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What Causes Pulsations In Eyes?
Question: My eye pulsates whenever I read. A doctor thinks this might be a neurological condition. Is this likely? The neurological medicine I took made my situation worse. Within 5 days of taking the medicine (Topomax), I see darkness whenever I look at the distance and there is a contrast between lightness and darkness. In other words, If someone is sitting a distance away from me in front of the lamp, I can't see that person's face, it's all blurry. Similarly, I can't clearly see digital clocks at a distance anymore. Do you have suggestions on what is causing the pulsating? Do you have suggestions on how this can be fixed? Do you have suggestions also as to how I can get my eyes treated to fix the problem caused by my medicine?
Brief Answer:
Pulsating eye- not likely neurological
Detailed Answer:
Good afternoon. My name is Dr. Saghafi. I am a neurologist and would like to answer this question though as you can imagine may be just more ideas at the fan since a definite explanation is hard to come by based upon your symptoms.
As I understand it you have pulsatile feelings in the eye which either occurs or is noticeable to you whenever you read.
There are many blog sites on the internet that actually talk about this problem but none truly give definitive answers. That's because there are likely many different possibilities. I'll give you the website at the end of my answer here and you can judge for yourself and even participate in the blog sites to see if you can get other ideas.
First, let's understand that pulsations within the globe or eyeball itself occur on the basis of the heartbeat. That's probably intuitively obvious. In other words, there is no mechanism that the eyeball has for pulsating itself. The vitreous humor which is what comprises the majority of the interior of the eye is so thick and viscous that it really doesn't pulsate in the same way or nearly as easily as blood or water.
I also can't think of a NEUROLOGICAL MECHANISM by which pulsations in the eye could occur ONLY UPON READING. That fact alone tells me one of 2 things. Either the act of reading somehow is the sole and major trigger to this phenomenon (and many people have the same complaint) or perhaps the act of reading makes you more AWARE of the problem because now your focus and atteniton on what your reading allows something like eye pulsations to be more "paid attention to" by you and your brain. Perhaps, pulsations are always there just not as noticeable.
Assuming pulsations are ALWAYS present then, 1 important entity which cause such a sensation would be some type of vascular abnormality. Either an aneurysm in the brain very close to the apparatus of the eyeball itself or the optic nerve or something south of the eyeball such as the carotid arteries which could cause strong enough pulsations to actually vibrate the globe. As well, even blood vessels that feed the eye itself could have small aneurysms...it's a rarity but can occur in certain forms of collagen vascular disease states.
And so, in my opinion the MOST IMPORTANT BAD PLAYERS that need to be ruled out with this problem would be any type of vascular abnormalities either in the carotid arteries, the blood vessels within the eye itself, or blood vessels in the brain which are likely close to the eyeball or its structures. For any of those problems it would be best to consult with an OPHTHALMOLOGIST---not an optometrist to see what sorts of imaging studies or procedures they'd like to perform to rule that sort of thing out.
I'm not at all sure I understand the logic of using Topamax for this sort of problem and I would not have chose such a medication to treat this problem. It simply does not have a role as far as I'm concerned and your question of its effect on your vision is not your imagination. Topamax is known to affect visual acuity and clarity in some individuals.
The way to solve that problem would be most likely simply discontinuing the drug. I would caution you, however, that since your doctor prescribed the drug for you he should be the one to discontinue it...again, I see no role for it unless he can give you a mechanism by which he can explain how it should work.
Other than what I explained above the only other things that come to mind in terms of causing your symptoms would be pure and simple eyestrain, positional considerations of your head during reading which could be compromising blood vessels within the neck or head (though this is a long shot)....you can try reading with your head in different positions (i.e. lying down, sitting, reclining, on your side, book up at eye level, and book above eye level and see which position seems to make any difference). By the same toke you could try reading from different distances and see if that helps.
I know you said you tried glasses but I don't know whether that means you recently had a refraction done and are using brand new prescription glasses or are just trying out reading glasses or what. I would suggest again, that a good ophthalmologist refract you and make sure that whatever glasses you're using are actually corrective for your eyes and not just some nonprescription pair of reading glasses from the pharmacy that magnify but nothing else.
Finally, stress from eyestrain can be reduced by placing warm compresses on the eyes for a brief period of time before starting to read and then, intermittently along with taking short breaks if the pulsation seems to intervene.
Here's the website that I looked over and you might find useful with others who have your same type of problem:
http://ehealthforum.com/health/topic30227.html
In conclusion, I do not believe your problem is a neurological one which involves the brain or the eye itself. If anything physically is wrong it would have to be vascular as I described above. For that sort of thing you need to see either an ophthalmologist or a vascular medicine doctor who will order appropriate imaging studies.
I do not see the role for Topamax in this case and would discuss this with your doctor as I believe it is responsible for the side effects you are mentioning having to do with alterations in your vision.
Try conservative methods of using warm compresses and rest periods while reading to see if that might help the problem.
I hope you find a solution to your problem.
If I have answered your questions satisfactorily I would appreciate your written feedback and a STAR RATING.
Also, if there are no further questions to ask I'd greatly appreciate your CLOSING THE QUERY on your end so to indicate to the network that we've addressed your concerns allowing the case to be archived.
All the best to you.
This query required 30 minutes of physician specific time to review, research, and document in final draft form for envoy.
Pulsating eye- not likely neurological
Detailed Answer:
Good afternoon. My name is Dr. Saghafi. I am a neurologist and would like to answer this question though as you can imagine may be just more ideas at the fan since a definite explanation is hard to come by based upon your symptoms.
As I understand it you have pulsatile feelings in the eye which either occurs or is noticeable to you whenever you read.
