“She was bisected, and half of her was missing.” This is how Dr Oliver Sachs perceived a nurse during the aura of a migraine. It is described in his book A Leg to Stand On, in which he explains how this experience is due to a transient hemianopia that he experiences as a migraine begins.1
I too have migraine with visual auras, which occur only in the left side of my visual field. Although I usually experience fortification spectra within the left hemi-field, I realised recently that occasionally I have a left homonomous hemianopia as the aura to my migraine.
Such headaches, for me, are provoked by stress, sleep deprivation, and dehydration. For this reason, while I was a senior house officer in a busy district general hospital my migraines often occurred just before or during the post-take ward round.
One such experience taught me the nature of my migraine aura. I was preparing for the ward round by reviewing the relevant basic investigations available for the recently admitted patients. I was developing a migraine with visual aura but continued to work. I reviewed a chest radiograph and was disappointed not to see the large right pleural effusion I clinically expected. So disappointed, in fact, that I double checked the name and date of the examination.
When the time came for the consultant and entourage to review my admission I had progressed, neurologically speaking, to a mild headache without visual aura. Now free from hemianopia, although none the wiser at this point that I had had one, and keen to show my thorough preparation, I told the consultant that the radiograph did not confirm my examination findings. Although visually unimpaired as I stood with the assembled doctors in front of the illuminated viewing box, I didn't have a leg to stand on. Now that I could see—indeed, now that I was aware of there being a left side to my vision—the large right pleural effusion was obvious.
I read A Leg to Stand On when I was a medical student, but I didn't realise its relevance to me until my experience as a senior house officer. While the book taught me the neurology, this experience taught me to appreciate the limitations imposed on my senses by impending migraine. Accordingly, I now avoid tasks that require complete vision until the aura has passed.
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References
- 1.Sachs O. A leg to stand on. London: Picador, 1991.