Hi @Seagull,

Thanks for answering. I’m happy to share; here’s a history of events. Sorry if it’s too verbose 🙂

2018 February:

·         Developed tardive cervical dystonia. I’ll come to this back in a bit.

2019 Autumn:

·         downdosed a bunch of meds abruptly (aripiprazole, paroxetine, biperiden, baclofen, pregabalin); I didn't stop them cold turkey, but reduced the doses by like 90% down. This destabilized my CNS making me extra sensitive to all further dose changes

·         Began seeing big rainbow halos around light sources (which I currently don’t) and got diagnosed with “spasm of accommodation”, a diagnosis that was repeated 2 years later by another doctor.

·         Developed severe myalgia and muscle spasticity that got permanently worse when I did any sort of significant exercise. This included especially my inner thigh muscles, as they were the ones I was exercising at the time. Everytime I wasn’t careful and made my muscles worse with exercise, the only thing that helped was raising my magnesium dose even higher. I attribute these muscle problems to the downdosing of aripiprazole, baclofen and pregabalin.

·         Was making some videocalls lying on my side in bed, and then first noticed I had to keep my left eye closed during the calls, to avoid eye discomfort. I don’t remember the exact kind of eye discomfort I was experiencing back then. But I think it was the same as it is now – an eye muscle discomfort that was identical to the aforementioned inner thigh myalgia/spasticity. Also an eye burning.

January 2020:

·         I learned about “drug withdrawal syndrome” and raised some of the meds (aripiprazole, paroxetine) back up while reducing biperiden further. This, IIRC, removed all eye problems for the time being. It also improved my leg problems a lot. Note that biperiden is an anticholinergic so it can cause dry mucuous membranes including dry eyes (especially when taken in combination with aripiprazole).

April 2020:

·         Switched from paroxetine to escitalopram. Started tapering escitalopram and aripiprazole down by about 10% a month (exponential taper).

July 2020:

·         Accidentally took a double dose of escitalopram (36mg which is an enormous dose). My heart ached for a week afterwards, and around this time, my past eye problems returned.

August 2020:

·         Started taking baclofen (2x10mg) again; it gave me a burning feeling in my eyes, and screen strain. Well, the screen strain might have been very related to the escitalopram overdose of July as well. Went down to 2x5mg baclofen as was planned by my doctor from the beginning. This eased the eye symptoms proportionally.

·         Tried washing my eyelids with dish detergent when they felt dry (don’t ask me how I got that dumb idea… 😃 ) and this sensitized my eyes to stuff like detergent preservatives (methylisothiasolinone etc) and worsened the screen strain. Switched to hypoallergenic preservative-free detergents/shower gel/etc, which helped.

September 2020 – present:

·         Tried reducing the escitalopram by a tiny amount (e.g. 1% or 3%) on a number of occasions. Every time, my screen strain got worse, and updosing it back did not make it better.

·         Overdid my screen time limit (self-imposed) on about 3 occasions (I call it “screen binging”) and every time, my screen time limit got shorter. (i.e. I could tolerate shorter periods of screen usage).

·         Got diagnosed with “dystonia” (no mention of “tardive” or “generalized”, just “dystonia”) wrt my whole-body myalgia/spasticity. I think this dystonia is a primary cause of my screen strain too.

Thanks for the detailed reply. I will write a detailed response in time when I have had time to think. What you have said is consistent with thoughts I have been having on serotonin. I think a deficit of serotonin receptors is responsible for both my migraines, and my frequent muscle pain.

    Seagull Any thoughts or theories on whether an SSRI, SNRI, or tricyclic antidepressant might help?

    I came across this interesting migraine "flow chart" at the bottom of this page from a well-known specialist in migraines. After trying diet, his first line of treatment is Effexor or amitriptyline/ nortriptyline.

    The doses he recommends for Effexor seem to be lower than is used for depression/anxiety.

    This quote seems particularly relevant to us:

    The current consensus is that migraines are caused by abnormality in the brain which represents a combination of familial tendency, trigger factors such as stress, sleep disturbance, hormonal fluctuations, and certain foods. While in the past migraine was felt to be related to vasospasm, presently it is thought that the blood flow changes are not primary. Instead, it is felt that migraine is related to abnormal sensitivity to sensory inputs

        a month later

        An update from me.

        The setup described in my original post no longer works for me - it causes me major eyestrain.

        So I bought a used laptop (Acer Aspire 5750G, which is a 2011 model). Other changes in my setup:

        • No longer using an external display - just the builtin laptop screen.
        • No longer covering eye with paper
        • No longer need to disable NVidia driver
        • No longer need big fonts and icons
        • I've disabled font antialiasing, via the Iris software
        • Haven't found a smartphone that works for me

        Under this setup, I'm able to use my PC for 3-4 hours a day which is great! 🙂

        7 days later

        Damn, my eyes are apparently used to the niceness of this laptop screen now; I can use it for only 20 minutes a day now. >_<

        Will probably buy some external monitor to try. I got a good recommendation in my other thread.

        12 days later

        Update:

        Still using that same laptop, but now I'm pulling 4-6hr workdays on it, which is the best I've done in the last year.

        To get there, here are my new tweaks:

        • Changed all LED overhead lighting to CFLs
        • Patching my left eye again
        • Started eating sugary things (honey and fruit) everytime my eyes start to hurt. This seems to raise my (ever low) blood pressure, which for some reason helps my eyes. I had fully stopped my sugar intake for the last 18 months.

        Feeling quite happy now!

