Nearly two years ago, I experienced a painless sparkling in both eyes, which lasted 15 minutes. Since then, it’s happened three times. A CT scan of my brain was clear and I was told it was probably a migraine, even though I don’t normally get them. I’m worried as I don’t understand what is going on in my brain.
Sarah-Jane Kitching, Sandown, Isle of Wight.
Dr Martin Scurr replies: The symptoms you describe are typical of migraine aura – a temporary shimmering, flashing or sparkling disturbance that starts in the centre of the visual field and spreads outwards.
As you don’t experience pain with it, I believe it might be migraine aura without headache, sometimes called acephalgic migraine – or silent migraine.
There is nothing that can be prescribed during an episode itself, as this resolves before any tablet could be absorbed, so the best solution is to find a quiet place to rest until it passes.
However, there are medications that can reduce the risk of silent migraines. These include the beta-blocker propranolol, which reduces the ‘excitability’ in the brain that leads to migraines; as well as topiramate (an anticonvulsant) or amitriptyline (an antidepressant), which calm hyperactive nerves involved in migraine onset.
In your case, I would not recommend preventative medication unless attacks become more frequent – weekly or more – as there is, as always with any drug, a risk of side-effects.
To confirm that it is silent migraine, the next time you experience an episode, try covering one eye, then the other. If the sparkling remains visible in both cases, this supports the migraine aura theory, as it shows the disturbance is in the brain.
A key symptom of acephalgic migraine is a temporary shimmering, flashing or sparkling disturbance that starts in the centre of the visual field and spreads outwards (picture posed by model)
If it disappears when one eye is covered, I’d suggest you need eye and vascular investigations (the latter to check blood flow).
Possible migraine triggers include stress, poor sleep, missing meals and dehydration – or even a combination of these.
I’ve had a cough for more than three years but scans show my lungs are clear. Doctors have tried various treatments, but nothing has worked. Will I just have to put up with it?
Jeff Carlton, Whitby, N. Yorks.
Dr Martin Scurr replies: It’s reassuring that your chest X-ray and CT scan were clear, as this excludes serious conditions including tuberculosis and lung cancer.
In your longer letter, you say your symptoms eased when you were prescribed the antihistamine azelastine, as this helped with nasal congestion that contributed to the cough. You also mention relief from your regular asthma inhaler (Fostair).
However, it seems the only time your cough has been fully resolved is when you were prescribed antibiotics – this cleared your chest for six months, then the cough returned.
This points to an underlying bacterial lung infection – and one factor involved here is the daily dose of the steroid prednisone you’re also taking for vasculitis (where the immune system attacks the blood vessels, causing them to narrow and restrict blood flow). Prednisone suppresses the immune system, possibly reducing its ability to fight off a lung infection.
It is also possible you do have a degree of bronchiectasis (where the lungs are damaged from repeat infections) that was missed on the initial scans.
Further investigations – by way of a high-resolution CT scan – might be required, along with three sputum samples to be cultured, to confirm this.
These samples should identify the specific bacteria involved, and look for fungal infection, as steroid inhalers such as Fostair are a risk factor for this.
Another possibility is that you have vasculitis that affects your respiratory tract or lungs. This, too, can cause a cough.
Your lung condition is complex and I suggest taking it up with your respiratory physician if you are under the care of one – or ask your GP for a referral to one.
In my view: Scans can’t always detect weak bones
As many as 50 per cent of women over the age of 50 will suffer an osteoporosis fracture – some following falls, others occurring spontaneously (the vertebrae in the spine collapsing, for instance). Clearly, it’s vital we diagnose women early, so they can receive the right treatment pre-emptively.
Taking calcium and vitamin D supplements and drugs called bisphosphonates can prevent further bone loss, and such measures have been shown to reduce vertebral fractures by more than 40 per cent.
The standard tool for diagnosis is a DEXA bone scan – yet most doctors fail to realise a woman can have normal bone density on a scan yet still experience a fracture after minimal trauma.
This is because bone strength is not just about how much bone there is, but the quality of that bone – affected by factors such as the size of the holes in the bones’ honeycomb structure.
As yet, there isn’t a standard way to measure this, so prevention is key: exercise regularly (include impact activities such as skipping or dancing) and eat a calcium-rich diet, with dairy products and bony fish such as sardines.
Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@dailymail.co.uk. Dr Scurr cannot enter into personal correspondence. Always consult your own GP with any health concerns.
