1.2.4 Retinal migraine

Identification: A 32-year-old female patient, a teacher, presents to the consultation with complaints of recurrent episodes of transient visual loss in the right eye, followed by a pulsatile headache. History of Present Illness: Approximately 6 months ago, the patient began experiencing episodes of scintillating scotoma (seeing flashes of light) in the visual field of the right eye, lasting 15 to 20 minutes, followed by a unilateral (right-sided) pulsatile headache of moderate to severe intensity, associated with photophobia and phonophobia. The episodes occur 1 to 2 times per month, without clear triggers, and the headache can persist for up to 4 hours. The patient denies bilateral visual aura or other focal neurological symptoms. Past Medical History: Migraine without aura since adolescence, with sporadic attacks treated with common analgesics. No history of ocular diseases, trauma, or ocular surgery. No use of hormonal contraceptives or history of thrombophilia. Physical and Neurological Examination: Visual acuity: 20/20 in both eyes. Fundoscopy: normal, with no evidence of embolism or retinal vasculopathy. Neurological examination: no focal deficits.