Migraine involves vision not pain

Dear Dr. Roach: In a recent column, you wrote that migraine ofanykind starting in a person’s 60s is uncommon. I ama 66-year-old male in relatively decent health. I have controlled blood pressure and cholesterol. In the past six months I have started following a “plantcentric” diet.

I recentlywent formy annual vision check at my eye doctor and told him about seeing a shimmery, jagged, half-moon blur in my vision, mostly on inmy left eye, but present in both eyes occasionally. He did a thorough retinaexamandfoundnoabnormality. He speculated that Iwas experiencing amigraine. I asked why there was no headache associated with the migraine. He said that since I amolder andmy blood vessels are not as flexible, there is no pain associated with the condition. We chuckled andmoved on.

The issue is not chronic and I have not had symptoms in over three weeks. Is this something to be concerned about? - R.F.

Your eye doctor may be right. There is a condition called ocular migraine, also called acephalgic migraine, where people have the aura of amigraineheadache butdonot develop headache. Most people will get headache sometimes, but a minority of people have never had a headache, only the aura.

However, what I said is also valid. Migraines starting in your 60s are less common, and though this may be the diagnosis, I would be concerned about a transient ischemic attack, which is caused by a loss of blood flowto the brain. Your eye doctor may not have been able to see anything abnormal in the retina, but I would be concerned enough to consider a look at the blood vessels of the neck and even the brain, an evaluation of your heart rhythm for atrial fibrillation, and some blood testing.