"Uneven" Pupil Dilation and Chronic Headache

[Kimberly__0__0]

  Thanks for a great service... I hope you can help me a bit as you've helped so many others.
  I am a 5'8" tall, 133-lb. female, age 26, taking NO meds, no major illnesses in my history.
  For the last 6 months or so, I have daily headaches and "burning" pain, primarily located at the back of my neck on my head's right rear side.  Usually, the pain is dull but relentless, occasionally it is sharp enough to make me stop what I'm doing.  At one point, I also had pressure-type pain around my eyes, as if someone was pressing binoculars to my face.  (This condition has lessened.)  Blood and urine testing by my PCP and an eye exam from an opthamologist revealed nothing... perhaps some "common eyestrain" and a prediction that my headache pain is of the tension variety.  
  Within the last couple of days I've been mildly to severely nauseated but not dizzy or without balance -- an EPT revealed I am not pregnant.  About 2 months ago and then just last evening, two different people pointed out to me that my left pupil stays enlarged while my right one expands and contracts normally in response to changes in light.  My vision feels "funny" (I apologize for being so vague, but I can't really articulate what is different than normal) but the eye doc said my lens prescription is right on target.  
  So - - Here are my questions...  1.  I have an appointment in 3 weeks with a neurologist. Is that longer than I should wait to get a specialist's advice?  2.  I have spent considerable time searching the net and have learned of conditions from meningioma to syringomyelia that scare me to death (hope not!) and wonder if there are conditions that are not-so-bad that relate to this suspicious combination of symptoms.  3.  When I do see this neuro, are there specific questions I should be asking to ensure we are keying-in on the "right" tests or possible diagnoses?
  Thanks for enduring this long message and for any insight you can offer.
Dear Kimberly:
I think the appointment with the neurologist is a very good idea.  Three weeks is a good time, tomorrow would be better but three weeks isn't too long (if you are like the people I know, yesterday would be too long-just joking).  The symptoms that you describe could be a number of things, some good and some bad.  Since you had a thorough eye exam (is was an opthalomogist, correct) than that would rule out some nasty things that you wouldn't want to have.  Blood work and urine stuff (which ones???) are normal, that is a good sign.  Do you have a family history of migraine headaches?  Without examining you or knowing exactly what tests have been performed, assuming a normal neurological exam, you might have a variant of migraine headache.  Some of your descriptions sound like a basilar migraine and some sound like an opthalmoplegic migraine.  These are just thoughts but would be in any neurologists differential diagnosis.  I think that you will probably need an imaging study of your brain just to rule out the
possibility of a mass or AVM or basilar artery problem.  I wouldn't think that these would be there, given the work up already but a good neurologist would probably want to rule these things out.  Is there a family history of early stroke? multiple abortions (spontaneous type)? DVTs?.  Just searching for the possibility of a hypercoagulable state.  I am assuming that you do not take BCPs, since you did a pregnancy test.  I am assuming that you have no numbness anywhere, do not smoke, do not have hypertension, or anything that you can think of that is out of the ordinary for you.  My best guess is a migraine variant.  Please understand that without examining you, it is difficult at best to give a prognosis of what might be causing your symptoms.  The two things that you mentioned would likely have other symptoms that you did not mention.  I hope that things work out.
Sincerely,
CCF Neuro[P] MD,RPS