title: Typical migraine or ophthalmologic emergency?
abstract: We describe the case of a 47-year-old woman who came to the emergency department (ED) complaining of worse than typical migraine headache and blurry vision after recently doubling the dose of topiramate earlier that day. After complete neurologic and ophthalmologic evaluation, she was found to have elevated intraocular pressures and was diagnosed with topiramate-induced bilateral acute angleclosure glaucoma, which is a rare side effect of this commonly prescribed medication. She was treated with timolol, brimonide, and prednisolone drops to reduce intraocular pressure as well as cessation of topiramate and was discharged home. This report briefly discusses the clinical history, appropriate evaluation, differential diagnosis, and approach to secondary acute angle-closure glaucoma in the ED.
authors.affiliation: Department of Emergency Medicine, Georgetown University Hospital, Washington Hospital Center, Washington, DC 20007, USA. mybarra@gmail.com
authors.forename: Michael
authors.initials: M
authors.lastname: Ybarra
authors.forename: Tina
authors.initials: T
authors.lastname: Rosenbaum
mesh_terms: D004636:Emergency Service, Hospital; D005260:Female; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D015812:Glaucoma, Angle-Closure / Q000139:chemically induced / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis* / Q000188:drug therapy; D018696:Neuroprotective Agents / Q000009:adverse effects / Q000627:therapeutic use; D000077236:Topiramate
chemical_list: D018696:Neuroprotective Agents; D000077236:Topiramate; D005632:Fructose