Acephalgic retinal migraine: A 6-year follow-up case report and literature review

RATIONALE: Retinal migraine is a rare cause of transient monocular visual loss that presents a significant diagnostic challenge and necessitates the careful exclusion of alternative etiologies. This case report describes the 6-year clinical course of a rare, headache-free variant of retinal migraine. PATIENT CONCERNS: A 42-year-old male experienced recurrent transient monocular visual loss episodes 2 to 3 times per year, affecting either eye, without any associated headache. Each episode involved stereotypical visual symptoms starting with photopsia, followed by an expanding altitudinal visual field defect. DIAGNOSES: Extensive investigations, including neuroimaging, vascular studies, blood work, and ophthalmological examinations, returned normal results. After years of investigations and excluding other etiologies, a diagnosis of retinal migraine was established based on the International Classification of Headache Disorders 3rd edition criteria. INTERVENTIONS: The patient opted for low-dose aspirin to decrease the risk of permanent visual loss. OUTCOMES: The patient continued to experience similar visual episodes without any change in frequency, severity, or characteristics. LESSONS: Retinal migraine may occur without headache, consistent with current International Classification of Headache Disorders 3rd edition criteria. Careful history-taking remains a cornerstone of accurate diagnosis, and time can serve as an invaluable diagnostic tool. Finally, a patient-centered approach is essential, particularly when evidence-based management options are limited.