnosis. This interview took place at the European Academy of Neurology (EAN) Annual Meeting 2024 in Helsinki, Finland.
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