Sarcouncil Journal of Medical Sciences

Abstract: Background: Migraine with visual aura is a complex condition that falls at the crossroads of internal medicine and neurology. Background & Aim: Migraine with visual aura is a complex condition that falls at the crossroads of internal medicine and neurology, therefore this cross-sectional study steeled to describe the spectrum of visual symptoms in patients with migraine, and to evaluate clinical outcomes of the occurrence of visual aura in a series of 127 consecutive migraine patients. Methods: Prospective, consecutive and between January 2024 and December 2025, 127 patients (mean age 36.4±11.2 years, 71.7% female) who met the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria for migraine were recruited. A detailed clinical evaluation was performed with detailed headache diaries, standard visual symptom questionnaires and laboratory tests such as coagulation profiles and metabolic panels. Results: Out of 78 patients (61.4%) who reported visual symptoms, the most common were scotomata (42.3%), followed by photopsia (33.1%), fortification spectra (24.4%), and visual field deficits (15.0%). Patients with visual aura had significantly longer disease duration (8.7±4.3 years vs. 5.9±3.8 years), higher number of attacks per month (5.2±2.8 vs. 3.4±2.1) and more white matter hyperintensities (WMH) on MRI (23.1% vs. 8.2%). Female sex (OR 2.41, 95% CI 1.12–5.18), disease duration >5 years (OR 3.17, 95% CI 1.48–6.79) and family history of aura containing migraine (OR 2.89, 95% CI 1.34–6.24) were independent predictors of occurrence of visual symptoms on logistic regression analysis. Conclusion: The visual symptoms of migraine are a diagnostically complex clinical field that should be systematically explored from the two angles of internal medicine and neurology. Characteristic visual aura patterns, when combined with recognition of red-flag features that require urgent investigation, are an important diagnostic pearl for clinicians caring for these patients in a variety of clinical settings.