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Intense Pain and Pressure in One Spot on Head
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Intense Pain and Pressure in One Spot on Head

Dear Doctor,

I am a 26 year old male. I have eczema and infrequent bouts of cluster headaches behind my right eye. I am on no medication, but take a multivitamin and fish oil.

Since last September, I have had an almost daily pain and pressure in a single spot on the top/front/left section of my head. It is a persistent, deep ache, sometimes spasming in a sharp pain; also, and most worrisome to me, there is an occasional, intense localized surge of pressure right at that spot in my head that lasts 3 seconds or so. Pressing on the spot or pulling the hair around it can sometimes exacerbate the pain and sometimes not affect it at all. The pressure also sometimes creates a tingling sensation across my left scalp. There is no redness or otherwise unusual marks on the skin at the area. There is a slight indent in the skull in this area but no palpitating mass or anything. The pain and pressure sometimes makes me lose focus, but it is hard to tell if there are any other neurological effects. Sleep seems to be the only thing that relieves it, but it comes back about two or three hours into the day.

Two years ago, I had a scare where an MRA showed a possible aneurysm on my left cerebral artery. After a number of CTAs and MRAs, it was concluded this was a false positive. I am worried that my current pain could be vascular in nature. Can vascular problems produce pain like this or do they only produce pain behind an eye? Are sinuses or muscle/tissue/nerve damage more likely? Can neuralgia produce these pressure sensations?

I know you can’t diagnose me with anything, but can you give me a range of things it might be? Do I need more vascular tests and evaluations?

Thank you for your time,
J

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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.

Vascular problems such as AVMs and large aneurysm could potentially cause transient head pains localized to one area such as in your case, but this is rare. Moreover, though you had a scare with a possible aneurysm, if one has not shown up on more conclusive testing, it would be unlikely for one to have grown, and particularly grown to a size that would cause symptoms.

If you have a confirmed diagnosed of cluster headache, it is possible you have another headache disorder, some occur together (i.e. one person may have more than one headache type, and some types of headache occur together more often than others). For example, in primary stabbing headache, sharp or jabbing pain in the head occur, either as a single stab or a series of brief repeated volleys of pain. Primary stabbing headache often occurs in people with migraine. The pain itself generally lasts a fraction of a second but can last for up to one minute in some people, and is usually localized to one area of the head. Another type of brief stabbing 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 last 30 seconds to a minute. Yet another type of stabbing headache is abbreviated SUNCT; 100s of stabbing pains lasting seconds occur and are associated with red eye and tearing.

Many of these types of headaches are treatable if your symptoms are causing discomfort, many respond to medications such as indocin or other medications. I recommend continued follow-up with your neurologist, with evaluation by a headache specialist as deemed necessary.

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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