Severe Headache, Neurologic Symptoms

[TommieB]

I've had a severe, persistent, incessant headache for four months.  The symptoms are bizarre, and came on very rapidly.  It started as a cap of pain at the top of my head, sometimes squeezing, sometimes pressure, then burning and tingling.  It then spread to the rest of my head, sometimes on one side, sometimes the other.  Sometimes back at the top, sometimes at the back, or behind the ears.  In other words, the pain travels.  My ears hurt off and on, and I have intermittent tingling in the right side of my face and in my legs, arms, and chest.  In addition, I have tremors in both hands, and episodes in which the skin over my whole body feels like it is on fire.  I also have the sensation of pressure/heaviness/hardness in my chest and esophagous.  And there is some problem with my right eye, diagnosed as aniscoria, but no apparent reason for the pupil's uneven dilation, and the optometrist says the optic nerve and retina are healthy.  The eye also hurts more often than not.  And I have general fatigue, and often feel weak and shaky.  I have had a CT, MRI, and CTA of my brain, and an MRI of my spine, all normal.  I have also had a lot of bloodwork done, and again, no sign of infection, inflammation, auto-immune disorder, etc.  The doctors are baffled.  I've been referred to a neurologist, but there's a waiting list (County Hospital).  Has anyone ever experienced anything like this?  What could it be?  

[Lama Chahine, MD]

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, there are many many causes but some include medication side effects, systemic illness, nervous system infection, tumors, bleeds in the brain or clots in the veins of the brain, and others. It sounds like you have had extensive imaging that has not shown a cause for the headache, which is in a sense reassuring. Other secondary headaches, such as elevated pressure around the brain (pseudotumor cerebri) is however not excluded with a normal MRI. Typically, this occurs in overweight women, or in people taking certain medications.

Primary headache disorders are much more common than secondary ones. There are several primary headache disorders.  For example  migraines, which usually a pulsating throbbing one-sided pain with nausea and discomfort in bright lights that lasts several hours. However, sometimes migraine headaches can migrate, such as in yourself. There are other headache disorders in which the pain may migrate over time during the same headache.

Your whole body burning pain is unusual and difficult to explain with a specific neurologic problem. Similarly, your chest pain and generalized fatigue may not be neurologic. Sometimes, a sleep disorder (obstructive sleep apnea), which usually occurs in overweight people but can occur in normal weight people as well, can lead to headaches and daytime fatigue; snoring is usually present. This can be diagnosed with a sleep study.

Often these symptoms may reflect emotional/psychiatric problems related to stress (what is called somatization disorder). The latter is a true medical condition whereby instead of a patient experiencing depression or anxiety, they experience physical symptoms, and once the stress is addressed, the symptoms resolve. Depression can also cause various physical symptoms, such as fatigue, headaches, generalized tingling or other pains and other symptoms. Fibromyalagia is another medical condition that leads to whole body pains, and is best treated with medications such as lyrica and neurontin, exercise, and physical therapy.

Anisocoria, or mild asymmetry in pupillary size, occurs in 20% of people and if there are not opthalmologic (eye) problems on eye exam, is usually not of significance.

You are on the right track with referral to a neurologist. Continued follow-up with your physicians is recommended.

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