Differentiating Retinal Migraine from Migraine with Visual Aura

Key Diagnostic Differentiation

The American Academy of Neurology recommends that retinal migraine be distinguished from migraine with visual aura based on the critical distinction of monocularity, with retinal migraine causing repeated monocular visual disturbances affecting one eye only, while typical migraine with visual aura produces binocular visual phenomena affecting both visual fields simultaneously 1, 2
Retinal migraine is characterized by visual symptoms occurring in one eye only, with the patient able to confirm symptoms persist when covering the unaffected eye 1, 2
Both conditions have aura symptoms that spread gradually over ≥5 minutes, distinguishing them from sudden-onset transient ischemic attacks 1, 2

The International Headache Society notes that individual aura symptoms typically last 5-60 minutes in both conditions 1, 3
Migraine with aura often has two or more aura symptoms occurring in succession 1, 3

The American Headache Society recommends that headache timing be considered, with both conditions having headache accompanying or following within 60 minutes of aura onset 1, 3
Migraine characteristics include unilateral, pulsating, moderate-to-severe intensity, aggravated by physical activity 1, 3
Associated symptoms include nausea/vomiting, photophobia, phonophobia 1, 3

The International Headache Society requires at least 2 attacks fulfilling the criteria for migraine with aura, including one or more fully reversible aura symptoms and at least 3 of 6 characteristics, such as gradual spread, succession, and duration 1, 3
Retinal migraine specific features include repeated monocular visual disturbances, not just single episode 1, 2

The American Academy of Neurology recommends that patients with monocular visual symptoms require urgent ophthalmologic consultation and aggressive migraine prophylaxis, not just symptomatic treatment 4, 5
Standard migraine prophylaxis applies, but urgency is higher given vision loss risk, and consider aspirin for potential antithrombotic effect in retinal vascular involvement 4, 5