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Diplopia Diplopia
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Author: Klaus Podoll 13. May 2007
Edited by: Klaus Podoll

Diplopia

Saffya, Comic, 2004. © 2004 Saffya

"Saffya's vision had been altered (this is a real symptom of a migraine you know, trust me, I've had three!), meaning that she sees two of each worm... and then the real pain kicks in her head..."

(Saffya, Team 17 Forum, Saffya's fan art, July 7, 2004)

Saffya is right - "double vision" may really occur as "a real symptom of a migraine", heralding or accompanying "the real pain kicks" of the actute migraine attack!

Definitions

"Double vision, also called diplopia, causes a person to see two images of a single object. There are two types of double vision: monocular and binocular. Monocular diplopia is double vision in only one eye. The double vision continues in the affected eye even when the other eye is covered. The doubling does not go away when you look in different directions... Binocular diplopia is double vision related to a misalignment of the eyes. The double vision stops if either eye is covered."

(Aetna InteliHealth Inc., Double Vision [Diplopia], December 4, 2004)

Both types of diplopia can be caused by many ophthalmological and neurological disorders (see here), including migraine with aura. A sudden onset of diplopia must always be investigated immediately by a doctor (Lee and Volpe, 2001).

Binocular diplopia

Binocular diplopia is commonly encountered as visual aura symptom in basilar-type migraine (Bickerstaff, 1961a), a subtype of migraine with aura in the IHS classification. For a diagnosis of basilar migraine, the migraine sufferer must meet the general criteria for migraine with aura and have two or more of the following symptoms: bilateral visual symptoms, double vision, dysarthria, ataxia, vertigo, tinnitus, bilateral paresthesia, decreased hearing, decreased level of consciousness, bilateral paresis.

"Over a decade ago, when I was in my late twenties, I was diagnosed with 'ophthalmic migraines'. If you've got to have migraines, these must be about the most benign kind there are. Once or twice a year I'd get twenty minutes of a zig-zaggy lines in my field of vision that would partly to totally [bilateral visual symptoms?] obscure my eyesight. There was never any pain, and it happened so seldom that it never really bothered me - I'd just settle back, watched the light show, and then get on with my life. ... I now get a variety of signs: dizziness [decreased level of consciousness], double vision [diplopia], numbness down the right side of my body, nausea, ringing in my ears [tinnitus], right sided weakness, cold teeth (yeah, I know it sounds weird, but I don't know any other way to describe the sensation), photophobia, hot flashes. It started out painless, but now I can also get pain in the back of my neck and head, and in my right temple. The pain isn't really incapacitating, though. It's the other symptoms that are knocking me out. The dizziness, weakness, and double vision have gotten so bad that once I ended up collapsing from them [loss of consciousness?, see Bickerstaff, 1961b], unable to move, and landed in the emergency room. I've lost track of how frequently I get attacks during the day; a good day might only be three or four times, but a bad day can be dozens of times. They can last anywhere from fifteen seconds to a full day. Sometimes it comes in waves, so it's hard to tell if it's just the same migraine easing up and getting worse again, or if it was two separate attacks. They can happen anywhere, any time, and if there's a trigger I haven't been able to figure it out."

(Sally Anne Aschenbrand, Newsgroups: alt.support.headaches.migraine, Subject: Weird Migraines(?) - Anyone Else?, November 7, 1997; additions in square brackets by Klaus Podoll)

"A few times/year I get a migraine that begins with wavy lines and double vision. I never get a violent headache and usually try to ignore the visual disturbances."

(Richard Silver, Newsgroups: sci.med, Subject: migraine and exercise, March 26, 1993)

"Today at work I developed what I can only call a sparkling twisting vision view in my left eye. It started out mild and developed so fast that I was seeing double. I assumed it was my contact lens so I threw it out, but symptoms still continued. My co worker suggested it was a migraine, and she was right. I spoke with my eye doctor ... she said in effect it is a migraine without the pain. Sure enough the double vision and kaleidoscope sensation went away in about 15-20 minutes but it scared the heck out of me."

(Steve Hunt, Newsgroups: alt.support.headaches.migraine, Subject: "Headacheless" Migraine?, February 2, 2000)

"Hey all Good morning ...... I was just wondering if double vision and dizziness can be a symptom to a migraine just before the really agonizing pain hits? I had that last night for about a minute and of course i felt headachey all day, tense, hyper, etc.... went to bed and woke up at 2 a.m. with such pain I thought my brain was going to blow. Horrible agonizing pain... Yes i have seen my doc and my eye doc all seems okay just the double vision scared the heck outta me i have never had that. It also could have been anxiety i don't know. I know you guys aren't doctors but was just wondering if it may have been a bad migraine warning. I had the migraine behind my eye entire right side worst at temple down the back of my neck... those are the worst!"

(leisa, Newsgroups: alt.support.headaches.migraine, Subject: Sure Ain't The Double Mint Twins!, December 12, 2001)

Are you acquainted with similar phenomena associated with your migraine attacks? Please contact Dr Klaus Podoll if you wish to share and discuss your experiences.

Monocular diplopia

Janet Morgan Mol, Through a Glass Darkly, 1989. © 1989 Novartis Pharmaceuticals Corporation (see here)

More rarely, monocular diplopia may occur as visual migraine aura symptom (Drake et al., 1983). Here the duplication may sometimes apply to parts of an object alone rather than to all contours of an object (e.g. only to the eyes and/or nose rather than to the entire face).

"double vision transient mono blindness. ... I have also had two episodes of sudden vertigo followed immediatly by double vision, vertically. My son had two sets of eyes one set above the other when I looked at him. This lasted about 5 minutes the 2 times that it has happened. I have had an MRI which the doctor said was beautiful and an MRA which showed no blockage. Before anyone out there shouts migraine, I do occasionally have a migraine headache with which I have an arc of sparkly aura which appears in both eyes and is quickly followed by severe pain, sometimes numbness, and definitely vomiting. What I am describing above is not the typical migraine which I do have, and have had since I was about 13. I am desperate to know ... what causes these times of ... double vision. I also want a name. I feel like my doctor is at a loss because when I asked him what I had he told me that for some reason the blood supply to my basilar artery was being restricted at times..."

(claireatlallybroch, Brain Talk Communities, March 30, 2004)

"There is such a thing as basilar artery migraine, which you might want to check out. Some of your symptoms, and your doctor's thoughts on restricted basilar artery flow, suggest this as a possibility. With basilar artery migraines... one can have visual symtoms without getting the head pain."

(LJL, Brain Talk Communities, Subject: double vision transient mono blindness, March 30, 2004)

Are you acquainted with similar phenomena associated with your migraine attacks? Please contact Dr Klaus Podoll if you wish to share and discuss your experiences.

References

Bickerstaff ER. Basilar artery migraine. Lancet 1961a; 1: 15-17.
Bickerstaff ER. Impairment of consciousness in migraine. Lancet 1961b; 2: 1057-1059.
Drake ME Jr. Migraine as an organic cause of monocular diplopia. Psychosomatics 1983; 24: 1024-1027.
Levin M, Ward TN. Ophthalmoplegic migraine. Curr Pain Headache Rep 2004; 8: 306-9.
Lee MS, Volpe NJ. Double Vision. Curr Treat Options Neurol 2001; 3: 383-388.
Podoll K, Robinson D. Migraine Art - The Migraine Experience from Within. North Atlantic Books, Berkeley, California 2009, p. 260-263.

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