        What I have notice works for me is using a computer with a 7 the gen Intel CPU, both my laptop and gaming PC has that, my work computer which give me eye strain if I use it for more than 15 mins has a 8th gen Intel CPU.

        The solution I came up with is.

        Projecting my working PC to my personal pc. So basically I'm projecting my 8th gen laptop to my 7th gen laptop which let's me work 8hrs a day.

          Business-Eyes Very interesting, I hadn't heard of this feature!

          What is the difference between projecting and remote desktop? A cursory google search didn't reveal much, except that I think projecting (Miracast) has lower latency and is done with peer-to-peer WiFi, rather than through the internet.

              logixoul ok let say PC "A" works well with you eye and PC "B" does not, when you project PC B to A the display uses PC "A" display drivers. When it comes to remote desktop I haven't tried simply because when I has ask company if I can install it on my work PC is was a security risk, but I figured it would be the same as projecting.

                Updates from me:

                1. Finally found a proper optometrist in my city.

                They evaluated me for 50 minutes, and found that my diplopia (monocular vertical double vision on high contrast text) is not caused by astigmatism nor by BVD. Because they tried cyllinder lenses on me, as well as prism lenses, and at no point did the diplopia disappear.

                They gave me some "yellow" filter glasses to try (more precisely: ML Filter C1. They wanted to give me "pink" (ML41) filter glasses instead (same link as for C1), but didn't have any at the moment (they'll call me when they do).

                They told me to wear the filter glasses on top of my regular prescription glasses (when using screens), as a test to see if they help. I'm typing this with them on.

                2. Tried a projector

                Last night I tried a friend's projector and was able to look at the image for 2 hours without any discomfort (didn't even need to take a break). Will keep experimenting with it.

                  logixoul Hi! Glad to hear that projector worked for you!
                  The first one, monocular diplopia, sounds like a big mystery. I know that brain damage can cause it, but that is most clearly not the case, and with more obvious reasons (astigmatism and BVD) ruled out, I deeply wonder what could cause it.

                      logixoul Last night I tried a friend's projector and was able to look at the image for 2 hours without any discomfort

                      Very interesting and promising! I know @Clokwork has had some success with projectors as a TV replacement (see the thread here). Wondering what model you used?

                          ryans I came across this interesting migraine "flow chart" at the bottom of this page from a well-known specialist in migraines. After trying diet, his first line of treatment is Effexor or amitriptyline/ nortriptyline.

                          The doses he recommends for Effexor seem to be lower than is used for depression/anxiety.

                          Wow. The m ost puzzling thing about this is that, being more a symptom than a condition itself, and basically noone has a clue about how to help, one has to figure out possible treatments.

                          I´v been using venlafaxine, in low and high doses: 37,5mg, then 75, then 150. Did absolutely nothing.

                          But then, again, my symptoms don´t match yours, so… no big surprise.

                          I´m currently trying some prescribed filtered lenses. Brand FL-41 filtered ones, pink tinted (concretely, Migralens) didn´t work out for me. I went for a second try at an optometrist, who put me through a "filter test", as we called it here. Basically, you are given different coloured glasses to try and see what happens. I picked up ones colored… blue. It´s the type of filter used by many migraine sufferers. They seem to help a little bit… we´ll see. But it seems a thing to try no matter the origin of the ledstrain condition.

                          Good luck with everything.

                            logixoul

                            Congrats on finding someone in your city that can help 😃

                            I've never heard of ML Filter C1 lenses, would you please let us know if they relieve any of your symptoms?

                            And that's very encouraging that you were able to watch the projector with no discomfort, do you happen to know the model?

                                Mrak0020

                                I take four medications: Lexapro, Abilify, Biperiden and Baclofen.

                                Excerpts from their leaflets (about side effects):

                                • Lexapro: diplopia, mydriasis
                                • Abilify: diplopia, blurred vision, photophobia
                                • Biperiden: mydriasis, accomodation disturbances, photosensitivity
                                • Baclofen: diplopia, mydriasis, blurred vision, strabismus (aka heterophoria)

                                So that pretty much explains it.

                                I don't really need the biperiden, so I'm slowly tapering it down (an year ago I was at 2.7mg, now I'm at 1.7mg)

                                ryans

                                bkdo

                                The model is BenQ MS502. I think the reason it works for me is that it's a DLP projector (so it has no LCD inside). It's a 800x600px projector, so it won't let me work comfortably (I mean, the res is just too low). But it's a great lead for me to find other suitable projectors.

                                bkdo I've never heard of ML Filter C1 lenses

                                Basically a company called Multilens (ML) makes a bunch of different filter "lenses" (not really lenses because they have no diopter), and they all block/reduce a (different) specific portion of the light spectrum (and thus they have different effect on human eyes).

                                Quote from their site:

                                ML Filter C1 - Allows parts of the blue light transmits to maintain a natural color perception. Absorbs 80% of the harmful shortwave blue light.

                                ML41 - A pink lens that absorbs some of the blue light but also a bit of the green. The greatest absorption lies in the boundary between blue and green. There is a proven effect at benign essential blefarospasm (BEB), both in terms of photosensitivity and blink frequency. Many people perceive the filter as generally comfortable and many experiences a relief in migraines.

                                The ML41 is what the optometrist will give me soon.

                                I'll make sure to update you guys on the C1 filter glasses when I've used them for a couple days.

                                        Bought a DLP projector: Acer X122

                                        Gives me eyestrain for some reason. I tested the light reflected off the wall, and it is *not* polarized (just like I expected).

                                        So I think polarization is not my problem.

                                        dev