There are many blog sites on the internet that actually talk about this problem but none truly give definitive answers. That's because there are likely many different possibilities. I'll give you the website at the end of my answer here and you can judge for yourself and even participate in the blog sites to see if you can get other ideas.
First, let's understand that pulsations within the globe or eyeball itself occur on the basis of the heartbeat. That's probably intuitively obvious. In other words, there is no mechanism that the eyeball has for pulsating itself. The vitreous humor which is what comprises the majority of the interior of the eye is so thick and viscous that it really doesn't pulsate in the same way or nearly as easily as blood or water.
I also can't think of a NEUROLOGICAL MECHANISM by which pulsations in the eye could occur ONLY UPON READING. That fact alone tells me one of 2 things. Either the act of reading somehow is the sole and major trigger to this phenomenon (and many people have the same complaint) or perhaps the act of reading makes you more AWARE of the problem because now your focus and atteniton on what your reading allows something like eye pulsations to be more "paid attention to" by you and your brain. Perhaps, pulsations are always there just not as noticeable.
Assuming pulsations are ALWAYS present then, 1 important entity which cause such a sensation would be some type of vascular abnormality. Either an aneurysm in the brain very close to the apparatus of the eyeball itself or the optic nerve or something south of the eyeball such as the carotid arteries which could cause strong enough pulsations to actually vibrate the globe. As well, even blood vessels that feed the eye itself could have small aneurysms...it's a rarity but can occur in certain forms of collagen vascular disease states.
And so, in my opinion the MOST IMPORTANT BAD PLAYERS that need to be ruled out with this problem would be any type of vascular abnormalities either in the carotid arteries, the blood vessels within the eye itself, or blood vessels in the brain which are likely close to the eyeball or its structures. For any of those problems it would be best to consult with an OPHTHALMOLOGIST---not an optometrist to see what sorts of imaging studies or procedures they'd like to perform to rule that sort of thing out.
I'm not at all sure I understand the logic of using Topamax for this sort of problem and I would not have chose such a medication to treat this problem. It simply does not have a role as far as I'm concerned and your question of its effect on your vision is not your imagination. Topamax is known to affect visual acuity and clarity in some individuals.
The way to solve that problem would be most likely simply discontinuing the drug. I would caution you, however, that since your doctor prescribed the drug for you he should be the one to discontinue it...again, I see no role for it unless he can give you a mechanism by which he can explain how it should work.
Other than what I explained above the only other things that come to mind in terms of causing your symptoms would be pure and simple eyestrain, positional considerations of your head during reading which could be compromising blood vessels within the neck or head (though this is a long shot)....you can try reading with your head in different positions (i.e. lying down, sitting, reclining, on your side, book up at eye level, and book above eye level and see which position seems to make any difference). By the same toke you could try reading from different distances and see if that helps.
I know you said you tried glasses but I don't know whether that means you recently had a refraction done and are using brand new prescription glasses or are just trying out reading glasses or what. I would suggest again, that a good ophthalmologist refract you and make sure that whatever glasses you're using are actually corrective for your eyes and not just some nonprescription pair of reading glasses from the pharmacy that magnify but nothing else.
Finally, stress from eyestrain can be reduced by placing warm compresses on the eyes for a brief period of time before starting to read and then, intermittently along with taking short breaks if the pulsation seems to intervene.
Here's the website that I looked over and you might find useful with others who have your same type of problem:
http://ehealthforum.com/health/topic30227.html
In conclusion, I do not believe your problem is a neurological one which involves the brain or the eye itself. If anything physically is wrong it would have to be vascular as I described above. For that sort of thing you need to see either an ophthalmologist or a vascular medicine doctor who will order appropriate imaging studies.
I do not see the role for Topamax in this case and would discuss this with your doctor as I believe it is responsible for the side effects you are mentioning having to do with alterations in your vision.
Try conservative methods of using warm compresses and rest periods while reading to see if that might help the problem.
I hope you find a solution to your problem.
If I have answered your questions satisfactorily I would appreciate your written feedback and a STAR RATING.
Also, if there are no further questions to ask I'd greatly appreciate your CLOSING THE QUERY on your end so to indicate to the network that we've addressed your concerns allowing the case to be archived.
All the best to you.
This query required 30 minutes of physician specific time to review, research, and document in final draft form for envoy.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. XXXXXXX Saghafi,
Thank you very much for the detailed response. I appreciate the help with figuring out how to solve my eye problem.
Maybe if I add some more details, that might provide added information that can be used to figure out how to solve my eye problem?
I had been seeing ophthalmologists since September 2013. They were unable to figure out what has been causing my eye to pulsate and be painful.
Recently, I saw a neurologist for the first time. He said he thinks I have a migraine-related problem that's causing my eye pain. He wrote "migraine tic syndrome" as my diagnosis. He prescribed Topomax because it is known for preventing migraines. However, after those extreme side effects, I stopped the medicine; but the side effects--the vision problems--have continued.
He did suggest that I have an EEG, VER, carotid doppler test, MRI, and bloodwork. All of these tests came back as normal, but the neurologist did not examine them yet.
Also, this pulsating results in much pain after I stop reading or focusing on something.
Interestingly, the neurologist I talked to said my eye pulsating might be related to a migraine-equivalent condition, and the effect of arteries. It's interesting that you mentioned arteries, as well. Do you think something with my arteries might be causing this problem?
Do you have any suggestions on what can be causing my eye problem and how I can alleviate it?
