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

Fluids Hypertension Syndromes – Dr. Leonardo Izecksohn – page 85
This Table VIII-1 shows that an average of 85% of glaucoma patients has plenty signs and
symptoms from the Glaucoma, with an average of three migraines, variants, signs or symptoms per
patient. These patients are medicated by most physicians only for reducing their aches and other signs
and symptoms, thus permitting the glaucomatous evolution without correct medication.
“The superior portion of the retinal nerve fibers layers presented significantly smaller thickness values
in the patients with migraines with aura, suggesting possible ischemic damage to the neural fibers,
related to the migraine.”(Translated from Portuguese). (Medeiros, F A A and others).
“However, 12 of the 27 patients with Normal (Peak) Tension Glaucoma gave a history of common or
classic migraine. This unexpected finding raises the possibility that migraine-related ischemia might be
the pathogenic mechanism in some cases of normal tension glaucoma” (Corbett J. J. and others).
“The higher prevalence of headache in normal tension glaucoma patients, who were usually elderly,
was especially striking when their age was considered, since headaches are less common in elderly normal
subjects than in young normal subjects” (Phelps C D and Corbett J J).
Glaucoma and retinal nerve fiber layer lesions from the Migraines of intraocular pressure rise:
At the beginning, there are many migraines, few retinal nerve fibre layer lesions only at the temporal
quadrant, and no glaucoma: “70 eyes of 70 patients (mean age 28.2 (SD 7.9) years) with migraine with
or without aura... Optical coherence tomography was performed with the Stratus OCT... the temporal
quadrant retinal nerve fibre layer thickness in the migraine patients was significantly lower than that of
the control group, 62.2 (10.8) mum vs 70.8 (12.4) mum, respectively.. and was significantly correlated
with the Migraine Disability Assessment Score and the frequency of migraine attacks... No one was
qualified as having glaucomatous damage. We found a strong correlation between migraine severity
and the retinal nerve fibre layer average thickness parameters.” (Martinez A, and others).
When years along not correctly medicated, the Optic Nerve’s disk cup of some patients with migraines
of the Ocular Hypertension Syndrome can slowly get bigger, with progressive reduction of
their Migraines. There is no clear borderline between the Intraocular pressure Migraine and the chronic
Glaucoma: it is a progressive and continuous evolution, and both sicknesses are integrated. Each ophthalmological
physician defines were is his border of the glaucoma beginning. These definitions are
useful for statistics, and useless for the patient therapy.
Whether the physiologic and healthy Optic Nerve’s disk cup will evolve to some minimal glaucomatous
damage (glaucomatous Optic neuropathy), and from this to still bigger and deeper disk’s cup with
consequent glaucomatous visual field loss, it will depend from the fluids hypertension etiologies and
treatment. The most common etiologies are the excessive liquids drank, caffeine, wine, beer, medications,
all the patient’s life circumstances, aging, and the inherited Lamina cribosa’s frailty:
“Laminar thickness... was thinner in the primary open-angle glaucoma and normal tension glaucoma
groups than in the normal control group.”(Park H Y, Jeon S H, Park C K).
The patients that have Optic Nerves’ disk Lamina Cribosa with endurance against the raised intraocular
pressure and hardly turn cupped, are those:
- Who suffered uveal inflammation or with pre-disk membranes;
- Who have chronic edema from the Cerebrospinal Fluid pressure rise;
- With congenital thicker lamina cribosa.
- With congenital small disks, common on Hyperopia.
“Older age, larger cup-to-disc ratio, …, higher intraocular pressure, and thinner central corneal thickness
appear to be good predictors for development of glaucoma in patients with ocular hypertension”
(Lee, B L, Wilson M R).
Whether and when the Optic Nerve’s disk cup reaches the size of 0.7 of the whole Optic disk diameter
and with 3 or 4 diopters of deepness, or with lamina cribosa pores visibility grade 3 (perfectly visible),
which we consider as incipient glaucoma, the patient’s Migraines turns milder or are substituted by
some of the other signs or symptoms. This occurs after many years of Migraines or variants, regardless
the nowadays values of intraocular pressure or ages.