intractable chronic daily headache and spinal tap

[bob411]

http://www.medhelp.org/forums/neuro/messages/34022.html

Hello again, This is post #2 a followup to the post above.  Please review that link for the discussion.  You suggested an MRV, I printed your response and my neurologist had me an MRV done a few days later (brain, without contrast).  It was negative.    

I would also like to add, that in addition to the 24/7  dull, boring, moderate pressure, I have occasionally been waking up with a completely different type of headache, a more intense, severe nausea, and often vomiting.  These morning headaches typically go away after several hours of the day has passed, and then the dull, boring ache sets back in...back to "normal"

Two more things I have noticed my ears become flushed, red, and hot, often times one ear is hot and the other is cold...  
The other thing is that my forehead muscles (the ones that raise your eyebrows) feel very stiff, or partially paralyzed (but I still retain full movement...they are just extremely stiff, and when I raise my eyebrows I feel pressure throughout the entire top of my skull).this by itself isn't extremely bothersome, but I am trying to explore various signs that weren't there before this pain set in early in 2005.

Final thing I want to ask, is if I was your patient, do you think it would be time for a spinal tap?  To verify CSF pressure, myelin basic, look for chronic infections and so on?  Also, might I need a workout with an Endo specialist or should the basic TSH and metabolic panel suffice?
(i know you can't do official diagnosis, but i seek only guidance)

Very Helpful!

[CCF-Neuro-M.D.-PW]

The stiffness in the forehead muscles is most likely due to muscle tension/contraction, and this can contribute significantly to headache, and is often described as the dull boring headache you refer to.
Assessing the headache after dealing with this is one way of diagnosis - if the headache disappears after getting some botox (now often used for muscle contraction or even migraine headache), then there is your answer!
I note you stated before that your MRI was normal.

Intense headache with nausea can be a sign of increased intracranial pressure - you should have your eyes looked at for papilledema if not already (a bulging of the disc in the back of the eye caused by increased pressure). Dangerous increaed pressure can usually be seen with the MRI too, as the brain spaces would be enlarged. But sometimes the pressure can be elevated in teh absence of this MRI abnormality and cause headache - called benign intracranial hypertension or pseudotumor cerebri. A CSF pressure level can help diagnose this condition - the other CSF tests are not especially indicated.
Treament of this condition is difficult and consists of mediations for pain, medication to reduce the secretion of CSF (acetazolamide, ACTH), or CSF shunting. It is important to diagnosis as if uncontrolled it can result in loss of vision from compression of the optic nerve

Good luck

[bob411]

PS, for everyone's info, this is my second post, i am aware of the 2 post limit, so i won't be posting again for 6 months,  thanks

[bob411]

One thing about the new change in headache I forgot to mention is that during those morning headaches, the are greatly aggrivated by physical activity (walking up stairs),  however the usual dull boring ache isn't effected much at all by level of activity.

Thank you so much, once again

[markbos]

Your morning headaches sound like common migraine headaches.  Have you been treated for migraines before?

[bob411]

Yes, inderal and topomax (topamax) and verapamil.....now i dont take anything because nothing worked...  the morning headache change is different very different actually  than the dull boring pressure i have in my head all day.

i have to wonder if the blood pressure in my head could be higher than the pressure measured on my arm due to some vascular motor problem