Also, I have been off Topomax for six days, but the vision problems have continued. Will it just take more time off the medicine for my vision problems to get better? Would an ophthalmologist or neurologist be better for me to talk to about these vision problems? I began getting these problems while taking a neurological medication, Topomax, so I am wondering whether a neurologist is who I should talk about this? Or should I talk to an ophthalmologist because it is a vision problem? In case I didn't describe the problem clearly enough, ever since a few days after I began taking Topomax, I've had a painful and blurry time trying to see things where there is a contrast between light and dark. For instance, if someone walks through a door into the house during the day, that person looks like blackness, and the light behind that person is painfully bright.
Thank you for the helpful information. I would appreciate your thoughts on what type of condition might be causing the eye pain, pulsating, and side effects. I would appreciate any suggestions about how this problem can be resolved. Also, do you think I should see an opthalmologist again, even though multiple ophthalmologists whom I saw from September 2013 until July 2014 could not diagnose it, besides suggesting that it might be migraine related?
Thank you very much for the detailed response. I appreciate the help with figuring out how to solve my eye problem.
Maybe if I add some more details, that might provide added information that can be used to figure out how to solve my eye problem?
I had been seeing ophthalmologists since September 2013. They were unable to figure out what has been causing my eye to pulsate and be painful.
Recently, I saw a neurologist for the first time. He said he thinks I have a migraine-related problem that's causing my eye pain. He wrote "migraine tic syndrome" as my diagnosis. He prescribed Topomax because it is known for preventing migraines. However, after those extreme side effects, I stopped the medicine; but the side effects--the vision problems--have continued.
He did suggest that I have an EEG, VER, carotid doppler test, MRI, and bloodwork. All of these tests came back as normal, but the neurologist did not examine them yet.
Also, this pulsating results in much pain after I stop reading or focusing on something.
Interestingly, the neurologist I talked to said my eye pulsating might be related to a migraine-equivalent condition, and the effect of arteries. It's interesting that you mentioned arteries, as well. Do you think something with my arteries might be causing this problem?
Do you have any suggestions on what can be causing my eye problem and how I can alleviate it?
Also, I have been off Topomax for six days, but the vision problems have continued. Will it just take more time off the medicine for my vision problems to get better? Would an ophthalmologist or neurologist be better for me to talk to about these vision problems? I began getting these problems while taking a neurological medication, Topomax, so I am wondering whether a neurologist is who I should talk about this? Or should I talk to an ophthalmologist because it is a vision problem? In case I didn't describe the problem clearly enough, ever since a few days after I began taking Topomax, I've had a painful and blurry time trying to see things where there is a contrast between light and dark. For instance, if someone walks through a door into the house during the day, that person looks like blackness, and the light behind that person is painfully bright.
Thank you for the helpful information. I would appreciate your thoughts on what type of condition might be causing the eye pain, pulsating, and side effects. I would appreciate any suggestions about how this problem can be resolved. Also, do you think I should see an opthalmologist again, even though multiple ophthalmologists whom I saw from September 2013 until July 2014 could not diagnose it, besides suggesting that it might be migraine related?
Brief Answer:
Doubt neurological problem
Detailed Answer:
Thank you for some of those clarifications regarding the reason that the neurologist placed you on Topamax. I must admit though that after reading the second message you sent I am slightly confused. In the first message, it seemed as if the only time you had the pulsations in the eye was when you were actually reading something. However, in the second message you state that the painful pulsations of the eye begin after you stop reading or focusing on something.
Therefore, would you please clarify for me exactly when you have these pulsatile pains? In other words, is it a constant phenomenon which continues unless you are doing something or is it something that only occurs during certain activities?
As I stated in my earlier message to you the most common and likely causes for pulsation of the by itself would be from the presence of an aneurysm which is either inside the eye such as a retinal artery or A blood vessel which is close to the eyeball itself within the substance of the brain or close to the optic nerve which would be big enough to pulsate against the globe or against the nerve so that you would actually feel such pressure.
There is also the possibility of an aneurysmal swelling in the trajectory of the carotid artery's selves which could conceivably be felt with in the eye as you describe. this may be why the neurologist would like to get a carotid Doppler as well as additional tests that you mentioned.
You state that the MRI of the brain and the orbit has been negative up to this point. Was an MRA also performed or just the MRI? MRA stands for magnetic resonance angiography and specifically images blood vessels within the brain, the base of the brain, the carotid arteries, etc. It is a more sensitive diagnostic test if one were looking for smaller aneurysms which would otherwise be missed on a regular MRI film. I would've imagined that the neurologist should've ordered the MRA in addition to the MRI.
Other reasons for the sensation of a pulsatile eyeball or eyeballs would be a situation of possible thyroid dysfunction as in Graves' disease where there is what is referred to as exophthalmos which is basically a "bug eyed appearance" of the patient due to increased fat deposition from the malfunctioning thyroid system into the orbits and this could conceivably be sensitive enough to feeling pulsations in the arterial system although that is a very very rare complaint of most patients with this disease. On the other hand, a hyper thyroid condition could give the sensation of pulsations within the eyeball.
But again, this all is contingent upon exactly when you feel these pulsations which in your previous message sounded as if it were only the case that you felt such things when you were reading or focusing on something.
As far as the visual acuity problems following administration of Topamax that would be something that you should discuss either with the neurologist who gave you the medication or perhaps an ophthalmologist who may be able to look into the side effect profile of that medication to determine what the most likely cause for it to affect your vision would be.
There is another entity which can fall into the differential diagnosis of pulsatile exophthalmos and so I would ask the following questions of you. First of all, when the MRI was performed of the brain was it done with gadolinium contrast or not? If it was then, was there any review of the optic nerve themselves behind the eyeball in other words the retro bulbar region of the optic nerve. Sometimes there can be a very subtle swelling of the nerve itself which is otherwise undetectable unless gadolinium contrast is used.
