- With the publication of certain articles, migraine pathophysiology has advanced from the Dark Ages, and, evolved from a descriptive art to stand at the threshold of science (see attachments).
- While we cannot pretend that all is known, we also should not keep going back to hypoxia of the brain at high altitudes that affects entire populations rather than a discrete relatively small percentage of the general population in say, Nepal (Manandhar et al. The Journal of Headache and Pain (2015) 16:95 DOI 10.1186/s10194-015-0580-y).
- Staying deeply entrenched in the past has never been proved to be scientific.
- The leap of conviction is never easy, and, migraine does not offer its comprehension on simple demand or simplistic investigations or fatuous theories.
- When will we learn to focus on physiology, on physiology, and on physiology?
Vinod Kumar Gupta
22/08/2017 06.52 A,M. in New Delhi, India
- Migraine at high altitudes is very likely linked t0 a higher intraocuar pressure (IOP). (see Gupta VK. Adaptive Mechanisms in Migraine. A Comprehensive Synthesis in evolution. Breaking the Migraine. Nova Science Publishers, Inc. New York, 2009, pp 25-37).
- This is the first time that such a link has been proposed between high altitude, IOP, and migraine frequency, openly in a public forum.
- There appears to be a strong-link between migraine prevention, low systemic blood pressure, and low IOP. ( see Gupta VK. Adaptive Mechanisms in Migraine. A Comprehensive Synthesis in evolution. Breaking the Migraine Code. Nova Science Publishers, Inc. New York, 2009, pp 25-37.)
- The reason for the observed increase in IOP may include both changes in CCT and exercise but a complete understanding of the mechanisms behind these changes remains distant. Although IOP appeared ineffective at predicting severity of AMS or HAR, further research is necessary to evaluate changes in these parameters in the most severely affected and to assess whether these changes are of significance when advising those who have ocular hypertension and glaucoma about traveling to regions of high altitude (.What Happens to Intraocular Pressure at High Altitude? John E. A. Somner, Daniel S. Morris, Kirsten M. Scott, Ian J. C. MacCormick, Peter Aspinall, and Baljean Dhillon .. (Invest Ophthalmol Vis Sci. 2007;48:1622–1626) DOI:10.1167/iovs.06-1238).
- There is a fundamental difference between glaucoma (including primary open angle glaucoma ) and the ocular hemodynamic aberration proposed for migraine (Gupta, 1992; 2005).
- Visual field analysis and OCT at high altitude in those that do develop migraine will reveal the basis and occult retinopathy of high-altitude.
- Propranolol, atenolol, flunarizine -- all migraine prophylactic drugs lower IOP (see table 2,--page 33---Gupta VK. Adaptive Mechanisms in Migraine. A Comprehensive Synthesis in evolution. Breaking the Migraine Code. Nova Science Publishers, Inc. New York, 2009, pp 25-37.)
- You can collaborate with me in such an investigation. I will guide you.
- Good Luck
- New Delhi, 22/08/2017 6.36 AM
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