CONTACT DR SCURRTo contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details.Dr Scurr cannot enter into personal correspondence.His replies cannot apply to individual cases and should be taken in a general context.
This has been an alarming experience, and if it wasn’t for the fact that you have suffered for such a long time, these symptoms could easily ignite anxiety about the possibility of a sinister illness.
Fortunately, there is a clear and positive diagnosis, and I hope you will find the explanation reassuring.
From your accurate description, it seems to me the problem is fortification spectrum or, as it’s more commonly known, a visual migraine.
You are fortunate that you do not also suffer the usual cracking headache that accompanies these symptoms. I suspect the dull ache you describe fades away after an hour or two, or perhaps it’s easily rid with a simple painkiller such as aspirin.
On several occasions I have come across patients who experience this condition, but without having the subsequent headache, which is the usual clue to migraine.
However, this lack of pain often triggers even more anxiety, as people assume there is some problem with their eyesight.
Migraine is a disorder of the brain with widely varying presentations: some people have the headache without any visual or other disturbance (migraine without aura); others have visual disturbance or odd transient symptoms such as dizziness and abdominal pain, but with little or no headache.
We are unclear what the cause is, but it is thought to be triggered by some malfunction in the area at the base of the skull called the brain stem.
The condition is usually due to genetic factors and can appear unpredictably at different times of life and with variable frequency.
Some patients can identify definite triggers for attacks. But this is not always the case, and unless it is obvious and clear-cut, obsessing about trigger factors is not particularly helpful.
You tell me in your longer letter that you suffer from high blood pressure and an underactive thyroid, but there is no reason to think these conditions are related to your migraine.
Keeping a diary of attacks may be helpful. In people who have more than six or eight bouts a month, we look to find a regular medicine that can avert episodes and reduce the frequency. But in the meantime, my suggestion would be not to worry about your symptoms and merely keep an eye on how many episodes you experience over the next 12 months. At least you do have a diagnosis. It is an annoying, but benign condition, with no threat to future health.
For the past 25 years, I have been talking the painkiller diclofenac for arthritis. I have briefly tried two alternatives, but neither was as effective. However, I have recently read alarming reports that diclofenac can cause heart attacks. Is this true? Mrs A. Bryan, West MidlandsDiclofenac is a good and widely used non-steroid anti-inflammatory drug (NSAID).
It is used for relief in many different conditions, from post-operative pain to chronic long-term conditions such as osteo-arthritis or rheumatoid arthritis.
It is also commonly used to reduce the agony of kidney stones, gout and migraine.
Diclofenac is a useful tool in our weaponry, which arrived when I was first a GP in the late Seventies.
It was an ideal alternative to the drugs in the morphine family, which we relied on heavily at that time (drugs such as pethidine or papaveretum), which caused heavy sedation and carried the risk of addiction and abuse — none of which applies to diclofenac.
The well known long-term complication of diclofenac and other NSAIDs such as ibuprofen and aspirin is ulceration in the stomach or small intestine, which can be dangerous because of the potential bleeding it can cause.
As a result, the risk versus benefit of long-term use must be weighed up very carefully.
The difficulty is that for some patients, this side-effect may be random and unpredictable — a person who has tolerated the drug with no symptoms for a long time may quite suddenly experience bleeding, much as can happen with simple aspirin.
The Medicines and Healthcare products Regulatory Agency (MHRA) — the government body responsible for drug safety — has conducted a review of the use and complications of diclofenac, and has drawn attention to potential heart and circulatory side-effects.
It appears that three patients in every 1,000 on diclofenac for a year may develop such complications (put simply, it increases the risk of death from stroke or heart attack by two to four times).
We are unclear why this should be. Against this you must set the fact that another large study found no additional cardiovascular (heart) risk from the use of diclofenac. So the evidence is confusing and the risk is certainly not obvious.
When the regular use of the drug is giving such benefit as you experience, there is a strong incentive to stay on it.
You should do all you can to reduce other risk factors for coronary heart disease or stroke — this means avoiding exposure to tobacco smoke, making certain your blood pressure is in the normal range, keeping your weight down at all costs, taking regular exercise and ensuring your cholesterol is controlled (this means a reading of below five).
By doing this, you are minimising the chances of heart attack or stroke.
More from Martin Scurr... How can I get this heavy feeling off my chest? 03/06/13 Ask the doctor: Bad breath is ruining my self-confidence 27/05/13 Ask the doctor: Will my shingles pain ever go away? 20/05/13 Ask the doctor: Is blood in my urine a reason to worry? 13/05/13 Ask the doctor: What has caused my unbearable leg pain? 29/04/13 Ask the doctor: Why are my teeth starting to crumble? 22/04/13 Ask the doctor: Simple steps for easing a hormone headache 08/04/13 Ask the doctor: Why do my wife's hands bruise so easily? 01/04/13 VIEW FULL ARCHIVE By the way...Bribing people to diet? It's not unthinkable Improving the health of the nation is not just about high technology inventions such as antibiotics or MRI scanning, but about changes in public health policy. The example often quoted to medical students is that of Dr John Snow. Bribing people to diet? It's not unthinkable Though he was famous as an anaesthetist — giving Queen Victoria chloroform when she was in labour with two of her children — he is best known as for his work as an epidemiologist (someone who studies the incidence, pattern and control of disease). He studied the outbreak of cholera in central London in 1854 and identified the source as a public water pump in the middle of Soho (this was before we even knew about germs as a cause of disease). His arguments persuaded the authorities to remove the handle of the pump, stopping people drawing their water from that source, and many lives were saved. As a result Snow was credited with founding the science of epidemiology.In this era of tight NHS budgets, we need to be thinking outside of the box in a similar way. With a quarter of adults obese and the costs of treating the associated diseases spiralling, the think-tank Demos has suggested people should be bribed to take exercise and eat a balanced diet. By giving them an incentive — for example, priority to access in healthcare (helping them jump the queues) in return for eating a healthier diet and exercising regularly — the think-tank believes the nation would become healthier and fewer resources would be spent trying to patch up people. Of course, this would need a vast raft of paid supervisors, administrators and inspectors — Big Brother really would have to be watching you — and what would that cost? But others are thinking along similar lines to try to alter damaging lifestyles. The Behavioural Insights Team is a government body at the centre of thinking about how to change the way we act, using the tools of psychology. It consists of nine clever people tasked with turning theory into government policy. Their idea is to make us feel happier about choices we make; encourage us into better decisions about healthcare by presenting choices in different ways. Let’s hope that this is applied usefully to health. At least someone is thinking about it, and what I hope is that they come up with strategies that are as effective as Dr Snow’s.
