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Typical migraine or ophthalmologic emergency?
Michael Ybarra1, Tina Rosenbaum
1Department of Emergency Medicine, Georgetown University Hospital, Washington Hospital Center, Washington, DC 20007, USA. mybarra@gmail.com
The American Journal of Emergency Medicine
|April 26, 2011
Summary
A woman experienced severe migraine and blurry vision after increasing her topiramate dose. She was diagnosed with rare topiramate-induced acute angle-closure glaucoma, a condition treatable by lowering eye pressure and stopping the medication.
Area of Science:
- Ophthalmology
- Neurology
- Pharmacology
Background:
- Topiramate is a commonly prescribed medication for migraines and epilepsy.
- Acute angle-closure glaucoma is a medical emergency characterized by a sudden increase in intraocular pressure.
- Drug-induced glaucoma can occur as a rare side effect of various medications.
Observation:
- A 47-year-old woman presented with severe headache and blurred vision after doubling her topiramate dosage.
- Ophthalmologic examination revealed elevated intraocular pressures.
- Neurologic evaluation ruled out other causes for her symptoms.
Findings:
- The patient was diagnosed with bilateral acute angle-closure glaucoma secondary to topiramate use.
- This represents a rare but serious adverse effect of topiramate.
- Prompt management included topical medications to reduce intraocular pressure and discontinuation of topiramate.
Implications:
- This case highlights the importance of considering drug-induced glaucoma in patients presenting with acute visual changes and headache.
- Emergency department physicians should be aware of this rare side effect of topiramate.
- Early diagnosis and management are crucial to prevent permanent vision loss.
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