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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 10896
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I have, recently, been waking up with a severe headache. I

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I have, recently, been waking up with a severe headache. I have very bright, colorful dreams, then when I wake up, my head is just throbbing. It's the worst headache pain I've ever had, but it, thankfully, only lasts about 10-15 minutes. This morning, when I woke up, my eyeballs also hurt a lot. When I tried to shut my eyes again, they hurt even more. Upon rising, I noticed that my eyes were really red and bloodshot. They look somewhat better now (4 hours later), but they still feel weird. I know that this headache is not related to sleep apnea. I am very used to those symptoms, and I do sleep with a CPAP mask. This feels different. I am also having some persistent, low-grade nausea. Any ideas? I'm kind of freaked out by this.
Hi. I'm Dr. Rick and I have two decades of medical experience. I'm online and happy to answer your question today.

How long has this been going on for?

Is the headache worse when you bend over?

Do you have any other symptoms?

How tall are you and how much do you weigh?

Does it only start when you wake up or has it occurred at different times?

Have you had any visual problems/double vision?

Do you have any medical problems or take any medications?

This is not an answer, but an Information Request. I need this information to answer your question. Please reply, so I can answer your question. I look forward to helping you.
Customer: replied 3 years ago.

Hi, and thanks. This has been going on for about three weeks, I guess. Although, this is the first day that I noticed the eye pain.


 


I haven't noticed it getting worse when I bend over, but then I try to just stay in bed until it passes. Sometimes I get the same headache when I have been seated for awhile and then I stand up abruptly.


 


I have been have been having some minor, but constant nausea for about a week.


 


I am 5'7, 350 lb.


 


It does happen at other times (see above), but is less severe, and even shorter than when I wake up.


 


This morning, I noticed some marked blurriness in my right eye. It didn't last very long.


 


Yes, I am diabetic. I take Metformin 1000mg ER, once a day. I have had intracranial hypertension. It has seemed to be controlled by Furosemide for years now. (I am allergic to Diamoxx). I take Lamyctal as a mood stabilizer, and Nortryptaline, (100mg) for fibromyalgia pain. I don't know the doses of some of those, right off the top of my head. Sorry also about the spelling.


 


Thanks for your help.

Thank you for that extra information.

 

Have you recently had any imaging studies done of your head?

 

Do you have any hearing problems or hear any sounds in your head?

 

 

Customer: replied 3 years ago.

No recent studies. The last one was a couple years ago. I do not have any hearing issues.


 


I forgot to say that I have neck pain. I think it's just from sitting at my computer all day, but I guess I should mention it.

Thank you for that extra information.

There could be many causes for your symptoms, one that comes to mind is called pseudotumor cerebri.

Don't panic! The name is XXXXX XXXXX it is not from a brain tumor but rather increased pressure inside your head.

I suggest you have a complete eye exam by an ophthalmologist. Why an eye doctor for a headache? Because in this disease the optic nerves swell from the pressure and an ophthalmologist can see this on exam. Also, it can cause vision loss...

If the eye exam is normal then your next step should be to consult with a neurologist who specializes in headaches.

Does this make sense to you?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS
Customer: replied 3 years ago.

Dr. Rick,


 


If I am having symptoms of Pseudotumor Cerebri, I assume that means that the lasix I have been taking is not doing its job any more, correct?


 


Can you please tell me how urgent the eye issue is? I only ask because I do not have medical insurance at this time (thus my asking you instead of going to the clinic). I need to decide whether to try and get some treatment at the weekly free clinic, or if I need to get to an ER. Opthamalogist and Neurologist are not really options for me at this time.


 


Advice? Thanks.

I didn't notice your history of high ICP in your above post but at least I came up with the correct diagnosis :)

To answer your question: That is correct. With your symptoms the lasik is not doing enough anymore....

If you are having damage to your optic nerve and loss of visual field, which requires an exam by a ophthalmologist to tell for sure, then it is important to get treatment sooner rather than later.

Why? Because any loss of visual field or damage to the optic nerve quickly becomes irreversible if not treated.

Going to the ER really won't be of much value as they are not equipped to evaluated the optic nerve and visual fields. If at all possible I would urge you to do everything in your power to be seen by an eye MD.

Since you have already had the workup for pseudotumor cerebri you should not require another lumbar puncture etc.

Since Diamox is not an option and it seems that lasix is no longer working you may need to have a luboperitoneal shunt placed. This is very effective in PTC.

Another option, although still surgical in nature, would be gastric bypass or banding to help you loose weight. Marked weight loss has been proven to lower ICP, decrease vision loss, headaches and other symptoms.

So. What is the take home message? I would not ignore the resurgence of your headaches and other symptoms as severe, and permanent, vision loss could result.

Does this make sense to you?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS
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