• Isin Unal-Cevik and F Gokcem Yildiz.
• Hacettepe University, Faculty of Medicine, Department of Neurology, Pain Unit, Ankara, Turkey.
• Headache. 2015 Nov 1; 55 (10): 1436-41.

ObjectiveThis study aims to investigate characteristics of visual snow accompanied by migraine and special interest on occipital bending, electrophysiological properties, and response to treatment.BackgroundVisual snow is characterized by continuous dynamically flickering dots in the visual field. Most patients also have comorbid migraine. Cortical hyperexcitability is a feature of migraine. Recent studies indicate an association between occipital bending with psychiatric disorders such as depression. Here, we demonstrate a patient with visual snow, migraine with aura, left occipital bending, and cortical hyperexcitability. Treatment response to lamotrigine was objectively assessed by repetitive pattern reversal visual evoked potentials (rVEP).MethodsA 25-year-old woman with a 10-year history of migraine with aura (2-3 attacks/week) admitted for 1-year history of visual snow. She reported continuous bright and colorful lights, palinopsia, floaters, nyctalopsia, and photopsia. Brain magnetic resonance imaging (MRI) was performed. Visual habituation response was assessed before and after lamotrigine treatment by rVEP.ResultsBrain MRI revealed left occipital bending. On rVEP study, there was potentiation response. After lamotrigine treatment, the patient had no more complaints of visual snow, was able to sleep, and the frequency of migraine decreased to 2 attacks/month. Electrophysiologically, the cortical hyperexcitability was improved.ConclusionsThe visual snow and loss of habituation ability in migraine associated with occipital bending can be improved with lamotrigine treatment. This report may provide new insights on "visual snow" pathophysiology in migraine.© 2015 American Headache Society.

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