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Suggest Treatment For Persistent Headaches And Ocular Migraine

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Posted on Thu, 25 May 2017
Question: I have been having auras or ocular migraines for some time now, but they are increasing in frequency and the symptoms are now varied instead of always the same. I had been told that I was probably having TIA's but those have now been ruled out after having an MRI. What causes these? Why are they increasing in frequency? Is there anything I can do to alleviate them? What kind of MD should I be seeing for them?
doctor
Answered by Dr. Dariush Saghafi (24 minutes later)
Brief Answer:
Ocular migraines without loss of vision not usually serious

Detailed Answer:
Good afternoon. Based strictly upon the presenting symptoms in your introduction I would say that if your "aura" and condition DOES NOT involve a visual loss of any type occurring in JUST ONE EYE the likelihood of being something serious at this point is low. Such benign conditions include zigzag lines, geometric floating shapes, no real headaches, and can be said to "involve" both eyes....though this is not exactly accurate since nothing is going on in the eyes so much as it is going on in the brain. These types of presentations usually don't represent anything particularly "bad" compared to what are called RETINAL MIGRAINES which also have aura of a visual nature BUT visual loss is usually restricted to ONE EYE.....and the visual loss is actually due to some pathology (usually alterations of blood flow through the eyeball's vasculature) in the eyeball itself...meaning that an ophthalmologist should be looking at you and YES, there could be something afoot so it should be checked out as soon as possible.

If MRI is not picking up anything then, you may be suffering from PRIMARY MIGRAINE HEADACHES WITH AURA. For you to develop these type of headaches without any prior history of similar headaches is extremely unusual and so I would definitely recommend a visit to either a NEUROLOGIST or a HEADACHE SPECIALIST.....but with a clean MRI.....bad things such as tumor, stroke, and aneurysm are much less likely. BTW, did they do an MRA as well? If not, get it done for completeness sake.

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 15 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dariush Saghafi (19 hours later)
What is an MRA and how does that differ from an MRI? The sensations I have been having are in both eyes and do not include throbbing headaches. The problem that I had on April 3 started with the zig zag auras in both eyes followed by my talking total jibberish for a few minutes. That really scared me because the problem seems to be spreading in my brain. Is that so? What is going on?!
doctor
Answered by Dr. Dariush Saghafi (12 hours later)
Brief Answer:
MRA= Magnetic Resonance Angiography

Detailed Answer:
An MRA is simply the noninvasive way of visualizing the blood vessels of the brain and is more sensitive than MRI at detecting things such as blockages, aneurysms, and other vascular abnormalities within any organ...in this case the brain.

Just to be clear, the phenomenon you are "seeing" are not actually occurring "in the eyes"....rather the images and light shows you've been describing are activating the occipital regions and visual association areas of the brain. You can localize which side of the brain is being activated depending upon which side things seem to be VISUALIZED on....so, if things appear to be in the RIGHT visual field then, the neuronal activations are in the left occipital area and vice versa.

Speaking in unintelligible form could be part of the migraine complex and is sometimes referred to as a "stroke equivalent" since it has all the features of a stroke but without any demonstrable lack of blood flow to the brain. Having said that, if I were the treating neurologist I would consider obtaining an MRI of the brain with a DIFFUSION and PERFUSION gradient study to rule out ischemic regions of the brain. If this can be demonstrated then, the etiology of underlying acephalgic migraine or migraine (without the headache) becomes the most parsimonious diagnosis to explain the symptoms.

I believe that a Headache Specialist looking at this case would be of great help to making the final call on these thoughts since they will have you to speak to and examine. I also still believe that an OPHTHALMOLOGICAL examination is worthwhile getting done.....NOT OPTOMETRIC.....rather OPHTHALMOLOGICAL as a good ophthalmologist will also look at any potential pathology of the retina and retrobulbar territory (optic nerve behind the eyeball) as well as optic nerve head more cautiously (in my opinion) than an optometrist.

If you are determined to have a PRIMARY HEADACHE type of some sort whether it be migraine with complicated stroke like symptoms, acephalgic migraines, or ocular migraines then, medications primarily suited for migraine headaches may be reasonable to employ as treatment. I would also like at the possibility of magnesium levels in serum and be prepared to replace that electrolyte if significantly low.

Once again, could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine feedback along with a 5 STAR rating? I hope you can use some of these suggestions to find relief soon.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 40 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2472 Questions

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Suggest Treatment For Persistent Headaches And Ocular Migraine

Brief Answer: Ocular migraines without loss of vision not usually serious Detailed Answer: Good afternoon. Based strictly upon the presenting symptoms in your introduction I would say that if your "aura" and condition DOES NOT involve a visual loss of any type occurring in JUST ONE EYE the likelihood of being something serious at this point is low. Such benign conditions include zigzag lines, geometric floating shapes, no real headaches, and can be said to "involve" both eyes....though this is not exactly accurate since nothing is going on in the eyes so much as it is going on in the brain. These types of presentations usually don't represent anything particularly "bad" compared to what are called RETINAL MIGRAINES which also have aura of a visual nature BUT visual loss is usually restricted to ONE EYE.....and the visual loss is actually due to some pathology (usually alterations of blood flow through the eyeball's vasculature) in the eyeball itself...meaning that an ophthalmologist should be looking at you and YES, there could be something afoot so it should be checked out as soon as possible. If MRI is not picking up anything then, you may be suffering from PRIMARY MIGRAINE HEADACHES WITH AURA. For you to develop these type of headaches without any prior history of similar headaches is extremely unusual and so I would definitely recommend a visit to either a NEUROLOGIST or a HEADACHE SPECIALIST.....but with a clean MRI.....bad things such as tumor, stroke, and aneurysm are much less likely. BTW, did they do an MRA as well? If not, get it done for completeness sake. If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out. Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others. This query has utilized a total of 15 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.