Do you have any lesions on your skin which are referred to as café au lait spots?These are usually small oval shaped brown and cream in color and they can be seen over the arms, the back, and the trunk.
I can understand why the neurologist is thinking in terms of a migraine type of headache since a common complaint is that of I pain which throbs but there is generally also a severe headache as well as other symptoms of typical migraine such as nausea, vomiting, and visual aura is which can be bizarre and sometimes colorful. Since you are not describing any of these symptoms at all I think it is less likely that what you are feeling is that of a migraine headache and nothing else.
I hope you are able to take some of the suggestions and discuss them with either your neurologist or with an ophthalmologist although if none have found abnormalities within your orbital region or I sensed 2013 then, it would seem unlikely that there is an ocular problem.
Having said that, to this point a neurological workup based on what has been obtained and what you have told me seems to be negative as well.
My recommendation, if you were my patient and I were working you up myself, would be to obtain a contrasted imaging study and to look very carefully at the optic nerves as well as acquisition of an MRA to look for small aneurysmal swellings in the carotid arteries as well as the vasculature of the intra-cerebral arteries in and around the orbital region that is being affected.
I would also run blood tests which I am sure your neurologist has already thought of to rule out problems such as lupus, thyroid disease, and other hormonal derangements that could involve the adrenal gland, etc.
if any of this information was found to be useful I would appreciate a written feedback message along with a star rating of the response. In addition, if there are no further questions to raise then, Closing the Query on your end would be greatly appreciated so that the network may file this as having been satisfactorily addressed.
All the best to you.
The query took 47 minutes to review, research, and document final draft for envoy.
Doubt neurological problem
Detailed Answer:
Thank you for some of those clarifications regarding the reason that the neurologist placed you on Topamax. I must admit though that after reading the second message you sent I am slightly confused. In the first message, it seemed as if the only time you had the pulsations in the eye was when you were actually reading something. However, in the second message you state that the painful pulsations of the eye begin after you stop reading or focusing on something.
Therefore, would you please clarify for me exactly when you have these pulsatile pains? In other words, is it a constant phenomenon which continues unless you are doing something or is it something that only occurs during certain activities?
As I stated in my earlier message to you the most common and likely causes for pulsation of the by itself would be from the presence of an aneurysm which is either inside the eye such as a retinal artery or A blood vessel which is close to the eyeball itself within the substance of the brain or close to the optic nerve which would be big enough to pulsate against the globe or against the nerve so that you would actually feel such pressure.
There is also the possibility of an aneurysmal swelling in the trajectory of the carotid artery's selves which could conceivably be felt with in the eye as you describe. this may be why the neurologist would like to get a carotid Doppler as well as additional tests that you mentioned.
You state that the MRI of the brain and the orbit has been negative up to this point. Was an MRA also performed or just the MRI? MRA stands for magnetic resonance angiography and specifically images blood vessels within the brain, the base of the brain, the carotid arteries, etc. It is a more sensitive diagnostic test if one were looking for smaller aneurysms which would otherwise be missed on a regular MRI film. I would've imagined that the neurologist should've ordered the MRA in addition to the MRI.
Other reasons for the sensation of a pulsatile eyeball or eyeballs would be a situation of possible thyroid dysfunction as in Graves' disease where there is what is referred to as exophthalmos which is basically a "bug eyed appearance" of the patient due to increased fat deposition from the malfunctioning thyroid system into the orbits and this could conceivably be sensitive enough to feeling pulsations in the arterial system although that is a very very rare complaint of most patients with this disease. On the other hand, a hyper thyroid condition could give the sensation of pulsations within the eyeball.
But again, this all is contingent upon exactly when you feel these pulsations which in your previous message sounded as if it were only the case that you felt such things when you were reading or focusing on something.
As far as the visual acuity problems following administration of Topamax that would be something that you should discuss either with the neurologist who gave you the medication or perhaps an ophthalmologist who may be able to look into the side effect profile of that medication to determine what the most likely cause for it to affect your vision would be.
There is another entity which can fall into the differential diagnosis of pulsatile exophthalmos and so I would ask the following questions of you. First of all, when the MRI was performed of the brain was it done with gadolinium contrast or not? If it was then, was there any review of the optic nerve themselves behind the eyeball in other words the retro bulbar region of the optic nerve. Sometimes there can be a very subtle swelling of the nerve itself which is otherwise undetectable unless gadolinium contrast is used.
Do you have any lesions on your skin which are referred to as café au lait spots?These are usually small oval shaped brown and cream in color and they can be seen over the arms, the back, and the trunk.
I can understand why the neurologist is thinking in terms of a migraine type of headache since a common complaint is that of I pain which throbs but there is generally also a severe headache as well as other symptoms of typical migraine such as nausea, vomiting, and visual aura is which can be bizarre and sometimes colorful. Since you are not describing any of these symptoms at all I think it is less likely that what you are feeling is that of a migraine headache and nothing else.
I hope you are able to take some of the suggestions and discuss them with either your neurologist or with an ophthalmologist although if none have found abnormalities within your orbital region or I sensed 2013 then, it would seem unlikely that there is an ocular problem.
Having said that, to this point a neurological workup based on what has been obtained and what you have told me seems to be negative as well.
My recommendation, if you were my patient and I were working you up myself, would be to obtain a contrasted imaging study and to look very carefully at the optic nerves as well as acquisition of an MRA to look for small aneurysmal swellings in the carotid arteries as well as the vasculature of the intra-cerebral arteries in and around the orbital region that is being affected.
