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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 11360
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I've had nonstop migraine with 24/7 visual disturbance for 5

Customer Question

I've had nonstop migraine with 24/7 visual disturbance for 5 years straight now. MRI, MRA, MRV, and MR myelogram are all completely normal. I've tried 40 medications now and while some (IV DHE, methergine) relieve the back of head pain temporarily, nothing touches my visual "aura" which looks like this with swirling scotomas that make reading and driving extremely difficult:
Do you have any unorthodox ideas as to what could be causing this? I've seen about 10 neurologists, a neuroopth, opthalmologist at major medical centers. Neuros say it's status migrainosus with constant visual aura. Neuroopth noted macula thinning and optic nerve atrophy, both in both eyes but only slight. Second neuroopth said everything looks fine. Oh I was also diagnosed with POTS, orthostatic tachycardia. Could that cause the back of head pain and neurological visual disturbance? lumbar puncture was normal. so were blood tests. i'm grasping at straws here because i want to go to medical school and become a surgeon but vision is kind of important to make that happen.
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.

Hi. My name is***** and I am online and available to help you today. Thank you for your patience.

Question and answer is just one of the services I offer. I can also provide you with premium services, such as live telephone or skype consultation, at a small additional cost. Let me know if you are interested.

To tell you the truth, from what you have posted, you have had the best workup that modern medicine can offer. As a fellow migraine sufferer, I do not believe that you have left any stone un-turned.

It you were wanting another opinion you could go to the Mayo Clinic in Rochester, MN but I bet they would tell you the same thing: You have a bad case of migraines....

You do not have to worry about going to medical school or becoming a surgeon: I did it and so can you. Let me explain:

I, personally, have been suffering from this condition for almost 30 years. I almost never got the headaches after the visual effects.

There was one time, I was in the middle of a very delicate retina operation, when an attack started. After a few moments I lost most of my central vision and the inferior part of my visual field. I, calmly, removed my surgical instruments from the patients eye and we all sat around in the OR for 15 minutes until my vision returned. Other than that my ocular migraines have not really caused me any significant problems :o)

Does this make sense to you?

Don't forget to mash the positive feedback button for me...the one labeled "excellent" is the most fun to push by far ;)

It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.

Dr. Rick MD FACS

Customer: replied 1 year ago.
The blind spots shimmer across my central vision 27/7, not just for 15 minutes now and then
Expert:  Dr. Rick replied 1 year ago.

Well, then, you might need some advanced retinal testing such as a focal ERG or and EOG. But, given what extensive workup you have already had I wouldn't be surprised if this has not already been done.

Unfortunately you may never get a good diagnosis.......

I realize that this was not the answer you were hoping to hear but it would be unfair to you and unprofessional of me were I provide you with anything less than truthful and honest information.

Surely, you prefer that I tell the truth rather than what you wish to hear. Because it reflects very poorly on me unless you press one of the top three feedback choices, keep this in mind when rating my answer and please do not punish me for being honest. I understand that this may not be easy to hear, and I empathize.

Even though my answer was not quite what you were hoping for, please understand that my priority was to provide you with the most honest information. With that in consideration, I hope that you found my answer useful. Please click the excellent feedback button so that I can receive credit for my efforts.

Dr. Rick MD FACS