Doc: Possible link between migraines and glaucoma
Dear Dr. Roach: Recently a reader was asking for help with a chronic migraine that was little helped by various medications.
I also suffer from migraines, and they have really diminished since my diagnosis of normal pressure glaucoma and the use of eyedrops, which have brought that pressure down several points. My pressures were at the high end of the normal range.
I still get migraines, but far less often. Most importantly, I do not wake up with a headache every day, like I used to. What a relief!
Maybe there are others like me. The diagnosis came after irreversible eye damage. Perhaps people with daily migraines, especially when they wake up in the morning, should be referred to an eye specialist for a visual field test. It might be the pressure in the eyeballs that’s causing the headaches.
Dear J.G.: Glaucoma is a common eye condition of damage to the retina, usually, but not always, associated with elevated pressure inside the eye. Since damage to the retina can occur at pressures that are within the broad range of “normal,” as it did in your case, it’s appropriate for adults to be periodically evaluated, even in the absence of symptoms. Some groups recommend every-other-year screening between ages 40 and 60, and annually after age 60. Other groups, including the influential U.S. Preventive Services Task Force, don’t make a specific recommendation. However, in the presence of eye symptoms, a regular exam is essential, regardless of age.
Many studies have found a link between glaucoma and migraine headache, especially glaucoma in those whose measured eye pressures usually are normal. Others have not found a link. However, I think it reasonable for a person with migraine to be sure he or she has seen an eye professional for a pressure measurement and a retinal exam to look for any retina damage.
Dear Dr. Roach: I am age 82 and in reasonably good health and weight. However, my cardiologist advises me not to add salt to any dish. I have oatmeal (not instant) two or three times each week. I am not too worried about the quantity, but am more curious about why the directions say to add a dash of salt to oatmeal before cooking?
Dear J.K.: Salt is not necessary for oatmeal. Salt is in the recipe simply because many people don’t like the taste of oatmeal without salt. If you like it without salt, that’s fine.
Dear Dr. Roach: I am 82 years old, have advanced COPD and had an aortic valve replacement in August 2015. I also have the expected (but not crippling) arthritis in my hands, knees, feet, back and hips. A recent article says that acetaminophen is useless in treatment of arthritis pain. Since Plavix is a necessary medicine for me following my valve replacement, and since aspirin, Advil, etc., are no-nos with it, what medications are available to me for relief of arthritis pain?
Dear R.M.: I disagree that acetaminophen (Tylenol) is useless against arthritis pain. The majority of research on this subject shows that acetaminophen is superior to placebo, and my clinical experience confirms that most people get some relief and a good number of people get near-complete pain relief. I recommend acetaminophen as first-line treatment for mild to moderate arthritis pain, along with regular exercise.
For those people who can’t take anti-inflammatories, I also consider the use of both OTC creams, which contain various ingredients, such as menthol and camphor, and prescription ones such as diclofenac (Voltaren). Capsaicin-based creams work for some people, but cause a burning sensation when first applied.
Email questions to ToYourGoodHealth@med.cornell.edu.