I would also run blood tests which I am sure your neurologist has already thought of to rule out problems such as lupus, thyroid disease, and other hormonal derangements that could involve the adrenal gland, etc.
if any of this information was found to be useful I would appreciate a written feedback message along with a star rating of the response. In addition, if there are no further questions to raise then, Closing the Query on your end would be greatly appreciated so that the network may file this as having been satisfactorily addressed.
All the best to you.
The query took 47 minutes to review, research, and document final draft for envoy.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. XXXXXXX Saghafi,
Thank you very much for the detailed, thorough response. To clarify, when I read (or focus on the writing or diagram on a board in class), my eye ball starts to pulsate. Usually, I start feeling pain within seconds after I stop reading, or stop focusing on the classroom board. The pain then lasts for hours, and often overnight. The pulsating and pain always happen after I do certain activities, such as reading. If I do not read or visually focus on anything, pain and pulsating do not start to occur. The pain feels sharp, and is almost always only in my left eye ball--not the right eye ball.
So, to clarify, if I read, I get pulsating in my eye. When I stop reading, I feel the pain.
However, when I do extensive reading, I get the pulsating early on, and then the eye pain usually occurs during the reading, a while after the pulsating has already started.
I have only seen a neurologist once so far. I also made an appointment to see him in a couple days from today. When I saw him, he seemed pretty sure that it's probably a migraine-related problem, and he ordered an MRI, but he did not order an MRA. I will be sure to talk to my neurologist about getting an MRA.
The MRI was performed without and with contrast. First it was done without gadolinium, and afterward, gadolinium was used.
I do not have the skin lesions you mentioned.
This point that you mentioned was very helpful to hear: "I can understand why the neurologist is thinking in terms of a migraine type of headache since a common complaint is that of I pain which throbs but there is generally also a severe headache as well as other symptoms of typical migraine such as nausea, vomiting, and visual aura is which can be bizarre and sometimes colorful. Since you are not describing any of these symptoms at all I think it is less likely that what you are feeling is that of a migraine headache and nothing else." I am surprised by this point because when I saw the neurologist, he seemed pretty sure it is a migraine causing my problem. I will definitely let him know that I do not have the other symptoms. Is it impossible for a migraine to be causing my problem since I do not have the other symptoms you mentioned?
Also, I had a standard blood test in 2013. I know that it checked my thyroid gland, and that came back negative. Are most of the blood test items that you mentioned tested on a standard, regular blood test?
Thank you for the helpful information. It's very interesting to hear that it's unlikely for me to have a migraine-equivalent problem causing my pain. It's also good to have the MRA suggestion. I will be seeing the neurologist in a couple of days, and I will definitely mention these points to him. I would appreciate if you have more ideas about what can be causing my eye pulsation and pain, now that I've provided more details about when the pain occurs. Thank you for the help.
Thank you very much for the detailed, thorough response. To clarify, when I read (or focus on the writing or diagram on a board in class), my eye ball starts to pulsate. Usually, I start feeling pain within seconds after I stop reading, or stop focusing on the classroom board. The pain then lasts for hours, and often overnight. The pulsating and pain always happen after I do certain activities, such as reading. If I do not read or visually focus on anything, pain and pulsating do not start to occur. The pain feels sharp, and is almost always only in my left eye ball--not the right eye ball.
So, to clarify, if I read, I get pulsating in my eye. When I stop reading, I feel the pain.
However, when I do extensive reading, I get the pulsating early on, and then the eye pain usually occurs during the reading, a while after the pulsating has already started.
I have only seen a neurologist once so far. I also made an appointment to see him in a couple days from today. When I saw him, he seemed pretty sure that it's probably a migraine-related problem, and he ordered an MRI, but he did not order an MRA. I will be sure to talk to my neurologist about getting an MRA.
The MRI was performed without and with contrast. First it was done without gadolinium, and afterward, gadolinium was used.
I do not have the skin lesions you mentioned.
This point that you mentioned was very helpful to hear: "I can understand why the neurologist is thinking in terms of a migraine type of headache since a common complaint is that of I pain which throbs but there is generally also a severe headache as well as other symptoms of typical migraine such as nausea, vomiting, and visual aura is which can be bizarre and sometimes colorful. Since you are not describing any of these symptoms at all I think it is less likely that what you are feeling is that of a migraine headache and nothing else." I am surprised by this point because when I saw the neurologist, he seemed pretty sure it is a migraine causing my problem. I will definitely let him know that I do not have the other symptoms. Is it impossible for a migraine to be causing my problem since I do not have the other symptoms you mentioned?
Also, I had a standard blood test in 2013. I know that it checked my thyroid gland, and that came back negative. Are most of the blood test items that you mentioned tested on a standard, regular blood test?
Thank you for the helpful information. It's very interesting to hear that it's unlikely for me to have a migraine-equivalent problem causing my pain. It's also good to have the MRA suggestion. I will be seeing the neurologist in a couple of days, and I will definitely mention these points to him. I would appreciate if you have more ideas about what can be causing my eye pulsation and pain, now that I've provided more details about when the pain occurs. Thank you for the help.
Brief Answer:
Specific task of reading's important in my opinion
Detailed Answer:
Well, now we have more information. Very good...Thank You.
Also, it seems that this problem is in both eyes correct? You've never specified one eye or the other although you always use the word EYE in all your writings. I'm getting the impression though that it's both eyes, no?
It is possible to have migraine headaches WITHOUT THE HEADACHE. This is referred to as acephalgic migraine headaches. However, usually in that presentation there are other symptoms which you do not have such as nausea, vomiting, light/sound sensitivity, glittering lights, etc. Your symptoms are those of eye pulsation(s) which turn into PAIN once you stop the focusing or reading activity.
