시각증상으로 안과에 내원하여 편두통으로 진단된 환자의 임상분석 = Clinical Features of Patients Complaining of Visual Symptoms and Diagnosed with Migraine

국문 초록 (Abstract)

목적: 시각 증상으로 안과에 내원하여 편두통으로 진단된 환자들의 임상양상을 분석하고자 한다.
대상과 방법: 안과에 내원 후 편두통으로 진단된 환자 31명을 대상으로 환자가 호소하는 증상, 두통의 양상 및 안과 검진 소견을 후향적으로 검토, 분석하였다.
결과: 환자의 평균 나이는 38.1세(12-71세)이며, 남자 9명, 여자 22명이고, 증상이 처음 시작된 평균 나이는 35.7세(12-64세)였다. 환자가 호소하는 증상은 시각 흐림(35.5%), 암점(22.6%), 섬광(22.6%)의 순으로 나타났다. 16명(51.6%)의 환자에서 5분 이내로 시각적 증상이 사라졌으며 13명(41.9%)에서 항상 두통 이전에 시각 증상이 나타났다. 뇌 자기공명영상을 시행하였던 17명 중 미약한 소혈관 질환이 관찰된 3명을 제외한 14명은 정상소견이었다. 사시검사상 외사시가 있던 1명을 제외하고는 안과적 이상소견은 관찰되지 않았다.
결론: 시각 증상이 있던 편두통 환자 대부분에서 안과적 이상소견은 관찰되지 않았으며 시각 흐림, 암점, 섬광 등 다양한 시각 증상으로 안과를 내원하는 것으로 관찰되었다. 편두통의 조기 진단에 안과 의사의 역할이 있음을 인지해야겠다

다국어 초록 (Multilingual Abstract)

Purpose: To describe the characteristics of patients who visited Korean ophthalmology clinics complaining of visual symptoms and were diagnosed with migraine.
Methods: A retrospective study was performed by evaluating the patterns of visual symptoms, timing of headaches, and results of ophthalmologic examinations in 31 migraine patients who were recruited from a neuro-ophthalmology clinic.
Results: The patients consisted of 9 men and 22 women, with a mean age of 38.1 years (range, 12-71). The average age of symptom onset was 35.7 years (range, 12-64 years). The most common three visual symptoms were blurred vision (35.5%), blind spots (22.6%), and flashes of bright lights (22.6%). Visual symptoms disappeared within 5 minutes in 16 patients (51.6%) and 13 patients (41.9%) experienced visual symptoms before the onset of a headache. Brain magnetic resonance imaging findings in 14 cases revealed normal results and the remaining three patients showed minimal small vessel disease. Except for one patient who had exotropia, there was no other specific abnormality observed upon ophthalmologic examinations.
Conclusions: Most of the migraine patients who first visited an ophthalmology clinic with visual symptoms had no definite ocular abnormalities. Thus, ophthalmologists must be aware that migraines could first present with various visual symptoms in order to make an early diagnosis of migraine.

참고문헌 (Reference)

1 전현선, "편두통으로 안과에 의뢰된 소아의 임상분석" 대한안과학회 53 (53): 1500-1504, 2012

2 홍정택, "편두통 소아에서 나타난 지속적 양안 하측 반맹" 대한안과학회 51 (51): 1537-1542, 2010

3 최정훈, "눈근육마비편두통 3예" 대한안과학회 51 (51): 307-311, 2010

4 Schankin CJ., "‘Visual snow’ - a disorder distinct from persistent migraine aura" 137 (137): 1419-1428, 2014

5 Vos T., "Years lived with disability(YLDs)for 1160 sequelae of 289 diseases and injuries 1990-2010 : a systematic analysis for the Global Burden of Disease Study 2010" 380 : 2163-2196, 2012

6 McKendrick AM., "Visual field losses in subjects with migraine headaches" 41 : 1239-1247, 2000

7 Schankin CJ., "The relation between migraine, typical migraine aura and"visual snow"" 54 : 957-966, 2014

8 Brandes JL., "The influence of estrogen on migraine : a systematic review" 295 : 1824-1830, 2006

9 Kelman L., "The aura : a tertiary care study of 952 migraine patients" 24 : 728-734, 2004

10 Headache Classification Committee of the International Headache Society(IHS)., "The International Classification of Headache Disorders, 3rd edition(beta version)" 33 : 629-808, 2013

11 Aiba S., "Prevalence of typical migraine aura without headache in Japanese ophthalmology clinics" 30 : 962-967, 2010

12 윤경철, "Prevalence of Eye Diseases in South Korea: Data from the Korea National Health and Nutrition Examination Survey 2008-2009" 대한안과학회 25 (25): 421-433, 2011

13 Russell MB., "Prevalence and sex-ratio of the subtypes of migraine" 24 : 612-618, 1995

14 Shyti R., "Migraine genes and the relation to gender" 51 : 880-890, 2011

15 Schürks M., "Migraine features, associated symptoms and triggers : a principal component analysis in the Women’s Health Study" 31 : 861-869, 2011

16 Fleming JB., "Migraine aura without headache : prevalence and risk factors in a primary eye care population" 71 : 381-389, 2000

17 Viticchi G., "Diagnostic delay in migraine with aura" 34 (34): S141-S142, 2013

18 Queiroz LP., "Characteristics of migraine visual aura in Southern Brazil and Northern USA" 31 : 1652-1658, 2011

19 Queiroz LP., "Characteristics of migraine visual aura" 37 : 137-141, 1997

20 Russell MB., "A nosographic analysis of the migraine aura in a general population" 119 (119): 355-361, 1996