Unusual Headaches

[MdlAgeMale]

I'm a 59 year old male, in generally good health. For approximately 35 years I have had occassional strange headaches.  They are above the right ear and slightly toward the rear, and slightly on top.  The headache is fairly dull, occassionaly throbbing, and often with a cold sensation.  It feels as if there is something inside my head, about an inch deep and working up and out.  On a scale of 1 to 10 in pain, it is never above a 4.  However, the knowledge that it is there and unusual, is disconcerting.

When I first got this strange headache (around 35 years ago),  I remember going to a hospital (NY Montefiore) headache clinic, and I believe they took conventional x-rays.  I don't think they had MRIs or CT scans back then.  They could find nothing wrong and suggested it was stress related.

The headache, which often lasted as long as a week, with on and off periods, would go away.  I might not get the headache again for months or even years.  So, when it would come back years later, I would basically ignore it, as it would invariably last a short time, not cause significant discomfort, and then disappear. In fact, I never told a doctor about it, as I was not experiencing headaches at the same time as my office visits, so I simply forgot about it.

Several weeks ago, it came back.  This time it has been almost constant, and perhaps a notch above the usual in terms of pain, but still not serious pain.  However, now that its back and has seemed to stay, and is a notch up inseverity, I've been getting worried.  I'll be seeing my family doctor about it this week, and he told me we may have to refer it to a neurologist.  

Obviously, I'm quite worried.  I've been all over the net and my symptoms don't seem to match any others I read about.  Has anyone heard of this type of headache, and/or have any idea what it might be?

Thanks - Steven

[dorrie11]

My optic migraine's sound like what you are getting--A Retinal Specialist can confirm them

[Esteban Cheng-Ching, 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 detailed history, I can not tell you what the exact cause of your headaches is or how to treat it. However I will try to provide you with some useful information.
Many patients present with headaches, and this is a common symptom. It could be a primary condition with no underlying cause, but is important to determine if there is an underlying cause that needs to be treated. For this is important to obtain a detailed neurologic exam and if needed, you may need imaging studies like CT or MRI.
Most commonly patients have no underlying cause for their headaches, the there are different types of headaches.
For example, migraine usually is a unilateral headache, pounding, lasts for few hours up to 72 hours, usually severe and the patient stops doing what they were doing at the moment. Light and noise bothers, and patients may complain of nausea and vomiting. If the headache is infrequent, treatment is for the attacks, however if the headaches are frequent, the patient may need preventive treatment, and there are specific medications for this, as well as for the attacks. This does not seem to be your case, however there are multiple presentations of migraines, and this needs to be considered.
A cluster headache, is usually unilateral, behind the eye, with lacrimation and “runny nose”. In this case, oxygen helps, and there is specific treatment.
Your case sounds more like something called hemicrania continua or paroxysmal hemicrania, however it is difficult to give you a diagnosis without obtaining the full history and a good neurologic exam. This type of headache may be intermittent or continuous headache, with a dull and a sharp component, and usually on one side or on the top. It sometimes comes and goes. This type of headache responds to a medication called indometacin, but before trying anything I think you should discuss this with your doctor.
I think before you start trying any medications, you should see a neurologist in order to determine what is the cause of your headache, and what specific syndrome it correlates with if there is any. Depending on the case, further studies like MRI may be needed.
As I said, without being able to obtain a good history and a physical and neurologic examination, I cannot tell you what the cause of your headaches is.
I think it is important for you  to have an evaluation by a neurologist, who can help you to determine if more tests are needed, if there is an underlying cause, and what specific treatment is better.
I hope this information is useful.