Seeing "spots", zig-zag lines, and flashing lights

Popularly referred to as "ophthalmic" or "ocular" migraines, this common condition primarily causes visual symptoms and has the official classification from the International Headache Society of "ancephalgic migraine with aura." Ancephalgic means that there is no headache and the term aura refers to the visual symptoms experienced. This condition is distinguished from a classic migraine in which a headache is a predominant symptom, and the far less common and more serious condition known as a "retinal migraine". Today's Health Tip deals with the more common and possibly misnamed ophthalmic or ocular migraine.

What is a migraine? Migraine is a common neurological disorder usually associated with one-sided, throbbing headache. Up to 12 % of the U.S. population have migraines. At one time migraines were thought to be caused by constriction of blood vessels but more recent research involving the use of imaging studies indicates that there may be actual structural changes involving the white matter of the brain. Migraine sufferers have different triggers or precipitating factors for their headaches, such as fatigue, bright lights, weather changes, and others.

What is an aura? Some migraines are preceded by sensory warning symptoms called auras. In the case of ophthalmic migraine, the aura will be visual in nature and may be described as:

• Seeing flashing or flickering lights (scintillations)
   
• Seeing zig-zag lines or waves
   
• Seeing an enlarging blind spot (scotoma) in the center of the visual field
   
• Having blurred vision

In the classic migraine the aura precedes the development of the typical symptoms---one-sided headache, nausea, light sensitivity, etc.

How serious is an ophthalmic migraine? Often someone with an ophthalmic migraine will have just the visual warning signs or aura of their migraine attack without the headache. Characteristically these visual symptoms affect both eyes, last around a half hour and resolve on their own. While they can temporarily interfere with activities such as driving or reading, they are not considered to be serious. In contrast to the ophthalmic migraine, the visual symptoms associated with the retinal migraine affects only one eye and can cause temporary blindness.

When should a doctor be consulted? Since it can be difficult for someone who is experiencing unusual visual symptoms for the first time to know whether they are related to a benign or serious condition, it is a good idea to see an eye specialist for evaluation.

Is treatment available for ophthalmic migraines? Because they generally are harmless and typically resolve on their own, ophthalmic migraines usually require no treatment. Since they can adversely affect driving or performing certain tasks, it is best to stop these activities and relax during an episode. By keeping a journal of your diet and activities it may be possible to identify something that consistently triggers the migraine, offering an opportunity to avoid the precipitating factor. Treatment, including medicines designed to prevent future attacks, is available for frequent ophthalmic migraines, particularly if a headache is a part of the symptom complex.

The terms "ophthalmic", "ocular", and "retinal" migraines are often used interchangeably and sometimes inappropriately. If you are labeled as having one of these, be sure that you understand which specific condition applies to you. What is commonly referred to as an ophthalmic or ocular migraine is actually the aura of a more typical migraine, often without the headache component.

Office Ergonomics

Most of our eDocAmerica clients regularly use computers at home or at work. In fact, it has been estimated that approximately 70% of the U.S. work force now sit while performing their jobs, many in front of computers. As with many other jobs, there are occupational hazards related to working on a computer. For example, poor sitting posture and poorly designed workspaces are major causes of neck and back pain. Fortunately, there are measures that can help improve the "ergonomics" of the workstation and help to prevent many of these problems.

Chair adjustments

Contrary to the popular belief that sitting is relaxing, it is actually hard on the back. Sitting for long periods of time causes increased pressure on the intervertebral discs - the spongy discs between the vertebra. Sitting is also hard on the feet and legs. Gravity tends to pool blood in the legs and feet and create a sluggish return to the heart. The following recommendations can help increase comfort for computer users:

• When performing daily tasks, alternate between sitting and standing. For every 50 minutes you work sitting at your desk, take a 10 minute break.
  
  
• The chair back should have a lumbar feature that supports the natural inward curve of the lower back. If it does not, use a rolled towel, lumbar roll or cushion to support the low back.
  
  
• Proper sitting posture while at your computer is as follows: feet flat on floor, knees at 90 a degree angle, thighs parallel to the floor, and elbows at a 90 degree angle. The neck and wrists should be in a "neutral" position (neither flexed nor extended).
  
  
• Position adjustable armrests so they support your lower arm and allow your upper arm to remain close to the torso. If the armrests cannot be properly adjusted, or if they interfere with your workstation, remove them, or stop using them.
  
  
• Have enough space under your work surface so that you can pull yourself all the way up to the edge of the desk with room for your legs and knees to fit comfortably.

Proper keyboard and mouse set up and usage

Many musculoskeletal problems associated with computer workstations occur in the shoulder, elbow, forearm, wrist, and hand. Working on a computer, especially if the workstation is not set up properly, may expose soft tissues to injury due to repetitive stress or being in an awkward position. The following adjustments can help prevent some of these problems:

• First adjust your chair as mentioned above, then position the keyboard directly in front of you at a distance that allows your elbows to stay close to your body with your forearms approximately parallel with the floor.
  
  
• The elbows should be at approximately the same height as the keyboard and hang comfortably to the side of the body.
  
  
• Shoulders should be relaxed, and wrists should not bend up or down or to either side during keyboard use.
  
