Transient visual disturbances in adolescents: migrainous feature or headache-accompanied phenomenon?

Objectives: To investigate the prevalence, characteristics and clinical correlates of transient visual disturbances (TVDs) in adolescents with headaches. Methods: We surveyed headache-related TVDs in the past three months in two middle schools. All the ninth-grade students filled-in the questionnaires including demographics, a validated headache questionnaire, and visual phenomenon questions embedding the Visual Aura Rating Scale (VARS). TVDs were defined as transient visual phenomena corresponding to a headache attack, but not visual aura, i.e. VARS < four. Results: Six hundred and sixty-three adolescents (341 boys and 322 girls; mean age 15.1 +/- 0.3 years old) participated in this study. In subjects reporting at least one headache during the past three months (N = 371), 33.4% reported TVDs, which accounted for 18.7% in total participants. TVDs were described mainly as flickering lights or scotoma, movable, monochromatic, occurring over bilateral visual fields, developing and lasting < 30 seconds, and experienced during the headache phase. Subjects with migraines reported a higher frequency of TVDs than those with non-migraine headaches (67.1% vs. 31.2%, p < 0.001). TVDs were independently associated with photophobia (OR = 12.6, p < 0.001) and pulsatile headache (OR = 2.1, p = 0.012). Conclusions: The major features of TVDs were distinguishable from visual aura. TVDs were common in adolescents with headaches, especially in migraineurs.