I just can't help but coming back to the notion that since the focusing and reading are so specific to the rest of the picture that in fact, it's not migraine headache causing your symptoms, it's the activity of focusing which utilizes the extraocular muscles that initiates the whole process. Following this there is a long lasting pain in the eye. I agree that it is possible to think of this in terms of migraine headaches only because the trigeminal nerve is being stimulated when the eye muscles contract and move the globe and so forth, however, where are the rest of the typical headache symptoms for this to be legitimately called MIGRAINE as opposed to ocular tension or pain syndrome? Of course, it would also very interesting to know exactly how long you've had this problem and if anybody else in your family has similar problems, history of migraine headaches, or other neurological disease.
I think that some form of task specific eye muscle strain is precipitating this phenomenon and I have no further information to add as to where the pulsatile feelings are coming from than what I've already mentioned in terms of trying to rule out some type of vascular anomaly. I was also thinking in terms of something called dystonia that could be triggered by the act of extraocular muscle use and I'm wondering if that could be something. Again, though why the pain only comes on after you're done with the task would be difficult to explain though why it gets triggered (i.e. act of reading or eye focusing) would not be as difficult to explain. However, the truth is you are ALWAYS focusing on something with your eyes during your waking hours so is it really upon "FOCUSING" or is it the specific ACT of reading following by NON-READING that precipitates this whole thing.....very interesting indeed.
In the case of MIGRAINE TIC-SYNDROME it has been written that gabapentin has shown to be useful at least in some cases. Again, your presentation is entirely unlike any case of this which is written or that I've seen.
The lab tests I mentioned to you are not typically found in routine blood work.
I think it is worthwhile following the possibility of some kind of very unusual form of migraine headache phenomenon if nothing else really pans out...but again, the idea of this picture being primarily precipitated by reading or focusing vision on something makes me believe that any type of acute treatment for migraine headaches will be wholly inadequate since you would simply be trying to chase down the consequence of the act that started everything. You wouldn't really be chasing down the cause with that approach.
If on the other hand one tried targeting the headache theory from a prophylactic point of view (and that's what the neurologist tried to do with Topamax) then, there may be some success.
I would encourage you to fill out a headache diary or log with respect to these symptoms and to really look for other accompanying things such as HEADACHE, sensitivity to light/sound/smells, shimmering lights, zig zag lines, flashes of lights, etc. If you discover any of those things then, we're looking more at what I would expect for migraines than what we've been hearing about thusfar.
If you would like to discuss these a bit more in a webcam format where we could meet over telecommunication lines through the internet that would be WAY COOL and that way I could get more information from you. If that idea appeals to you then, please feel free to look for me on a network known as HealthTap found at www.HealthTap.com. My name is XXXXXXX SAGHAFI, MD and I am in the State of OHIO. I don't know exactly how you'd track me down specifically from where you were connecting except to say that I am on shift from 3a-7a Eastern Standard Time on Wed (tonight for example), Thurs, Friday, and Saturday.
Please feel free to look me up either there on HealthTap using your webcam or back on this network by writing specific questions to my attention and I'll be happy to answer. I think this is a very unusual case and I'd love to see this through to a resolution ALTHOUGH truth be told I am not very sure it's a neurological problem if we take migraine out of the equation. I think it comes down to ophthalmology needing to get in here to do some work (assuming MRI/MRA etc. are all negative).
Nevertheless, I'm sure there must be a solution to this problem. Who is the neurologist you're seeing? You don't have to identify if you choose not to but I'm just curious to know with which group, clinic, or hospital they are affiliated. Is it a headache specialist you're seeing?
Whew!
If I've provided useful information to you I'd very much appreciate your written feedback with a STAR RATING of our conversations and also would be very thankful if you could CLOSE THE QUERY assuming there are no further questions to discuss. Having said the previous statements I would somehow like to continue to keep tabs on what's going on to find out how this proceeds or turns out. I think it's fascinating but I think there should be a resolution to the problem as well...which of course, is our ultimate goal.
This query required 39 minutes of physician specific time for review, research, and documentation of final draft for envoy.
Specific task of reading's important in my opinion
Detailed Answer:
Well, now we have more information. Very good...Thank You.
Also, it seems that this problem is in both eyes correct? You've never specified one eye or the other although you always use the word EYE in all your writings. I'm getting the impression though that it's both eyes, no?
It is possible to have migraine headaches WITHOUT THE HEADACHE. This is referred to as acephalgic migraine headaches. However, usually in that presentation there are other symptoms which you do not have such as nausea, vomiting, light/sound sensitivity, glittering lights, etc. Your symptoms are those of eye pulsation(s) which turn into PAIN once you stop the focusing or reading activity.
I just can't help but coming back to the notion that since the focusing and reading are so specific to the rest of the picture that in fact, it's not migraine headache causing your symptoms, it's the activity of focusing which utilizes the extraocular muscles that initiates the whole process. Following this there is a long lasting pain in the eye. I agree that it is possible to think of this in terms of migraine headaches only because the trigeminal nerve is being stimulated when the eye muscles contract and move the globe and so forth, however, where are the rest of the typical headache symptoms for this to be legitimately called MIGRAINE as opposed to ocular tension or pain syndrome? Of course, it would also very interesting to know exactly how long you've had this problem and if anybody else in your family has similar problems, history of migraine headaches, or other neurological disease.
