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Re: eye pain, followed by headache, fever, light sensitivity

Posted By CCF Neurology W6 MD on November 20, 1998 at 18:40:26:

In Reply to: eye pain, followed by headache, fever, light sensitivity posted by Diana on November 04, 1998 at 16:37:52:

Thanks for taking the time to hear my story and answer a few questions.
I am a 38 year old woman who has always been really healthy.  In the last
four months I have become incapacitated with headache pain, unable to work
or function normally.
In mid-July I started to experience eye pain in my left eye & blurring of
vision.  The pain eventually travelled into my right eye, but has never
hurt as much in the right eye.  I became extremely sensitive to light.
Moving headlights at night are the worst - it's impossible for me to
drive even a few blocks at night.  My eye exams showed no problems.  By
early August I was having flu-like symptoms:  low-grade fever, achey joints,
a "walking-pneumonia" feeling.  Around that time the eye pain turned
into a constant headache pain around my forehead & top of me head.  The
pain fluctuates, but is always there.  I started to feel dizzy and unsteady
on my feet.  I also started to have lots of trouble with language: dyslexia,
trouble finding words, lots of trouble concentrating on reading and writing.
This symptom varies:  sometimes I can read or write for a few hours before I
I have to stop; sometimes it's so bad I can't understand what people are
saying to me.  I occasionally have tingling in my right hand, the bottom of
my right foot, and on my inside right shin.  I'm also just exhausted all
the time - a fifteen minute errand leaves me huffing for breath.  I'm
constantly thirsty and in the last month, my eyes have been really dry.
I was first diagnosed with Lyme Disease and, after a one month course of
anti-biotics, had ten pretty good days where all my symptoms except the
exhaustion disappeared.  Unfortunately, my eyes became sensitive to light
again and two days after that, I was back to everything being the
way it was before.
I've had an MRI and lots of bloodwork - all the tests were negative.  My
Doctor thinks I have cluster headaches.  I've tried six different
medications for clusters so far & none has helped.  Only the pain medicine
seems to make a difference.  So here are my questions:
-Looking up cluster headaches on the internet, I don't seem to match some
symptoms:  one-sided pain, headaches that come and go(not the constant one
I have), tearing of eye or dripping of nose.  Since I haven't responded
to the medication, does it sound like I may be going down the wrong path?
-Could this be an autoimmune problem?  The only other thing that has
affected my health is a hip injury that is over a year old.  I took anti-
inflammatories for several months to help with swelling that didn't go
away for over a year.  Could that anti-inflammatory medication have
caused a swelling reaction in my blood vessels or some such thing?  I
had an allergic reaction to one of the anti-inflammatories AND had
conjunctivitis in my left eye three months before all this started
happening - is there any way it could be related?
-Can you think of any other possibilities that might be explained by my
Many, many thanks for your advice - I truly appreciate it!

Dear Diana,
thank you for your question.
I will try to answer them in order:
1. Depending on where you live, Lyme disease may be endemic.
It has been dubbed as the new "Great pretender" as it can mimic just about any disease. I personally think it is over diagnosed, but then again that is just one neurologist's opinion.
2. Your symptoms do not sound like cluster headache, I agree with you.
3. THe fact that you have had negative brain imaging and blood work is reassuring, at least many of the life threatening and treateable diseases have been looked for and not found. We now are left with symptoms and no diagnosis. In this cases, it depends on how far you want to go, more tests can be done, but very low yield, or just treat the symptoms, in your case fatigue and head pain.
4. Your symptoms are rather non specific although having normal blood work (e.g. normal sedimentation rate,negativel autoimmune antibody,
such as ANA, RF, etc. ) does not favor an autoimmune base of your symptoms. Nothing is impossible however. I seriously doubt that the anti inflammatory medication has anything to do with your symptoms.
5. Now that all the test you have had showed no major abnormalites,
a diagnosis of complicated migraine may be entertained, i.e. migraine with neurologic deficits. THis is a diagnosis of exclusion, especially in patients with risk factors for stroke (age, sex, hypertension, diabetes, previous stroke, et. al.).
Good luck.

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