Unsure of diagnosis

[Helpme155]

I am a 28 year old female and have had a few health problems in the past.  I have graves disease with was treated with radioactive iodine in 2006.  Now I have an underactive thyroid gland, which I am taking 150mcg levothyroxine to treat.  I suffered from glandular fever in 2007 and shingles in 2005.  In October 2007 I went for a routine eye test and was told myy eyes were except I had a slight deterioration in one eye, my prescription wasn't changed.  On the 10th May 2008 I purchased new glasses and at first they felt strange but I soon got used to them.  On 6th June 2008 I went to my GP and explained that I had been suffering from a constant left sided headache for 3 weeks, behind my eye of a throbbing, dull nature.  Sine then I have seen a neurologist who has diagnosed chronic migraine but no medication he has prescribed has helped (anti depressants, beta blockers, NSAIDs, anti epileptics).  Currently I am on 600mg of gabapentin, which is being steadily increased and have been prescribed sumatriptan today.  This is the first time I have had an abortive treatment.  It seemed to improve things slightly but not significantly.  A CT scan showed no abnormalities.   It hurts when I look up with or without my glasses on and the pain is always there.  I wear my glasses constantly and only take them off for bedtime.  My prescription last time was -3.75 and - 4.25.  My headache seems to get worse whilst looking a computer or concentrating.  I have also seen a chiropracter to no avail.  Any suggestions would be greatly received, Thankyou

[rgngsmom]

Hi.  Read all of your comments regarding your eyes and have a couple of thoughts for you....Antidepressants usually take a month or so to work up to therapeutic levels.  Three weeks was probably an unfairly short trial time for a new med.  As far as I know, pain with looking up is not a typical ms symptom for problems with the eyesight, but more of a sinus issue.  Double vision is an issue for many ms pts.  The prism you mention is frequently prescribed for that.  

You should see a neurologist who will do some simple tests on you, such as  balance, reflexes, etc.  They also have some more specific tests such as the visual evoked response tests.  The MRI is a very useful tool, but is not necessarily conclusive.  There is also the spinal tap to look for oligoclonal bands.  

On the flip side, perhaps you are simply over tired or having anxiety issues.  Maybe your body is having a hard time adapting to stress in your life.  I hope that is what it is.  MS isn't a death sentence, but is is certianly an unconfortable illness to live with.  Good luck with your health.  :-)

[Helpme155]

Yeah I think that is my best option.  No it's something they fix into the lens (not noticeable to naked eye) but i'm unsure of it's function really.  Will probably have to wait until new year for a referral, things take so long to happen.  Definately interested in my other symptoms, even if not whole cause of headache definate cause for concern so i'm pleased i'm going down this route.  I'll keep you updated.

[tomsant]

See the ophthalmologist (eye specialist) and then decide on the new glasses. I don't understand what 'prism' is mentioned by the optician. You may ask the ophthalmologist. I am interested in what he comments on the diplopia and large pupil on one side.

Best,

TA

[Helpme155]

Hi, I have just got back from the optician and she recommends I purchase new glasses containing a prism so my eyes don't have to work so hard to focus (my eye muscles seem to be working overtime).  She has also recommended I have my thyroid function tested and has written to my doctor recommending a referral to an eye specialist to thoroughly check my eye muscles are working correctly (due to my graves history).  In the meantime I am going to start taking the topiramate, unfortunately new glasses are costly and I cannot afford them right now, especially because I am unsure this is the problem.  I am probably going to wait until my appointment with the eye specialist.  

[Helpme155]

Hi , I have seen my doctor.  I have to stop the gabapentin over ten days then start topiramate (another anti epileptic).  He is going to write to my neurologist so I will probable have an appointment to see him in the new year.  I expect then I will get an MRI.  I can't see these new tablets working, if the other anti epileptics have failed??  He doesn't think it is my glasses or a cyst!!  So I suppose I try these and wait, still going to my eye appt tomorrow but unsure whether to purchase new glasses!  He just gave me a funny look when I said about my double vision aaah!

