since dec21 2010

since dec 21, 2010 ev had headacehs on and off and nause vomiting gettn realy hot dizzie left side of my head waitn for a MRI test

[Shazia Alam, DO]

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 obtain a history from you and examine you, I cannot comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.

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.

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:
-Tumor
-medication side effects
-central nervous system infections (meningitis)
-CNS vasculitis (which often shows up on MRI but sometimes requires an angiogram and lumbar puncture for diagnosis)
-neck problems (as in cervicogenic headache which causes predominantly pain at the back of the head)
-bleeds in the brain
-clots in the veins in the brain (called venous sinus thrombosis, best diagnosed with a test called MRV. Risk factors include the use of oral contraceptives and blood conditions in which the blood is prone to clotting, called hypercoaguable state)
-benign intracranial hypertension (due to elevated pressure in the fluid around the brain called CSF, suggested by the presence of papilledema, or optic nerve swelling in the eye as diagnosed by an eye doctor, commonly occurs in overweight people or those taking specific medications, and best diagnosed by lumbar puncture)  etc.
-intracranial hypotension (too little fluid around the brain, as occurs following surgery or lumbar puncture or less commonly spontaneously. Suggested by the headache improving when a person lies down and worsens with sitting up)

Primary headache disorders are much more common than secondary ones. There are several primary headache disorders, over 50 different types.  For example  migraines, which usually a pulsating throbbing one-sided pain with nausea and discomfort in bright lights that lasts several hours. Another type is cluster headaches, which are sharp pains that occur around and behind the eye often at night and are associated with tearing of the eye and running of the nose. 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. Another type of 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.

Without further information about your headache, it is difficult to provide you with adequate information. However, it is important for you to understand that if you have not experienced headaches in the past and you are now having new head pains, seeing a neurologist is a good idea, just to make sure there is nothing serious causing this pain. Imaging of the brain and sometimes then neck may be indicated depending on your exact symptoms, your physical examination, and other factors.

If you are older than the age of 55, one potential causes is called giant cell arteritis or temporal arteritis. This is due to an inflammation in the temporal artery and other arteries in the body. Symptoms include one sided headache pain in the temple and jaw that may be triggered by chewing. This condition can be diagnosed by a blood test called an ESR and a biopsy of the artery. It is very important to rule this diagnosis out as it is highly treatable and if left untreated it can lead to vision loss. It is exceedingly rare in people younger than 55, and is more common in even older age groups.


I suggest that if headache persists and/or becomes more severe, and/or if you develop neurologic signs like weakness on one side of the body, slurring of speech, double vision, difficulty speaking, and so on that you be seen immediately by a doctor. If you frequently experience headaches or neck pain and are not finding relief, evaluation by a neurologist, and perhaps a headache specialist, might be helpful for you.