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 flashing lights) in the visual field of the right eye, lasting 15 to 30 minutes, followed by a unilateral right-sided headache, pulsatile in nature, with moderate to severe intensity, associated with photophobia and phonophobia. The episodes occur 1 to 2 times per month, without clear triggering factors. The patient denies diplopia, ptosis, or other focal neurological symptoms. She reports that the visual loss is always in the same eye and that the headache improves with rest in a dark environment. Personal History: Migraine without aura since adolescence (1 to 2 attacks per month). Use of common analgesics (paracetamol and ibuprofen) with partial relief. Denies use of hormonal contraceptives. Denies history of ocular trauma or ophthalmic surgeries. Physical Examination: General: unremarkable. Neurological: no focal deficits, cranial nerves intact, preserved muscle strength, normal and symmetrical reflexes. Ophthalmological: visual acuity 20/20 in both eyes, fundoscopy unremarkable, normal intraocular pressure. Complementary Exams: Brain MRI: normal. CT angiography of cerebral arteries: unremarkable. Electroencephalogram: within normal limits.