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Neurology (Expert Forum)
right sided headaches
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right sided headaches
by wiela, Aug 10, 2006 12:00AM
I am a 28 y/o female with a BMI of 29 and BP of 120/60 and have been suffering from migraine for 15 years. I don’t smoke or drink. The migraines have always been on the right side, with throbbing in ear/behind eye. I noticed a couple years ago that some migraines came about by laying down on right side, so I avoided that position, but now seem to get them if I lie down at all (noticed this for about the 8 months.) I now sleep sitting upright. When I lie down, I feel head pressure increase immediately.
The migraines have increased over the last 3 years, from 2 per mo. to 8 or 9 per month. In last 8 mos I have noticed i can see a pulse in right eye on waking. I have constant high-pitched tinnitus, louder in right ear. My CT of sinuses and head one year ago w/and w/out contrast were normal and recent LP w/open pressure of 15. Opthlam. said no papilledema and vis. fields are normal.
I have had bloodwork for migraine-lupus, etc all normal. I think I have tried every preventative-beta/calcium blockers, antidepressants, anti convulsants, bcontrol with no reduction in frequency/intensity of headaches. I only take Zomig or Cafergot now, which always seem to work. I don’t use OTC's.
Is there a test I can/should request to check blood flow, and is an aneurysm/avm a possibility? Neuro says CT should've shown that, but no other imaging done? Due to my normal CT and LP, I fear that my neuro will send me home with current meds and that will be it. The tinnitus, head/ear pressure and fact that can't lie down is worrisome to me and I don't know what to do if neuro has no ideas. thx
The migraines have increased over the last 3 years, from 2 per mo. to 8 or 9 per month. In last 8 mos I have noticed i can see a pulse in right eye on waking. I have constant high-pitched tinnitus, louder in right ear. My CT of sinuses and head one year ago w/and w/out contrast were normal and recent LP w/open pressure of 15. Opthlam. said no papilledema and vis. fields are normal.
I have had bloodwork for migraine-lupus, etc all normal. I think I have tried every preventative-beta/calcium blockers, antidepressants, anti convulsants, bcontrol with no reduction in frequency/intensity of headaches. I only take Zomig or Cafergot now, which always seem to work. I don’t use OTC's.
Is there a test I can/should request to check blood flow, and is an aneurysm/avm a possibility? Neuro says CT should've shown that, but no other imaging done? Due to my normal CT and LP, I fear that my neuro will send me home with current meds and that will be it. The tinnitus, head/ear pressure and fact that can't lie down is worrisome to me and I don't know what to do if neuro has no ideas. thx
Doctor's Answer
by CCF-Neuro-M.D.-SH, Aug 10, 2006 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes. From the symptoms/history you provided I agree that you are having migraine headaches. The other possible condition you were being evaluated for was pseudo-tumor cerebri (more correctly called Benign Intracranial Hypertension[BIH]). This condition is common in young females, especially if they are overwieght. It causes papilledema and can lead to vision loss. The medications used to treat this include diuretics such as diamox(carbonic anhydrase inhibitor), but also topamax has a weak carbonic anhydrase inhibitor activity and is sometimes used, usually when the line between BIH and migraine is not clear. It sounds like you have had a decent workup for this condition and an opening pressure of 15 on your LP and a normal ophthalmologic exam is encouraging. Another test that I would recommend is an MRV (magnetic resonance venogram) some patients with sinus venous thrombosis will have symptoms of increased intracranial pressure and if identified can be treated with blood thinners.
From your symptoms though, I would suspect a role of your neck precipitating your headaches. Lying down flat, often involves changing your neck posture and if you have tight muscles and limited mobility of the neck vertebrae this could precipitate your headaches. Neck problems can also be a cause of tinnitus (ringing in the ears).
I would recommend a Topamax starting at 12.5 mg at night with a taper up to 50-75 mg at night over the next 4-6 weeks (speak to your neurologist about this) for a migraine prophylaxis and possible help for any mild BIH you may have. I would also suggest a muscle relaxer such as Parafon Forte and some physical therapy on your neck by a physical therapist trained in cervicogenic migraine related neck physical therapy. I would continue with the Zomig for headache abortive therapy (they also make a nose spray that has a faster onset).
I would also recommend an MRI of your brain with and without contrast and MRV (as mentioned earlier). A CT is not adequate.
I hope this has been helpful.
From your symptoms though, I would suspect a role of your neck precipitating your headaches. Lying down flat, often involves changing your neck posture and if you have tight muscles and limited mobility of the neck vertebrae this could precipitate your headaches. Neck problems can also be a cause of tinnitus (ringing in the ears).
I would recommend a Topamax starting at 12.5 mg at night with a taper up to 50-75 mg at night over the next 4-6 weeks (speak to your neurologist about this) for a migraine prophylaxis and possible help for any mild BIH you may have. I would also suggest a muscle relaxer such as Parafon Forte and some physical therapy on your neck by a physical therapist trained in cervicogenic migraine related neck physical therapy. I would continue with the Zomig for headache abortive therapy (they also make a nose spray that has a faster onset).
I would also recommend an MRI of your brain with and without contrast and MRV (as mentioned earlier). A CT is not adequate.
I hope this has been helpful.
Have you ever had an MRI? In my experiences an MRI shows the imaging better than a CT. I too have had headaches but I don't think mine are migranes. In addition, I get dizzy, light-headed, and sometimes my arms are weak. You didn't mention any of these things. In the past I've had CT's but all was fine. In July however I had an MRI and it showed a lesion in the brain...we're not sure what it is yet. Thus, I think MRI's show more things than CT's. Good luck!!