Complicated Headache - cranial nerve problems

[motox320]

25 year Male SW PA
No history of headaches
Grandfather had migrains, but not my parents or sibblings

2.5 years ago Developed left sided facial numbness trigmenal nerve  Was terrible for one year, now has gone from a 10 to a 2 which is good, but is still is very slighty there. 5 months before this I was working in the woods-sewer lines, became very ill, for about 2-3 months, with fever, on and off fatique, and swollen lymth nodes in my groin. Had a slighty high WBC, but the doctors never found a true cause

7 weeks ago
had 2 days of feeling, gorggy, drunk, then 3rd day terrible headache  light sensative.
The next day i had mild vertigo
Now, I am suffering from daily headaches since then.
Feels like pressure in head usually forehead or temples but can move  More constant, rather than pules.  Both sides. When it happens, I am sensative to light The headaches are terrible, and usually start a little after noon and last till late evening. I usually sleep fine, and am ok in the morning, with near no pain.

I had 2 mri's for the left sided facial numbess last year  Both were unremarkable. I had a MRI-MRA of the brain about 3 weeks ago for my current headache issue, it was normal, also had a CT anogram of the neck, was normal. Had a VNG, was normal.

Now the balance, vertigo issue is better, but my head is killing me. One neuro is telling me classic migrain and the facial numbness was a seperate issue, and the other wants to due a spinal tap. hes says maybe chronic mennigitaus cause by something? (lyme, cat scratch, sacroid?) My neck isnt really too sore, sometimes a 3 on scale of 1-10 and I have never had a temperature in the last month. Again, these daily headaches have been going on for near 6-7 weeks.

Is there any possibilty that I have Increased inter cranial pressure or something bad like that? I saw my eye doc too, said eyes look great. what about the chronic mennigatuius thing, whats your opinion?
is the spinal tap safe?

[Lama Chahine, MD]

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 your doctor.

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

There are several causes of headaches. Headaches can be divided into primary and secondary. Primary headache disorders are headaches without a direct cause, such as migraine. These are diagnosed after secondary causes have been excluded. Secondary headache disorders are due to an underlying problem, there are many many causes but some include medication side effects, systemic illness, nervous system infection, tumors, bleeds in the brain or clots in the veins of the brain, and others.

In general, with intermittent headaches (headaches that resolve, such as in your case, that resolve with sleep and occur again in the afternoon) associated with photophobia (sensitivity to light) the most common cause is migraine. These are more commonly one-sided but can occur on both sides of the head, and while they are most often throbbing, some patients do not describe a throbbing sensation. Another type of common primary headache is tension type headache, which commonly occurs in younger adults, they are frequently but not always associated with stress. One of the most common causes of headaches in people with chronic headaches is called medication rebound or medication overuse headache: medications as simple as tylenol or advil if used too much can cause rebound headaches that are even worse then the headaches for which the medications were started for. This is very common and is most likely to occur with use of any medication for your headache more than a few times a week. If you are self-medicating with medications as such to treat your headaches, you should discuss this further with your physician so that appropriate therapy can be used to stop this medication overuse.

In general, in a younger person with severe headaches, imaging of the brain is indicated to exclude serious problems such as tumors or vascular malformations, such as the imaging you have had. If headaches start and occur following a systemic illness, then a lumbar puncture is sometimes indicated to exclude serious infections such as viral or fungal meningitis, which can occur for several weeks (most bacterial meningitis would be fatal if left untreated for several weeks, with the exception of tuberculous meningitis; TB meningitis is rare in the USA but can certainly occur). Lumbar punctures are in general safe procedures with very few complications; a transient headache is common, but other complications are rare, but these should be discussed prior to the LP being done. When there is nothing on MRI to indicate asymmetric pressures in the brain, then the risk of LP complications from elevated pressures in the brain are very low; sometimes, an LP is required to diagnose a condition called pseudotumor cerebri, or benign intracranial hypertension, which typically causes headaches in overweight people.

A normal LP would make a meningitis highly unlikely, and also can rule out benign intracranial hypertension and other causes of secondary headaches. There are several other secondary causes of headaches, but in general, these can be excluded based on MRI, history/examination, though sometimes other testing is indicated.

If a diagnosis of primary headache disorder (such as tension type headache or migraine) is made, specific medications can be very effective in treating the headache.

Continued followup with your neurologist is recommended.

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

[motox320]

Can I rule out TUBERCULOUS MENINGITIS ?