Do my symptoms suggest immediate treatment?

[southbel]

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?

[CCF-Neuro-M.D.-SH]

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.

[Sunny602]

Hmm, your case is interesting that's for sure. How about seeing an endocrinologist? That ionized Calcium is very low, there are glands that can malfunction to produce those results, not to mention neuro symptoms. Or how about a hematologist if your counts are really off without much reason? You have night sweats, many disorders have that as a symptom....Headaches too. How high was your red blood cell count as well as your white counts? It all just seems too odd just to brush off as a "migraine" diagnosis. Last time I checked, that disorder didn't cause electrolyte imbalances or wierd RBC and WBC values. Push your doc into maybe perhaps seeing other specialists. Sounds like other stuff is cooking for sure. Good luck, Sunny

[southbel]

Well, I am completely confused about what is going on with me now.  Latest development is that I have a high white blood cell count, intermittent low grade fevers and I still have horrible night sweats.  Since taking the Elavil, I have stopped with the twitching though, so that's something.  My headache, however, is still there and very very painful.  I do pretty well when I am sitting quietly.  It's at a pretty tolerable level then, but when I start moving around, egad, it's really bad.

I would guess sinus if it were anywhere close to my sinuses but nope.  It's the side of my head and the back at times.  I still have the unequal pupils thing too.  I fear I am never going to figure this out and it is quite debilitating.  

At my last doctor's appt, she said "I don't know what it is," but there is something going on because I keep getting odd bloodwork results, temperature, heart rate, pupil reactions, etc.  I seem to get continually worse, but with different symptoms each time!!

So here's the latest symptoms:
Persistent pressure headache on sides and back of head
Headache increases with movement
Low grade fever
Severe night sweats
High white blood cell count
Unequal pupils

I am confused because I keep having these odd symptoms with no consistency.  My serum calcium was non-existence one week and then high the next week.  Iron, same thing.  I am SO confused and just desperately want to be better.  This all started back on Jan 8, so I am looking at a month now of no answers!  Anyone have an idea of what could cause these varying symptoms??

[theflyjd]

It does sound like you had at least a TIA (trans ischemic attack or small stroke). I had my first stroke in 1988 and your symptoms sound very similar. I had a severe headache one night and tinnitus (ringing in the ear) started developing the next day. Within 2 weeks I was completely deaf in one ear and the headpain had increased to beyond the 1-10 scale range. It was blinding. Evidence of this stroke was compelling on the MRI. The second stroke I had was in 1995. I experienced paralysis on the right side and loss of periferal vision for several hours. Went to the hospital and an ER Dr. said I had experienced a TIA and sent me home. I called my Neurologist and had him read the MRI and he determined I had a severe stroke and hospitalized me immediately. His fast work probably saved my life. If you are experiencing ...'different...' kinds of pain and other symptoms, I would not hesitate to get a second opinion and go to ER immediately. Damage from a stroke can be permanent if not discovered quickly. My hearing loss and right side weakness have been with me since my strokes and I have had 2 others to put icing on the cake. Its better to be cautious when dealing with anything Re: brain. Good luck to you and let us know how everything turns out.

[alchris]

go to another doctor like an endcronolgist let them do extensve blood work on you.  Since your levels are out of range let someone take a deeper look and an endcrinolgist is another place to start with doctors.  good luck

[southbel]

I made it seem like I was diagnosed with MS in my last post.  I have not been, just this was a new reason offered for my symptoms via the ER doc.

[Jadis]

You may have something metabolic going on that is causing you to have neurological symptoms. For this type of problem, a neurologist is not the best type of doctor to see. My experience with them is that they will not consider that symptoms outside the nervous system are important to what is going on. Migraines or MS will not cause those blood abnormalities that you have. Perhaps see an internist. Whatever you do, keep searching for answers. Do not put your health in the hands of one doctor.

[southbel]

I am nearly at the end of my rope.  I am getting worse, with spasms in my arms and legs now that are near debilitating.  Last night, I had to go to the ER because my throat closed up and I couldn't breathe.  Well, turns out it was spasms in my throat and by the time the doctor saw me, I seemed to be okay.  Sent me home with instructions for seeing doctor for follow-up.  Finally saw a neurologist today and he checked my reflexes, did the finger to nose thing, and asked me about my symptoms.  He then accessed my records from my hospital visit and came back and told me migraine and prescribed me a different medication, which after research I found is the SAME thing as the one I have been on but a different brand name.  He then proceeded to tell me that since my MRI w/o contrast was clear and my blood work was pretty much ok (raised white blood cell count last night in ER, low calcium, low iron, raised hemoglobin) there was really nothing else it could be.  

