I47-yr-old generally healthy non-smoking male (BP 120/80) new issue with headaches goes like this. Two months ago during some vigorous love-making and at THAT point I got a feeling of dull pressure in my head and for an hour or two afterwards I felt some nausea and was a bit clammy. Not what I'd call a classic thunderclap coital headache OR the sever thunderclap sentinel headache associated with an aneurysm. Ever since then, I have had - for about 50% of the time & not worsening - a dull headache across my forehead (with occasional short bursts of light stabbing sensations anywhere across my forehead) along with some very mild nausea (nowhere near bad enough to cause vomiting or to stop me eating - just kinda a watery-mouthed-ness). The headache did get worse one evening to the point where it resembled a bad hangover headache. I've had sinus issues for years and had my adanoids out as a child. I've had an infuriating post-nasal drip on and off for all of my adult life that has been particularly bad over recent months but which has now settled down somewhat further to course of Doxycycline taken over Xmas and New Year. I do often have some quite heavy mucus that comes up when I cough and sneeze. I'm forever swallowing and clearing my throat - much to the annoyance of my girlfriend!
Whislt I'm aware that what I've developed could be sinus-related, I'm also - as I'm sure you'll have guessed by now - concerned about aneurysms and tumours. That said, my headaches always come on and get worse as the days go on and are never an issue whilst asleep or upon awaking. Neither do they get worse when I bend over or sneeze etc. No signs of papilloedema either. No other 'red flag' issues present. My own Doc isn't that concerned but I can't help but worry! I am considering self-funding an MRI just to check things out (I consider an MRI better than a CT - would you agree?). Any views and opinions would be gratefully appreciated.
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. Secondary headache disorders are due to an underlying problem, such as a tumor, medication side effects, central nervous system infections, clots in the veins in the brain etc.
There are several primary headache disorders, over 50 different types. For example migraines, which usually a pulsating throbbing one-sided pain with nausea and discomfort in bright lights that lasts several hours. Another common primary headache disorder is tension-type headache. 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.
As you mention, in people who generally have not experienced headaches in the past then in recent months develop a new headache, a secondary cause would need to be ruled out. In someone with new headaches that occur daily, an intracranial problem such as a tumor would need to be ruled out. While sinus problems can sometimes cause headaches, headaches are more commonly inaccurately attributed to the sinuses when in fact there is another cause (a primary or secondary headache disorder).
In general it is recommended that for people with either new headaches, or headaches that are different in quality from prior headaches, some sort of brain imaging (CT or MRI) needs to be done. CT scans are better to look for blood, MRIs have better resolution to look at brain tissues. Other types of headaches such as those due to high or low CSF pressure, are diagnosed with a test called a lumbar puncture. Which test is done is based on the symptoms, recent history (of trauma etc) and so on. While I can not recommend what imaging or further testing you need without examining you and obtaining a history, I do recommend that you be evaluated by a neurologist. If a secondary cause to your headache is not found, appropriate therapy for your headache disorder will hopefully help improve your symptoms.
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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