Headache and vision problems

Hello,

I have been experiencing headaches for approx. 5 yrs.   I recently stopped taking preventative medicine due to side effects.  I had been on various types of prev. meds. (Topomax (topamax), Lyrica, Depakote, Nortiptyline)  over a 4-year period, under the care of a neurologist.  Since stopping the medicine, I have had various visual disturbances (spots, flickering vision, strobe-like vision upon opening my eyes at night).  I went to an ophthalmologist recently who said that my eyes were fine, and that it was in my brain.  I had an MRI 4 yrs. ago which was fine.  I also had spinal fusion in August of my thoracic spine and lumbar fusion in 2001.  

Do you have any idea as to why I have these visual disturbances.  How often should a person have an MRI if they are still having headaches.

Thank you.

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

Visual disturbances associated with headache are not an uncommon association with migraine headaches; if the headaches you mention above that you have had for several years have been diagnosed as migraines, it is possible that stopping your medications may have potentially un-suppressed some of the visual phenomena that could otherwise occur with a migraine.

Another potential cause of headaches with visual disturbances is called benign intracranial hypertension. Benign intracranial hypertension, also called pseudotumor cerebral, or idiopathic intracranial hypertension, is a disorder characterized clinically by headaches and vision loss, and sometimes tinnitus (ringing in the ear that is synchronous with the pulse). Dizziness may also be a symptom. The headache is usually global (all over the head) and pressure-like; the headache presentation can be variable. BIH predominantly occurs in people who are overweight, women, and those taken specific medications such as retin-A (the acne medication), vitamin A, and tetracycline antibiotics. It is diagnosed based on clinical findings, optic nerve swelling on eye examination (called papilledema) and the finding of a high cerebrospinal fluid pressure on lumbar puncture. Other tests may include specific types of brain MRIs and an MRV. The treatment is usually with medications to decrease the amount of fluid around the brain, and these are mainly diuretics though other medications are also used. Patients who do not respond to medications or who have vision loss require procedures to relieve the cerebrospinal fluid pressure or at least the pressure around the nerves to the eye (to prevent vision loss). If a problem with the veins in the brain (cerebral venous stenosis is found), treatment for this may be indicated as well.

If you have had a normal MRI of the brain, a repeat MRI of the brain usually is not indicated unless the headache changes, new symptoms develop, or you have changes on your physical examination. Since you have new symptoms, visual symptoms, follow-up with your neurologist is recommended.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.