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Neurology (Expert Forum)
Do my symptoms suggest immediate treatment?
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Do my symptoms suggest immediate treatment?
by southbel, Jan 18, 2007 12:00AM
I am a 33 yr old woman. I have suffered from chronic headaches that were easily treated with OTC meds. One week ago, I had a different headache. It woke me from sleep, was very severe and in a different spot on my head. I normally have headaches in my temples, but this was a very deep, pressure-like, headache located on the sides of my head. In addition , I got night sweats, something I have never had before. My temperature was low, at about 96 degrees, so no fever. This headache continued, non-stop for a week, getting progressively worse with each day. I also began to get other symptoms, such as confusion, unable to find simple words when I spoke, blurred vision, spots in my vision, and balance problems. I also fainted once, which left me confused and very tired for many hours.
I went to Urgent Care and they put me in the hospital for admittance due to abnormal neuro exam (positive romberg, eyes dilated unequally, unable to walk heel to toe). I was in the hospital for 2 days, where they performed a 24-hour heart monitoring test (normal results) except low BP (approx. 80/50) and MRI without contrast. The doctor said the MRI was "basically normal". The internist treating me consulted a neurologist, who said that I had migraines, prescribed me Lortab and Trazodone, with follow-up in 4 weeks. After getting out of the hospital, my symptoms have progressed and now I have periods of involuntary twitching in my left arm and leg. Last night I had the most painful headache I have ever had.
Should I wait for appt or get more immediate care even with normal MRI?
I went to Urgent Care and they put me in the hospital for admittance due to abnormal neuro exam (positive romberg, eyes dilated unequally, unable to walk heel to toe). I was in the hospital for 2 days, where they performed a 24-hour heart monitoring test (normal results) except low BP (approx. 80/50) and MRI without contrast. The doctor said the MRI was "basically normal". The internist treating me consulted a neurologist, who said that I had migraines, prescribed me Lortab and Trazodone, with follow-up in 4 weeks. After getting out of the hospital, my symptoms have progressed and now I have periods of involuntary twitching in my left arm and leg. Last night I had the most painful headache I have ever had.
Should I wait for appt or get more immediate care even with normal MRI?
Doctor's Answer
by CCF-Neuro-M.D.-SH, Feb 06, 2007 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.
The symptoms and story that you present is non-specific and could represent a number of different problems. A 'new' headache that becomes progressively worse each day is the most commonly (or most concerning for) associated with brain tumors. However, given your 'basically normal' MRI this does not seem likely. The nightsweats are also non-specific and are found in many conditions including infections, menopause, certain drugs, tuberculosis, lymphoma, and certain anxiety/stress states. The symptoms of confusion, spots in the vision and balance problems/fainting, can all be found associated with migraine headaches. The fainting may suggest a syndrome called POTS (postural orthostatic tachycardia syndrome). The pupillary assymetry can be caused by a number of different things including a PCOM (posterior communicating) aneursym, brain tumor, migraine headache (or other cause of a Horner syndrome, such as lung mass, carotid vessel dissection, etc). Your normal MRI is reassuring, but I would suggest that you have an MRA (magnetic resonance angiogram) if that was not done on your original MRI (to look for aneurysm) and a chest Xray/CT to look for a lung mass. I would also suggest a tilt table test to evaluate you for POTS syndrome. I agree with your neurologist that all the things you decribe can likely be explained by migraine headaches, but I think other causes should be ruled out (as mentioned above). In migraines associated with features such as you describe (not acceptable to happen at any time), I would recommend a preventative medication to keep migraines (and their auras) from occurring, such as Nadolol, Elavil, Topamax, Zanaflex, etc. (taken daily). Medications such as Lortab are best at treating acute pain or occasional headaches, but if taken more than twice per week can actually cause headaches (called rebound headaches) and should be avoided.
I hope this has been helpful.
The symptoms and story that you present is non-specific and could represent a number of different problems. A 'new' headache that becomes progressively worse each day is the most commonly (or most concerning for) associated with brain tumors. However, given your 'basically normal' MRI this does not seem likely. The nightsweats are also non-specific and are found in many conditions including infections, menopause, certain drugs, tuberculosis, lymphoma, and certain anxiety/stress states. The symptoms of confusion, spots in the vision and balance problems/fainting, can all be found associated with migraine headaches. The fainting may suggest a syndrome called POTS (postural orthostatic tachycardia syndrome). The pupillary assymetry can be caused by a number of different things including a PCOM (posterior communicating) aneursym, brain tumor, migraine headache (or other cause of a Horner syndrome, such as lung mass, carotid vessel dissection, etc). Your normal MRI is reassuring, but I would suggest that you have an MRA (magnetic resonance angiogram) if that was not done on your original MRI (to look for aneurysm) and a chest Xray/CT to look for a lung mass. I would also suggest a tilt table test to evaluate you for POTS syndrome. I agree with your neurologist that all the things you decribe can likely be explained by migraine headaches, but I think other causes should be ruled out (as mentioned above). In migraines associated with features such as you describe (not acceptable to happen at any time), I would recommend a preventative medication to keep migraines (and their auras) from occurring, such as Nadolol, Elavil, Topamax, Zanaflex, etc. (taken daily). Medications such as Lortab are best at treating acute pain or occasional headaches, but if taken more than twice per week can actually cause headaches (called rebound headaches) and should be avoided.
I hope this has been helpful.
Basically, she said that I had definite signs something was wrong, but she isn't sure exactly what. It did feel good to have someone validate my not feeling well, and now it's just a matter of them figuring out what is wrong.