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Neurology (Expert Forum)
seeking advice on diagnosis, treatment options
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury
seeking advice on diagnosis, treatment options
by sue, Jan 20, 2000 12:00AM
My headache problem seems to have begun with surgery for a brain aneurysm in December of 1998. Sine then, I have had a constant (24-hour a day) severe headache. I had migraines before the surgery, but not like this, and this pain is somewhat different in nature, so I do not believe it to be migraine. I have consulted my neurosurgeon (no cause and effect, according to him), two neurologists, an oral surgeon, and two pain clinics, University of Virginia and Hampton (Virginia) Sentara. I have tried the standard neaurological mediacations, such as Paxil, anticonvulsants, and Neurontin and Lamactil. All make the pain even more severe. No one has been able to determine the cause, or diagnosis, nor how to treat it, except to take barbituate painkillers every four hours around the clock. Even these are not helping enough to keep me going, and I am currently unable to work, plus unable to qualify for disability due to a lack of diagnosis. Does this condition relate to the anuerysm surgery, of should I be looking for some other cause? Do you kmow where I might do further research and try to help myself--my current pain clinic doctors admit they're stumped. I have had CT scans and x-rays, but cannot have an MRI due to an implanted arterial clip. Are there other tests that might show something?
Doctor's Answer
by CCF Neuro[P] MD, RPS, Jan 20, 2000 12:00AM
Dear Sue:
There is a headache type due to aneurysm. Did your aneurysm bleed and where was it located? The blood irritiation would cause headache, also the hemisiderin that results from the bleed might also irritiate the brain to cause headache. Most neurosurgeons only use clips that are MRI safe, and yours also probably did as this is standard of care in most places. I would check with him/her to see if your clip was tested. I think I would try the usualy migraine stuff, but I would start with indomethacin as it might be more effected. A good place to begin is elavil at low doses at night with indomethacin for breakthrough headache (although maybe a trial with daily indomethacin once the elavil has gotten to steady state if the headache remains).
Let us know what happens.
Sincerely,
CCF Neuro MD
There is a headache type due to aneurysm. Did your aneurysm bleed and where was it located? The blood irritiation would cause headache, also the hemisiderin that results from the bleed might also irritiate the brain to cause headache. Most neurosurgeons only use clips that are MRI safe, and yours also probably did as this is standard of care in most places. I would check with him/her to see if your clip was tested. I think I would try the usualy migraine stuff, but I would start with indomethacin as it might be more effected. A good place to begin is elavil at low doses at night with indomethacin for breakthrough headache (although maybe a trial with daily indomethacin once the elavil has gotten to steady state if the headache remains).
Let us know what happens.
Sincerely,
CCF Neuro MD
Nail, cuticle biting (& surrounding skin ‘til bleeding).
If I bumped one elbow, I'd have to bump the other.
Counting – everything. The cars we passed, the steps I took etc etc.
Rubbing skin – usually on face, around mouth, ears, nose.
Smelling fingers – usually in figure of 8 pattern
Grunting
Toe scrunching
Toe (or heel) tapping
Leg movements – figure of 8 etc
Hands/fingers – tapping fingers with thumb, each in turn
Rolling thumb around each finger in turn
Flicking each finger on thumb
Drumming fingers
All movements of hands, feet, legs etc in rhythm and symmetry
Usually accompanied by counting (3s, 4s, or 5s, or rhythm in head)
Pen fiddling – always the same action. My thumb circles the top of the pen, and down & around the clip. Repeatedly – writing and colour fades!
Teeth grinding – again to rhythm in sync with other movements
Muscle clenching – knees & upper thighs, again to rhythm & in sync
Finger writing – I write my thoughts with very fine movements of index finger
Tutting
Repeated phrases in my head – apparently meaningless, and often find myself saying them out loud
A word or thought just pops into my head, perhaps obscene, perhaps violent and totally abhorrent
I used to worry about possible impending (I thought) disasters - perhaps of my own making
As a child, I'd try to catch a ball 10 times in a row (eg), if I achieved this, then such-&-such a thing wouldn’t or would happen
Picking. Over the years anything – from nose to ear, scab to toe
I eat certain foods in particular ways, and am unable to eat it the conventional way (esp. tomatoes)
Raising eyebrows
I have not paid much attention to them until now. My children are developing other habits. I'm now 39 years of age. I don't do all these things, but I have done them all at one time.
Is this something I should be concerned about?
I am not a doctor so take it for what it's worth, but what you describe sounds like classic tourette syndrome. You may want to do a search on Tourette syndrome and look up what it says about it.
To Sue: My husband has also had a 24-hour, 7 days a week headache since March 1999. He, too, is unable to work, due to large amounts of medications. He's been on MS Contin (and various other opiate pain meds), Indomethacin (anti-inflammatory), Elavil (tricyclic antidepressant), Atenolol (beta-blocker), Demerol shots (another opiate), Toradol shots (anti-inflammatory) with oxygen supplement.
His current medication roster is as follows:
2000 mg/day Depakote (anticonvulsant)
1800 mg/day Neurontin (anticonvulsant)
25 mcg/hour skin patch Duragesic (opiate)
160 mg/day Oxycontin (opiate)
40 mg/day Celexa (SSRI antidepressant)
All of this keeps the pain