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Suggest Treatment For Persistent Scintillating Scotoma

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Posted on Mon, 21 Nov 2016
Question: I have been having for the last year an almost daily occurrence of scintillating scotoma. It is usually always in the early morning, after getting out of bed, and before I eat breakfast. Most mornings I start out with a couple of hours on the internet, reading news stories and visiting Facebook. I find myself often bending forward toward the screen with my neck flexed. Once in a while I take magnesium supplements and it goes away soon thereafter. I have a history of ophthalmic migraines with aura. In those days, I would often have a peripheral vision deficit and a lingering basal headache afterward with malaise. The current scotomas do not have an associated loss of peripheral vision, no headaches either during or after the episode.
doctor
Answered by Dr. N K Mishra (15 minutes later)
Brief Answer:
Migraine.

Detailed Answer:
My Dear,
Thanks for sending your query to us.
This is a variant of migraine.Appearence of different types of scotoma and variability of pain may always occur.
The attacks may be precipitated by hypoglycemia,and strain,physical or mental.
This is to be treated on the lines of migraine,along with precautions like avoidance of physical and mental strain.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. N K Mishra (1 hour later)
Most of these occurrences are in the early morning, just after getting out of bed and before consuming any food. Therefore, I can understand how blood sugar may have something to do with it. However, I have had these scotomas at variable times of the day when meals would seem to have little to do with it. Can light stimuli, either sunlight or the light from a computer screen stimulate such phenomena? Do you have any recommendations for eliminating the scotomas or reducing their frequency? Are there any vitamin or mineral deficiencies that you might attribute these symptoms to?
doctor
Answered by Dr. N K Mishra (8 hours later)
Brief Answer:
Migraine.

Detailed Answer:
My dear,
Thanks for getting back to me.
This is common in migraine to have scotoma at variable times.I have had patients who after 10 pm dinner woke up with migraine at 2 am.If there is consistency in timing,that points to some definite cause.
Avoiding these attacks has been a challange.The exact reason how it is triggered on is not specific,so it can vary from person to person.Tofu,chocklate and banana have been reported to trigger the attack,watch their intake and attack if they coincide.
Physical and mental stress is one trigger.So avoid excessive stress and strain including exposure to extreme weather conditions,heat or cold.Hypoglycemia being another stress and most of the time when you are over worked and do not have time to eat,that is the perfect recipe for attack.
Proper ,good diet with vitamins and minerals,exercise and rest including yoga and medication where required ,have shown very prompt response as I see routinely in my practice..
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. N K Mishra (1 hour later)
I realize that this malady is difficult to pin down, in terms of its causation....which is really what I have been hoping to discover in writing to an expert. I guess I have always known that it is a form of migraine. In closing, I would ask if you think the fact that these scotomas are more frequent than even a year ago is any reason for concern. As I said, there is no numbness of face or extremities, no headaches during the episode or as a prevailing after- effect, no loss of peripheral vision or other visual sequelae. I do not feel that I am under any undue mental or physical stress. I am retired and have no work-related stress, nor any relationship or financial hardships. Is there any reason that the occurrences have become more consistent, and should I seek any medical treatment for them. Up until now, I have never used any medicine of any kind for migraines.
doctor
Answered by Dr. N K Mishra (14 hours later)
Brief Answer:
Migraine

Detailed Answer:
My dear,
Good of you to get back to me.
Usually the frequency of attacks go down with age or pain varies,at times there is no pain,and only scotoma.
We consider this as a part of life style management issue.Many patients respond to lifestyle management.Since you do not have apparently such stressful issues,there is no harm in having medication to control the problem.Though the treatment is long but most patients respond well to the treat.
Disease pattern varies with time,many of my patients have periods of 10 to 15 years of remission,even without treatment.
Let us decide about having treatment and get rid of the problem.
Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
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Dr. N K Mishra

Ophthalmologist

Practicing since :1977

Answered : 1297 Questions

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Suggest Treatment For Persistent Scintillating Scotoma

Brief Answer: Migraine. Detailed Answer: My Dear, Thanks for sending your query to us. This is a variant of migraine.Appearence of different types of scotoma and variability of pain may always occur. The attacks may be precipitated by hypoglycemia,and strain,physical or mental. This is to be treated on the lines of migraine,along with precautions like avoidance of physical and mental strain.