I think that some form of task specific eye muscle strain is precipitating this phenomenon and I have no further information to add as to where the pulsatile feelings are coming from than what I've already mentioned in terms of trying to rule out some type of vascular anomaly. I was also thinking in terms of something called dystonia that could be triggered by the act of extraocular muscle use and I'm wondering if that could be something. Again, though why the pain only comes on after you're done with the task would be difficult to explain though why it gets triggered (i.e. act of reading or eye focusing) would not be as difficult to explain. However, the truth is you are ALWAYS focusing on something with your eyes during your waking hours so is it really upon "FOCUSING" or is it the specific ACT of reading following by NON-READING that precipitates this whole thing.....very interesting indeed.
In the case of MIGRAINE TIC-SYNDROME it has been written that gabapentin has shown to be useful at least in some cases. Again, your presentation is entirely unlike any case of this which is written or that I've seen.
The lab tests I mentioned to you are not typically found in routine blood work.
I think it is worthwhile following the possibility of some kind of very unusual form of migraine headache phenomenon if nothing else really pans out...but again, the idea of this picture being primarily precipitated by reading or focusing vision on something makes me believe that any type of acute treatment for migraine headaches will be wholly inadequate since you would simply be trying to chase down the consequence of the act that started everything. You wouldn't really be chasing down the cause with that approach.
If on the other hand one tried targeting the headache theory from a prophylactic point of view (and that's what the neurologist tried to do with Topamax) then, there may be some success.
I would encourage you to fill out a headache diary or log with respect to these symptoms and to really look for other accompanying things such as HEADACHE, sensitivity to light/sound/smells, shimmering lights, zig zag lines, flashes of lights, etc. If you discover any of those things then, we're looking more at what I would expect for migraines than what we've been hearing about thusfar.
If you would like to discuss these a bit more in a webcam format where we could meet over telecommunication lines through the internet that would be WAY COOL and that way I could get more information from you. If that idea appeals to you then, please feel free to look for me on a network known as HealthTap found at www.HealthTap.com. My name is XXXXXXX SAGHAFI, MD and I am in the State of OHIO. I don't know exactly how you'd track me down specifically from where you were connecting except to say that I am on shift from 3a-7a Eastern Standard Time on Wed (tonight for example), Thurs, Friday, and Saturday.
Please feel free to look me up either there on HealthTap using your webcam or back on this network by writing specific questions to my attention and I'll be happy to answer. I think this is a very unusual case and I'd love to see this through to a resolution ALTHOUGH truth be told I am not very sure it's a neurological problem if we take migraine out of the equation. I think it comes down to ophthalmology needing to get in here to do some work (assuming MRI/MRA etc. are all negative).
Nevertheless, I'm sure there must be a solution to this problem. Who is the neurologist you're seeing? You don't have to identify if you choose not to but I'm just curious to know with which group, clinic, or hospital they are affiliated. Is it a headache specialist you're seeing?
Whew!
If I've provided useful information to you I'd very much appreciate your written feedback with a STAR RATING of our conversations and also would be very thankful if you could CLOSE THE QUERY assuming there are no further questions to discuss. Having said the previous statements I would somehow like to continue to keep tabs on what's going on to find out how this proceeds or turns out. I think it's fascinating but I think there should be a resolution to the problem as well...which of course, is our ultimate goal.
This query required 39 minutes of physician specific time for review, research, and documentation of final draft for envoy.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The pain is only in my left eye. Once in a while, after I'm in a lot of left eye pain, I'll feel pain in my right eye, but that's rare. Almost always, the pain is only in my left eye.
Also, I am seeing Dr. XXXXXXX Kaner in Michigan. I am not sure what he specializes in.
Also, just to clarify, the pain isn't just when reading. It's also when focusing on diagrams on boards in class.
Also to clarify, I have the pain while reading, as well.
Do you think the pain might be related to my eye muscles? Maybe they just get tired and strained very quickly? Thank you for the information!
I might try out the Health Tap website sometime. It sounds like a great resource.
Also, I am seeing Dr. XXXXXXX Kaner in Michigan. I am not sure what he specializes in.
Also, just to clarify, the pain isn't just when reading. It's also when focusing on diagrams on boards in class.
Also to clarify, I have the pain while reading, as well.
Do you think the pain might be related to my eye muscles? Maybe they just get tired and strained very quickly? Thank you for the information!
I might try out the Health Tap website sometime. It sounds like a great resource.
Brief Answer:
Eye strain likely cause of problem
Detailed Answer:
Good morning once again. After rereading your information with all the updated points you've provided that I could find here is what I have as an encapsulated summary of your condition:
1. Left eye pulsations primarily (sometimes on the right) which are brought on by reading and focusing on things such as diagrams on the blackboard and other things.
2. Pain that comes on FOLLOWING the activity of reading or focusing but not before. This pain can be prolonged and severe
3. There are no other symptoms to report either before or after the throbbing sensation such as nausea, vomiting, flashing lights, visual field defects, ringin in the ears, being off balance, etc.
4. Topamax was tried but seemed to cause visual problems and was stopped. Visual acuity has not yet gotten back to completely normal.
5. You've seen ophthalmologists who have thought that your presentation was more migraine than anything else. I do not see in your information that you've ever been fitted for eyeglasses or anything of that nature?
6. Dr. Kaner (neurologist) is working with the diagnosis of "migraine tic-syndrome." He has ordered a number of tests and studies which have all been reported as NORMAL.
7. I do not have any information on the length of time that this problem has been going on for nor do I have any family history information on similar medical conditions, neurological problems, headache history, etc.
Therefore, I put everything together this way. I believe your problem of left eye pulsation is precipitated by the acts of reading and focusing on things that are likely DIFFICULT for you to clearly see or perhaps are at a distance. I don't know how close or far you sit from boards in the classroom. But generally speaking, when people tell me they have "trouble seeing the board" it's almost always a case of sitting too far back.
