Fluids Hypertension Syndromes: Migraines, Headaches, Normal ...

Fluids Hypertension Syndromes – Dr. Leonardo Izecksohn – page 308
Some patients became angry, because “we forbidden them to drink the delicious beverages chocolate,
coffee, wine and beer.” These patients prefer to change their physician than to change their drinks.
- Effect of dietary measures on the sicknesses: We had a 61-year-old Black (around 80% Black, 10%
white and 10% Indian) patient, 1.78 meters tall, weighting 78 kilograms. He was complaining about
chronic eyelids itching and consequent recurrent sties. He also felt chronic rhinitis and dry cough. He
used to drink 100 milliliter of coffee, tea, and 4,000 milliliter of water daily. On the ophthalmologic
examination we found Optic Nerve’s disks with cups of 0.8/4/1/0 and 0.6/3/1/0 (cup diameter/ cup
deepness/ lamina cribosa’s pores visibility/ borders edema), which configures an advanced glaucoma
and a suspicion of glaucoma in his right and left eyes. His intraocular pressures were 25 and 22 mmHg
right and left eyes. His eyes' anterior chambers were physiologic, deep. We medicated his sty, prescribed
him eye drops to lower his intraocular pressure and to shorten all drinks.
After one year, he came back with another sty. He had shortened the coffee to 50 milliliter, few tea
and water daily, but never used the eye drops. He explained that he was all better, his rhinitis and dry
cough had gone, and his sties were rare, only once a year. On the examination, we found the same Optic
Nerve’s cups, the intraocular pressures of 22 and 20 mmHg right and left eyes, lower than the
former. His symptoms improvement was the result only from the drinks shortening, without any medication.
We explained him that he still was needing the anti-glaucoma eye drops.
XVIII- v -We control the treatment’s efficacy, when the patient returns, by the same exams described
above (Method):
1 – Detailed anamnesis: The well-controlled patient must not presented any symptom, and show better
the old signs. The migraines cure.
2 – Optic Nerve’s Disk direct ophthalmoscopy: The well-controlled patient must have stabilized his
Optic Nerve’s disk cup damage, if he had one. The Optic Nerve's border edema reduces few and slowly
for years, and sometimes it does not reduce at all.
3 – Ocular applanation tonometry at the office: The well-controlled patient must present the intraocular
pressures of 16 mmHg or less in each eye.
4 – The main control is the patient's feelings of any ache, migraine, or other sign or symptom. The
well controlled patient must not feel anything bad.
XVIII- w -Migraines' therapeutic paradox: The patient with intraocular pressure bigger than 21
mmHg and almost no Migraine (Graph V-1), when first time medicated with eye drops to lower his intraocular
pressure, usually feels Migraines for few days. This patient incriminates the medication to
worsen him, and sometimes this is the cause of the treatment rejection on its beginning. This Migraine’s
worsening is the ache of the Optic Nerve’s Lamina cribosa reducing its former squeeze, caused
by the Cerebrospinal fluid pressure on the other side. The damage is partially recovering, but the aches
are worsening for one week. This Migraine cease in few days with the continuity of the treatment. The
eyes with intraocular pressures that do not reduce to 16 mmHg or less can ache fifteen days with this
migraine.
The advise of these aches is included in the manufacturer's instructions for the use of Timolol
Maleate eye drops, which is a very efficient medication to lower the intraocular pressure.
The same aches can happen when the patient user of caffeine stops its use. It is known as a “caffeine
withdrawal symptom”.
The same aches can happen when the patient drinker of excessive water shorten his water drinks:
“Subjects experienced water-deprivation headache, aching in the majority and accentuated by head
movement, bending down, or walking.” (Blau J N, and others). This justifies the excessive water drinks
as a therapy for migraines: “The present study suggest a reduction in the total number of hours and intensity
of headache episodes after increased water intake.” (Spigt M G, and others).