[Helpme155]

No it said I had normal fundi and my cranial nerve was normal except for my short sightedness.  No mention of the optic nerve or chiasma?  What is chiasma? I have an appointment with my GP tomorrow and I expect to be referred back to the neurologist.  He is unaware of my most recent symptoms - double vision, pain on looking up and blurring vision. Hopefully the answer won't be more drugs !? Thanks for your comment

[tomsant]

If you can't get the ophthalmologist to help you, go straight to the neuro.

Best,

TA

[tomsant]

1. Contact the ophthalmologist as you visited her only recently and she had commented on unilateral pupillary dilatation. Though the cause may be from retina backwards to the brain, she will be able to comment from the appearance of retina (after ophthalmoscopy and seeing the eye reflexes)

2. Next comes the neurologist. (or neuro-ophthalmologist, whoever is available) I remember your recent CT of brain was normal. Any special comment on optic nerve and optic chiasma?

Best rgds,

TA

[Helpme155]

Hi again, since my appointment with the optician I have been wearing my contact lenses more.  I haven't worn my glasses since yesterday at 6pm.  Last night I was reading with my contact lenses in and I started suffering from double vision, the words on the page were also blurring.  I haven't suffered from double vision before.  I'm so confused, I wore my contact lenses all day today and have still suffered from a terible headache.  It hasn't changed.  If I close one eye for a while and then swap so i'm looking through the other it is terribly blurred and takes some time to rectify.  I don't know what to do, I don't want to purchase new glasses if there is no need to.  Could this be related to my thyroid?  It definately feels like something to do with my eyes but I really don't know where to go with this next?  Endocrinologist? eye specialist? neurologist? Please help!

[tomsant]

I guess Px means prescription?

Sad that astigmatism went undiagnosed. It is usually detected by 'indirect ophthalmoscopy' as I gather.

If one is wearing the wrong glasses, it can cause headache. But I wonder what is the role of one large pupil here !

Best rgds,

TA

[Helpme155]

Hi all, I have been to see the opthalmologist.  She thoroughly examined my eyes, looked at my glasses and noted a few things.  Firstly I have a degree of astigmatism which I have never had diagnosed.  Also she said my glasses were - -5.25 in the right eye and -4.5 in the left!!!!  She feels they are too strong.  As you know I believed my px was a lot lower than this and my contact lenses are actually -3.75 and - 4.25 (completely different to my glasses).  I asked my normal opticians and they have said my px is -3.75 and -4.25 so either my glasses have been made wrong or my contact lenses are wrong.  She said I have to go back in  a week with my old glasses, contacts and px details from my original opticians.  The thing is since my new glasses I haven't worn my contacts as much, maybe 3 x weekly, rather than daily.  I think she is right saying my px is too strong, what are your thoughts??????

[tomsant]

Larger pupils on the same side of headache ? Have to see you. Let the ophthalmologist sort it out. I will be interested in the opththalmologist's comments.

Best,

TA

[Helpme155]

Hi all, i'm beginning to doubt the theory it's my eyes.  Probably because I can't believe it would be that simple.  Recently I have found some other symptoms too.  My eyes are very painful when looking upwards like the muscles behind are aching and my pupils are different sizes.  This only occurs when i'm not wearing my glasses but my left pupil is larger than my right (same side as headache.  Anyone relate to this?

[Helpme155]

Thanks for your comment, I have booked an eyetest - it sounds very probable.  No migraine treatment has helped so far, the only thing that has eased it slightly is amitryptiline - which is used for tension headache which can be caused by eyestrain!

[tomsant]

28 F
Constant left sided headache (behind the eye, throbbing dull) of 3 wks, when visiting GP on 6 June 08
Wearing new set of glasses from 10 May 08

Other past medical history is not of importance here.

You have to visit the optician / ophthalmologist to have the new set of glasses and your vision rechecked.

Headache due to eye strain can mimic 'migraine'

Best rgds,

Thomas Antony

[Helpme155]

Please if anyone has had this type of headache before or any general advise I would really appreciate it!