I am sorry, but I have a hard time believing that.  Yes, a clean MRI is great news, but that certainly doesn't deem me perfectly fine.  My friends, when they see me, are appalled at how bad I look.  I kid you not, I look like death warmed over.  I am extremely pale, HUGE black circles under my eyes, the spasms throughout my body, and now I have totally different pupil sizes, which looks quite freaky.  The doctor in the ER last night felt very sure about MS (this is a new diagnosis) but was reluctant to give me tests since I was seeing a neurologist the next day.  He told me that I would get a lot of tests from the neurologist.  However, I got a prescription.  I just don't know what to do now!  I apologize for my tone, but I am getting very upset because I feel like I deteriorate a little more each day.

So, what now??  Do I accept the migraine dx and just try to get on with my life?  I guess I am a person that likes empirical evidence and I feel like I have gotten nothing of the sort.  I don't know what to do now!

[JCmcc]

yes

[ingcam]

Hello,
Just a note, I believe with your presenting symptoms MRI WITH contrast was indicated.  It would not surprise me if your Neurologist orders this as well.

[southbel]

By the way, on my calcium level...it was .1 in the ionized one where the low threshold is 8.5.  I wish I had remembered to ask for a copy of the blood work results so I could give a much more accurate reporting, but I do remember seeing the .1 and the range with the low threshold as 8.5.

[vega1318]

Bad headaches like that need to be worked up further.  Did you have a brain MRA done or a spinal tap looking for any evidence of blood (e.g., a small aneurysm bursting)?   Also, do you take any medications (prescription or over the counter)?  There is a rare condition that can be caused by certain type of medications (such as amphetamines, ephedrines, antidepressants, even nasal sprays) that can present with severe headaches and even strokes - it is caused by transient spasm in your intracranial arteries.  You would need either an MR angiogram or transcranial ultrasound done to rule it out.   But a small bleeding aneurysm would be the first and foremost -- I hope your doctors looked at that possibility.

[vega1318]

On your MRI, also make sure they rule out venous thrombosis - especially, if you are a smoker or take birth control pills (I don't know if you do).

[SAL1975]

You should try to get in to see a neurologist ASAP.Keep checking for cancellations to get in early.Start taking low dose aspirin as a precaution. Maybe have another MRI, and definately go to the ER if you feel those symptoms come on again. Wish you all the best. Take care!

[alchris]

please be careful of your calcium levels, too high to even too low can cause symtons and mostly heart problems.  Please look into that and best wishes to you

[southbel]

Well, I just got back from the doctor and apparently the doctors in the hospital didn't tell me everything.  My doctor looked at my blood tests and said she saw some very concerning items.  My hemoglobin is very high, I have the markers for severe dehydration even though I have pushed plenty of fluids, I have extremely low iron and my calcium level is near non-existent.  She called a neurologist that she likes and trusts and has me seeing him Monday morning.  She thinks they will do a MRA and lumbar puncture.

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.

[alchris]

Hi if your symtpons are getting worse talk to the neuro doctors office and see if they can squeeze you in sooner  or if you feel worse go to the ER again.  If you are taking the medication could this be adding to it.  Please listen to how you feel and make sure you get every test needed.  I wish you well

[SAL1975]

Sounds like you might have had a mini stroke. These usually do not show up for a while on the MRI. Sometimes they do not show up at all. Although, It may be migrane related, but your symptoms do sound like a mini stroke. My mother had one and her head hurt for months after it, and no one could tell why. You should take this as a warning sign, and make sure your cholesterol numbers are in check.

[southbel]

Is this something that I need to see a doctor for soon?  After I got out of the hospital, they set up an appointment with a neurologist four weeks from now.  My biggest concern is that I seem to be getting worse, regardless of the medications (Lortab and Trazodone).

[alchris]

Not to scare you but it does sound like a mini stroke .  A family memeber had a few mini strokes with the same syptoms.  We didnt know and it led to a major stroke.  Please have everything checked and MRI/CT scans done again and be read by someone you feel confident in.  This is highly treatable and taken care of.  the sooner the better.  I Wish you well.