Glaucoma or Migraine? Eye Health Concerns

Q: Glaucoma or Migraine? Eye Health Concerns

Hello, Sir： Glaucoma is a disease related to the optic nerve, and there are several causes and hypotheses regarding its development. <br>The two most commonly discussed types are： one caused by elevated intraocular pressure leading to mechanical damage to the optic nerve, and the

Is it glaucoma or a migraine?

Hello Doctor: My girlfriend fainted due to severe headaches about three to four years ago and was hospitalized at National Taiwan University Hospital for examination.
Eventually, a neurologist diagnosed her with basilar-type migraine.
After being discharged, her migraines have not been as severe over the past two to three years, but she still experiences them about four to five times a month.
Recently, she had an opportunity to see an ophthalmologist, who administered a dilating agent and checked her intraocular pressure and optic nerve.
The doctor mentioned that she has mild glaucoma in both eyes, which has made me very concerned.
I have a few questions that I hope you can answer:
1.
Since the symptoms of migraines can be similar to those of glaucoma, is it possible for the doctor to have made a misdiagnosis?
2.
Could the vascular dilation associated with migraines lead to increased intraocular pressure, resulting in glaucoma? However, the examining doctor stated that her intraocular pressure is normal.
When they mentioned glaucoma, did they mean she has normal-tension glaucoma?
3.
If she indeed has glaucoma and it was detected early, does regular treatment and monitoring significantly reduce the risk of blindness? In other words, what is the likelihood of blindness with treatment? How long could that be—twenty years? Thirty years? She is only 29, and I sincerely hope she can have a bright life until old age.

Mr. Lin, 30~39 year old female. Ask Date: 2007/01/04

Dr. Liu Jingxian reply Ophthalmology

Hello, Sir: Glaucoma is a disease related to the optic nerve, and there are several causes and hypotheses regarding its development.
The two most commonly discussed types are: one caused by elevated intraocular pressure leading to mechanical damage to the optic nerve, and the other due to poor blood perfusion of the optic nerve resulting in its atrophy.
The glaucoma caused by high intraocular pressure (mechanical damage to the optic nerve) is the type we are generally more familiar with.
Common symptoms of this type of glaucoma include blurred vision, eye pain, redness of the eyes, photophobia, tearing, nausea, vomiting, and rainbow-colored halos around lights.
The eye secretes a fluid called aqueous humor, which continuously circulates within the eye; it is produced by the ciliary body and drained through the anterior chamber angle.
If the drainage pathways are damaged, the aqueous humor cannot be expelled, leading to increased intraocular pressure.
Sometimes, the eye pain experienced by patients can resemble headaches.
Glaucoma caused by poor blood perfusion of the optic nerve can also be referred to as normal-tension or low-tension glaucoma, where the intraocular pressure is normal, but abnormalities can be observed in visual field tests and fundoscopic examinations of the optic nerve.
Regarding treatment, it is recommended to further investigate the possible causes and tailor the treatment accordingly.
Early detection and regular treatment are crucial.
Good control is closely related to the progression of the disease.
In summary, it is important to pay attention to eye care, avoid excessive eye strain, and not become overly fatigued, as this is the way to protect your eyes.
If you have any related questions, feel free to consult the ophthalmology department at the City United Hospital.
Wishing you good health.
Dr.
Liu Jing-Hsiang, Ophthalmology, Taipei City United Hospital, Zhongxing Branch.

Reply Date: 2007/01/04

More Info

Hello! Thank you for sharing your concerns regarding your girlfriend's health. It’s understandable to be worried, especially when it comes to conditions like migraines and glaucoma, which can have overlapping symptoms. Let’s address your questions one by one.

1. Can migraine symptoms be mistaken for glaucoma?
Yes, there can be some overlap in symptoms between migraines and glaucoma, particularly in terms of visual disturbances. Migraines can cause a range of symptoms, including visual aura, which may present as flashing lights or blind spots. However, glaucoma typically presents with symptoms such as peripheral vision loss, eye pain, and in some cases, nausea or vomiting. While it is possible for a physician to misdiagnose, a thorough examination, including measuring intraocular pressure (IOP) and assessing the optic nerve, is crucial for an accurate diagnosis. If your girlfriend has been diagnosed with normal-tension glaucoma, it means that her IOP is within the normal range, but damage to the optic nerve has still occurred.

2. Could migraine-related vascular changes lead to increased eye pressure and glaucoma?
While migraines can cause vascular changes, they do not directly cause glaucoma. Glaucoma is primarily related to the drainage of fluid in the eye, which affects IOP. In normal-tension glaucoma, the optic nerve damage occurs despite normal IOP levels, often due to other factors such as blood flow issues or structural vulnerabilities in the optic nerve. Therefore, while migraines may influence vascular health, they are not a direct cause of glaucoma.

3. What is the prognosis for someone with early-stage glaucoma?
The prognosis for early-stage glaucoma is generally good, especially with regular monitoring and treatment. If your girlfriend is diagnosed with glaucoma and follows her doctor's recommendations, including medication and regular eye exams, the risk of significant vision loss is greatly reduced. Many patients with glaucoma can maintain their vision for many years, even decades, with proper management. The exact timeline can vary based on individual factors, including the type of glaucoma, the effectiveness of treatment, and adherence to follow-up appointments.
In terms of statistics, studies suggest that with appropriate treatment, the risk of blindness from glaucoma can be reduced to less than 10% over a lifetime. However, it is essential to understand that glaucoma is a chronic condition that requires ongoing management.

In summary, while it’s natural to be concerned about your girlfriend's health, early detection and treatment of glaucoma can lead to a favorable outcome. Encourage her to maintain regular check-ups with her ophthalmologist, adhere to prescribed treatments, and report any new symptoms promptly. This proactive approach will help ensure that she can enjoy a healthy and fulfilling life. If you have further questions or concerns, don't hesitate to reach out to a healthcare professional for personalized advice.

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