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CT scan with contrast
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CT scan with contrast

Hello - I have recently experienced a month or so of headaches including eye pain, sinus like pain, base of skull, and neck stiffness / pain. I did have a CT Scan with contrast last week which cam back negative. The doc thinks I have migraines (I have never had headaches or migraines before).

I asked the nuero if the CT Scan can rule out any sort of tumor causing my symptoms and he said it could.

My root question is, would a brain tumor be detected using a CT scan with contrast? Or, can a tumor be missed with this type of imaging?

Should I push for an MRI?
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Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

A CT scan with contrast is a reasonable test to grossly look at the brain. An MRI of the brain would show the brain in more detail. The problem with a CT scan is that there is a lot of artifact in the posterior/lower part of the brain. If your headache is from here, it may be difficult to examine this area in much detail.

I also want to make you aware of other headache types from the neck region. These include cervicogenic headache and occipital neuralgia. (Another type can be a vessel dissection which was likely rule out with the CT scan).

Cervicogenic headache is a headache that is "referred" to the head from bony structures, muscles, and other soft tissue in the neck and shoulders. Symptoms are usually one-sided and include: precipitation of head pain by neck movement or awkward neck positions, head pain when external pressure is applied to the neck or occipital region, restricted range of motion of the neck, and neck, shoulder and arm pain. Treatment for cervicogenic headache includes physical therapy, medications, behavioral therapy, and other modalities.

Occipital neuralgia is caused by irritation or injury to two nerves that run from the upper neck to the back of the head. The irritation could be due to neck trauma, pinching of the nerves (by muscles or arthritis), and other causes. Symptoms include a piercing sharp pain that travels from the upper neck to the back of the head and behind the ears. It is usually a one sided pain but can be on both sides of the head. Treatment includes physical therapy, medications, and in some cases injections, "nerve blocks", during which a physician injects the irritated nerves with an anesthetic.

With any headache, if you have additional symptoms or change in headache type/frequency, severity, etc, you should be seen in the emergency room.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

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