Migraine or not ?

Question

I'm a 29 yr male. My headache problems started like 2 months back. I had intense throbbing pain in the left back side of my head (just around/above the ear). I never ever had headaches issues before so I just thought it was something temporary (maybe exposure to cold or something). Several Advil later, I realized that this is something that requires a trip to my PCP. She initially diagonsed it as a tension headache and put me on muscle relaxant/painkillers. Also my bp was slightly elevated so I was also given Lisinopril for it. Unfortunately this treatment didn't work too well and the pain would return whenever the effect of drugs would wear off. After like 12 days or so, I stopped taking muscle relaxant/painkiller drugs to avoid any dependency/rebound headaches. I realized that I was no more worse off than while taking them. After some delibrations, the PCP referred me to a neurologist who diagonsed it as a mixed headache (tension + migraine). He also ordered an EEG and put me on migraine preventive medicine "Inderal" 20 mg per day. After taking 10 days for reading the EEG, I was yesterday told that the report came in negative and they couldn't also infer migraine headache from the report. Also my headaches still continue. They are no longer of throbbing quality, rather a dull constant pain at the same location. I'm still taking Inderal but it doesn't seem to help so much. Even though the pain is not intense, it is really disrupting my life. My mood takes a downturn due to pain, also recently I noticed that my dreams are more vivid (maybe due to Inderal). Some days back I had noticed that neck exercises used to alleviate the pain but no more. Also physical exertion doesn't make headache any worse, infact it helps me take my mind off it. I'm terribly confused. It will be great if someone can advise me what to do from hereon.

VanessaMD · Answer

Hi, 

I understand that you are highly anxious about your condition. However, a clear scan should offer you some relief at this point. You are worried about an aneurysm you say?  It is best to avoid any unnecessary worrying now, given that a full assessment of your case is yet to be done. I suggest you seek consult with an ENT specialist to rule out ear, sinus , throat , nose and TMJ problems.An assessment of the cervical spine may also determine any musculoskeletal or nerve disorders that may contribute to the pain. 

Occipital neuralgia, cervicogenic headaches, tension headaches, and migraine without aura may be differentials. Keep a close follow up with your physician.If the intensity of the pain progresses, if other associated symptoms like vomiting, pain aggravated when coughing or straining, visual symptoms, dizziness ,then an immediate consult is necessary.

Take note of any events,conditions, food ,activities that seem to aggravate your condition.Avoid prolonged computer use,get a good pillow to support your head when you sleep,a good chair to fully support your back and neck and exercise regularly to improve circulation.

And by the way, create your own post, so your questions may be readily followed.

Keep in touch.

VanessaMD · Answer

Hi,

Yes, discuss this ( ENT visit ) with your physician so involvement of the underlying structures may be ruled out. And also, were any scans done (CT Scan or MRI)?

Discuss with your physician the possibility of occipital neuralgia.However, this diagnosis is best made after all other underlying conditions have been ruled out.At this point, it is best to wait for results of further assessment.

Do keep us posted regarding your progress.

cookienkikin · Answer

I'm a 22 yr old healthy male. About 4 months ago I had this new onset of a headache that made me naseus and hurt really bad, it lasted about a month and a half, I had a Ct scan of my head done without contrast and it came back normal. Well the headaches eventually went away and now a month in a half later the head pain is back. It's on the right side of my head about 2 inches above my right ear and an inch or two towards the back of the head.  It comes and goes throughout the day, its been back for 3 days now.  It sometimes makes me feel a little off balanced and out of it.  It seems like when I move my neck around and pop it, i get somewhat of a relief from it but it comes back.  The main thing that I'm scared of is an anuerism. The pain is not bad enough to where it affects my sleep but its an intermittent pain there when i go to bed and when i wake up in the morning, and throughout the day.  What could cause these symptoms? Thank you so much.

Ronin_Rocks · Answer

Thanks for replying. When I saw PCP/Specialist, they all looked into my ENT. Also all the bloodwork came normal. I dont have any cold or sinus like conditions. Also I see no issue like grinding of teeth while sleeping. Do you feel that a trip to ENT will help ?

I will take these things up with my PCP but she has a low patience towards listening to others.

VanessaMD · Answer

Hi,

Have you visited an ENT specialist to check for any ear and TMJ problems ?Another thing is,you may discuss with your physician the possibility that  this could be  occipital neuralgia and the advantages of a nerve block in your case. You have started on migraine prevention therapy already and your condition seems to persist. A complete eye, ear , and sinus assessment may help. A cervical spine evaluation may also rule out any direct involvement of the spine.

Do keep us posted regarding physician's advice. Headaches are quite complex conditions and even primary migraine or tension headaches may later transform into chronic daily headaches due to medication overuse.

Do keep us posted for anything.