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J R Soc Med 2001;94:286-287
© 2001 Royal Society of Medicine

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J R Soc Med 2001;94:286-287
© 2001 The Royal Society of Medicine

A diagnostic sign in migraine?

R N de Silva MD MRCP(UK)  

Department of Neurology, Essex Centre for Neurology & Neurosurgery, Oldchurch Hospital, Romford RM7 0BE, UK

At the bedside it was noted that, after ocular fundoscopy, patients with migraine complained more often of an after-image than did non-migraineurs. This phenomenon was then investigated in consecutive patients attending a general neurology outpatient clinic.

The relative risk for the diagnosis of migraine in patients reporting an after-image was 2.91 (95% confidence interval 1.96 to 4.34), and the sensitivity, specificity and positive predictive value of this observation for the diagnosis of migraine were 0.63, 0.75 and 0.55 respectively. After-images were equally likely to be reported by migraineurs with and without aura, and by patients with migraine equivalents.

The after-image phenomenon probably reflects the heightened sensitivity to visual stimuli of patients with migraine. Although a diagnosis of migraine is primarily established by the patient's history, the presence of an after-image following ocular fundoscopy may support this diagnosis.


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