Assessment of Visual Complaints in Patients with Chronic Migraine Syndromes

Migraine refers to a unilateral severe throbbing headache that is accompanied by nausea, vomiting, photophobia, and sonophobia. It affects about 14% of the global population, leading to significant disability and lower quality of life. Chronic migraine is characterized by having 15 headache days or more per month, with chronic migraineurs experiencing greater disease burden, worse socio-economic functioning, and worse visual quality of life. These disabilities are attributed to the higher cortical hyperexcitability in chronic migraine patients compared with episodic migraineurs. Among the experienced visual complaints, visual aura, visual snow, and transient visual loss are among the most frequently reported complaints, with the aura being the most common visual symptom among chronic migraineurs. Clinical assessment of visual complaints in chronic migraine patients is considered challenging, as chronic migraineurs often report atypical or prolonged visual symptoms that cause diagnostic ambiguity, requiring differential diagnosis and accurate assessment of the visual symptoms to rule out serious secondary causes and avoid poor patient outcomes. This narrative review aims to explore current evidence regarding visual complaints among chronic migraineurs, in addition to clinical assessment of these complaints and differential diagnosis of migraine-associated visual symptoms.