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Headache plus abdominal distress
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Headache plus abdominal distress

Hello, I will ask you about a hypothetical scenario. 28 yr old male patient has no med. history until 2 years ago when nonstop frontal headache onsets. Horizontal vertigo which improves when sitting up also ensues. Patient struggles to define headache, but it feels like (in his best words) that the cranial nerve which causes the eyebrows to raise is only at 50% efficiency (tense feeling in forehead and top of head), though no clinical deficit is obvious. In the same pattern as you would expect syncope (upon standing), Pt notes intense throbbing in head and pressure headache intensifies greatly before rapid returning to baseline pain/pressure.

Pt. is diagnosed with 3 cm supra orbital bone tumor which is stable upon repeat scans/nuc. med. imaging. All blood tests normal.

After 2 years of this headache/vertigo scenario Pt develops chronic low grade upper mid abdominal fullness/tenderness with nausea but no weight loss or vomiting, though a change in BM's. Brief low grade fever episode with body pain when gastro probs started. Dr. has not imaged abdomen but Pt wonders is these are connected and should he request Ct of abdomen, etc, or other tests.

Theories on these problems appreciated, as this hypothetical patient has no insurance. Many thanks.
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Avatar_n_tn
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 that you describe are non-specific, and cover several different trains of thought.  First your headaches have characterisitcs of either low pressure CSF headaches (as from a CSF leak either spontaneous or caused by a lumbar puncture) or migraines.  A low CSF pressure headache is relatively mild with lying down and then becomes painful with sitting up and even worse with standing.  These headaches are very common after a lumbar puncture and can be treated with fluids and caffiene.  Less commonly there can be spontaneous leaks around a nerve root, at the nose, ear etc, which results in chronic CSF loss.  This condition can be difficult to diagnose, but CT myelogram is probably the most effective diagnostic tool.  A blood patch and ACTH are often used to treat this condition.  A second possibility is that yhour headaches are migraines.  Migraines can have a positional component and is related to increased central sensitization. To investigate the migraine angle I would start a migraine prophylaxis medication such as elavil, topamax, verapamil, nadolol, etc taken daily (begins to work in 3-4 weeks).  It is unclear the extent that your bone tumor might be playing a role in this.  If any role at all, it is likely triggering your headaches by pressing on a branch of the trigeminal nerve.  As far as your nausea, low grade fever and abdominal fullness/tenderness, I would suggest that you see your PCP (primary care provider) who has more experience in this part of the body than a neurologist.  There are neurologic diseases that can affect the abdomen as well such as sarcoid, neuroblastoma, lymphoma, but I do not suspect these from what you have described.
I hope this has been helpful.
2 Comments
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Avatar_f_tn
Sorry to hear about these problems.  At first glance, it is hard to know whether the two complaints are related -- it seems rather unlikely.   But regardless, abdominal fullness with change in bowel movements is worrisome.   It may be as benign as bloating or as concerning as a growing mass, irritable bowel syndrome or peptic ulcer disease.  These situations are tricky when one has no insurance.  But the best idea would be to take him to the ED -- most hospitals will have to give emergency insurance coverage to patients who are admitted to the hospital.   The problem may be that some hospitals may not want to admit a non-emergent patient but that would then depend on how you talk to the ED docs down there.   The alternative would be to find a gastroenterologist who would be willing to perform the most focused and cost-effective workup without, obviously, missing anything.

I wouldn't worry about the connection, I would be more concerned about the abdominal symptoms themselves.  
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