Could I have MS or a brain tumor

I am a 42 yr old female. 5'5" 135 lb.  I have been suffering from headaches that will last for up to a week at a time.  These headaches are mainly on the right side of my head and will sometime go around to back of my head.   My head will go numb and tingles.  I have trouble with my short term memory, concentration, even trying to put a sentence together, the left side of my face twitches and is numb and tingles.  I have had a few occassions when my left leg and arm feel limp as if I am dragging them.  There is a place in my head about the size of a silver dollar that stays numb. I do not wear glasses, my eye doctor says I have 20/20 vision, however, when I close my left eye, my vision is blurry in my right eye, this is something new to me.  I am a non-smoker, non-drinker.  I have had an EEG, MRI of the spine and brain, all were normal.  My neurologist has ruled my headaches are not migranes (migraines) nor are the cluster headaches.  However, he has put me on Topamax which has seemed to helped with the severity of the headaches, however I am still experiencing them.   I don't like covering up the symptoms with medication, I would like to know what is causing them instead.  When this originally started my family doctor mentioned MS, however, the neurologist has never said anything about MS, could it be MS in the early stages and not be detected in the MRI, should I ask for a spinal tap or should I find a neurologist that specializes in headaches?  Please help me.

[Neuro Forum]

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. These are diagnosed after secondary causes have been excluded. Secondary headache disorders are due to an underlying problem, such as a tumor, medication side effects, central nervous system infections, CNS vasculitis (which often shows up on MRI but sometimes requires an angiogram and lumbar puncture for diagnosis), neck problems (as in cervicogenic headache which causes predominantly pain at the back of the head), clots in the veins in the brain (which are best diagnosed with a test called MRV) etc. In the presence of a normal MRI of the brain, multiple sclerosis is excluded as a cause to your symptoms. In addition, MS does not usually cause headaches. Many of the secondary causes of headaches listed above including tumor are almost entirely excluded with a negative MRI.

There are several primary headache disorders, over 50 different types.  For example  migraines, which are usually a pulsating throbbing one-sided pain with nausea and discomfort in bright lights that lasts several hours. Even if your headaches are not classic migraines, it does not mean that you do not have a primary headache disorder. One of the more common non-migrainous primary headache disorders is tension type headache. Another type of one-sided headache is called paroxysmal hemicrania. This is marked by episodes of stabbing or sharp pains that occur on one side of the head and may be associated with eye tearing or runny nose. Episodes may occur several times, and there are specific treatments for these headaches. Hemicrania continua is a similar headache that can be one sided and last for a longer duration. The latter two conditions are highly treatable with a medication called indocin. A common cause 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. Another cause of chronic headahes is called benign intracranial hypertension, in which there is an elevated pressure of the fluid in the brain called CSF. However, if your eye doctor did not see papilledema on your examination, and since you are not overweight based on the figures you provide above, this is an unlikely diagnosis.

It sounds like you are on the right track with your treatment if topamax has been helpful for you. However, if you continue to suffer from your headaches without significant relief, evaluation by a headache specialist is a good idea.

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