  
• The mouse should be placed adjacent to keyboard and at the same height as the keyboard. When using the mouse, do not bend your wrist upward.
  
  
• The slope of the keyboard may need to be adjusted so that it is flat in order that your wrists are straight and not bent back while you are typing.

Monitor position and placement

Once the chair and work surface height are properly adjusted, the computer monitor should be placed so the top of the screen is at or just below eye level when seated in an upright position. The following suggestions can help prevent the development of eye strain, neck pain and shoulder fatigue while using your computer workstation:

• Position the monitor directly in front of the user to avoid excessive twisting of the neck.
  
  
• Make sure the surface of the viewing screen is clean and adjust brightness and contrast to optimum comfort.
  
  
• Position the monitor at a comfortable viewing distance, approximately 20-40 inches from the user. Tilt the monitor so it is perpendicular to your line of sight.
   
• Position monitors away from direct lighting which creates excessive glare or use a glare filter over the monitor to reduce glare.
  
  
• Rest your eyes periodically by focusing on objects that are farther away (for example, a clock on a wall 20 feet away).

In addition to these ergonomic measures, it helps to periodically stretch or perform exercises during the work day to relieve fatigued muscles and joints.

Drug Interactions

Did you know that drinking grapefruit juice with certain cholesterol-lowering drugs can result in dangerously high levels of those drugs in the body? Were you aware that some over-the-counter (OTC) pain medications can be harmful if you are taking a prescription anti-inflammatory drug? These are examples of problems that can develop when one medication interacts with another. Drug interactions may make a medication less effective, cause a drug level to become dangerously high, or produce serious physical or mental side effects.

Most drug interactions fall into one of three categories:                     

• Drug-Drug interactions. Two out of every three patients who visit a doctor leave with at least one prescription and up to 40 percent of the U.S. population receive prescriptions for four or more medications. This sets the stage for the possibility of drug-drug interactions. If the prescribing physician is unaware of all the medications that a patient is taking or if that the medication is capable of interacting with another drug, unexpected reactions can occur. For example, mixing a medication to "calm your nerves" (a tranquilizer) and a drug you take for allergies (certain antihistamines) can slow your reactions and make driving a car or operating machinery dangerous.
  
  
• Drug-Food/Beverage interactions. What you eat and drink can affect the way that certain medications are absorbed or metabolized (broken down) by the body. Depending on the drug and food ingested, this can lead to dangerously high levels of the medication or levels that are too low to be therapeutically effective. For example, grapefruit juice can interact adversely with a number of medications including certain antibiotics, high blood pressure medication and cholesterol-lowering medications.
  
  
• Drug-Dietary Supplement interactions. According to the National Institutes of Health, about half of American adults use dietary supplements on a regular basis. These include vitamins, minerals, amino acids, and herbs or botanicals. One example of this type of interaction is taking Vitamin E with the blood-thinning medication, Coumadin. Doses of Vitamin E higher than 1000 IU have been noted to produce or increase anti-clotting activity and may cause an increased risk of bleeding.
  

In addition to the efforts of doctors and pharmacists to avoid drug interactions, it is important for anyone who is taking more than one medication to be vigilant also. Here are some ways that you can become a more informed consumer and prevent interactions from occurring:

1. Read labels. Over-the-counter (OTC) drug labels contain information about ingredients, directions for use, side effects and in many cases, interactions. With prescription medications, ask your pharmacist if you can have the package insert detailing information about any new drug being prescribed. This information is especially important for someone to read who is currently taking medications or nutritional supplements.
   
   
2. Talk to your doctor about the drugs you take. When your doctor prescribes a new drug, make sure he or she is aware of all the OTC and prescription drugs, dietary supplements, vitamins/ minerals and herbals that you take. Before taking the new medication, ask your doctor the following questions:
   
   
   • Can I take it with other drugs?
     
   • Should I avoid certain foods, beverages or other products?
     
   • What are possible drug interactions I should know about?
   
   
3. Get help from your Pharmacist. If possible, have your prescriptions filled at the same pharmacy. Most pharmacies are able to perform a computerized interaction screen if they know the medications, supplements, etc. that you are taking. Make sure that you know how and when to take each medication for the best therapeutic results. In some cases it is best to take medications with meals, whereas other medications are best taken on an empty stomach.
   
   
4. Think about "hidden" medicines.  Many herbal remedies, nutritional supplements and even vitamins have the potential to cause drug interactions. Just because something is marketed as a nutritional supplement (rather than a drug) or a "natural" product does not mean that it is always safe to take along with other medications.
   
   
5. Keep a record of all of your medications. This includes prescription drugs, OTC drugs, and dietary supplements (including herbs). Keep this list with you when you go for a doctor's appointment and make sure that the doctor is aware of the various medications or products that you are taking for your health.

The problem of drug interactions is almost certain to get worse. Increasing numbers of people are taking more than one medication. Medications that were formerly available by prescription only are being released to the OTC market. The increased interest in herbal and "natural" remedies has led more people to "self-prescribe" these products. For these reasons, doctors, pharmacists and consumers must all stay alert to the possibility of interactions occurring.