Once the problem has been initiated and pulsations begin you are on a road of pain and discomfort for some period of time after the activity. I believe this comes about as a SECONDARY effect of the reading and focusing. I do believe that treating the pain component of this problem as one would treat a migraine is a reasonable way to proceed. I am not yet convinced that the ocular pulsations are headache prodrome and that the pain is the actual migraine but I certainly think it's possible.
We know that Topamax is not a good drug for you because of its side effects on your vision. There are other options which I am sure Dr. Kaner can or will suggest to treat the acute painful component of this picture.
However, if we assume that you have normal labs, normal other studies, and there is no chance you have a rogue aneurysm hiding out either in or around the eye or inside the brain close to the optic nerve or in the carotid arteries THEN, I believe the real definitive treatment to this whole thing comes down to addressing a problem of EYESTRAIN. Pure and simple. I just had a patient the other day in Headache Clinic (By the way, I'm the Director of the Headache Service at the VA Medical Center in XXXXXXX OH) who was having terrible headaches and pain behind the eyes (both eyes) whenever he was reading or driving. He had full blown symptoms of nausea, vomiting, etc.
I sent him to the optometry service and they fitted him with some glasses. He was slightly myopic in one eye and astigmatic in the other. His headaches precipitated by reading and driving resolved upon putting on the glasses. He was so happy that I don't think he has taken his glasses off his head since he put them on! Miracle! LOL.....
Please get to an ophthalmologist who is willing to do an EXCELLENT refraction and get that problem solved. Also, SIT UP CLOSER TO THE BLACKBOARDS.....and DON'T READ SUCH SMALL FONT on computer screens or in books for the time being until you get some STYLISH specs.....(I'm not a fan of laser surgeries or contacts....but those are different stories to tell when you've got time!).
If it comes to having to treat pain then, I believe following a plan of treating these as migraine headaches (SECONDARY to eyestrain) is a reasonable plan.
Start keeping a detailed LOG of your episodes. You can find good HEADACHE LOGS on a number of different websites.
Eye strain likely cause of problem
Detailed Answer:
Good morning once again. After rereading your information with all the updated points you've provided that I could find here is what I have as an encapsulated summary of your condition:
1. Left eye pulsations primarily (sometimes on the right) which are brought on by reading and focusing on things such as diagrams on the blackboard and other things.
2. Pain that comes on FOLLOWING the activity of reading or focusing but not before. This pain can be prolonged and severe
3. There are no other symptoms to report either before or after the throbbing sensation such as nausea, vomiting, flashing lights, visual field defects, ringin in the ears, being off balance, etc.
4. Topamax was tried but seemed to cause visual problems and was stopped. Visual acuity has not yet gotten back to completely normal.
5. You've seen ophthalmologists who have thought that your presentation was more migraine than anything else. I do not see in your information that you've ever been fitted for eyeglasses or anything of that nature?
6. Dr. Kaner (neurologist) is working with the diagnosis of "migraine tic-syndrome." He has ordered a number of tests and studies which have all been reported as NORMAL.
7. I do not have any information on the length of time that this problem has been going on for nor do I have any family history information on similar medical conditions, neurological problems, headache history, etc.
Therefore, I put everything together this way. I believe your problem of left eye pulsation is precipitated by the acts of reading and focusing on things that are likely DIFFICULT for you to clearly see or perhaps are at a distance. I don't know how close or far you sit from boards in the classroom. But generally speaking, when people tell me they have "trouble seeing the board" it's almost always a case of sitting too far back.
Once the problem has been initiated and pulsations begin you are on a road of pain and discomfort for some period of time after the activity. I believe this comes about as a SECONDARY effect of the reading and focusing. I do believe that treating the pain component of this problem as one would treat a migraine is a reasonable way to proceed. I am not yet convinced that the ocular pulsations are headache prodrome and that the pain is the actual migraine but I certainly think it's possible.
We know that Topamax is not a good drug for you because of its side effects on your vision. There are other options which I am sure Dr. Kaner can or will suggest to treat the acute painful component of this picture.
However, if we assume that you have normal labs, normal other studies, and there is no chance you have a rogue aneurysm hiding out either in or around the eye or inside the brain close to the optic nerve or in the carotid arteries THEN, I believe the real definitive treatment to this whole thing comes down to addressing a problem of EYESTRAIN. Pure and simple. I just had a patient the other day in Headache Clinic (By the way, I'm the Director of the Headache Service at the VA Medical Center in XXXXXXX OH) who was having terrible headaches and pain behind the eyes (both eyes) whenever he was reading or driving. He had full blown symptoms of nausea, vomiting, etc.
I sent him to the optometry service and they fitted him with some glasses. He was slightly myopic in one eye and astigmatic in the other. His headaches precipitated by reading and driving resolved upon putting on the glasses. He was so happy that I don't think he has taken his glasses off his head since he put them on! Miracle! LOL.....
Please get to an ophthalmologist who is willing to do an EXCELLENT refraction and get that problem solved. Also, SIT UP CLOSER TO THE BLACKBOARDS.....and DON'T READ SUCH SMALL FONT on computer screens or in books for the time being until you get some STYLISH specs.....(I'm not a fan of laser surgeries or contacts....but those are different stories to tell when you've got time!).
If it comes to having to treat pain then, I believe following a plan of treating these as migraine headaches (SECONDARY to eyestrain) is a reasonable plan.
Start keeping a detailed LOG of your episodes. You can find good HEADACHE LOGS on a number of different websites.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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