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Neurology  (Expert Forum)
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vascular relation to chronic headache syndrome
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.

vascular relation to chronic headache syndrome

by kif5040, Dec 23, 2005 12:00AM
I have had unexplainable (frontal) chronic headache with dizziness that NEVER goes away, unresponsive to many various meds including beta blockers.  Its very annoying and puts a tremendous damper on my life.  I also seem to have non-allergic chronic turbinate swelling.



Is a non-contrasted MRA of the brain and cervical-4-vessels sufficient to rule out any vascular cause, including Basilar artery insufficiency or other problems?  I had these scans done and were negative.  The MRI with contrast of my brain and without contrast of my cervix spine was also negative.  



Things that make me feel better:

Hyper extending my neck and or moving my head around causes a "squishing" sound and temporarily relieves the pain a good bit.  Also, oddly enough, holding my nose and blowing air into my ears and holding it temporarily gives 90% relief of symptoms, as does sneezing makes me feel a bit better for a moment.



Question:  

Do these negative tests 99% rule out any vascular insufficiency, pathology, entrapped nerves in the neck, and so on?



What else could I be on the lookout for?





Thank you.

by CCF-Neuro-M.D.-PW, Dec 26, 2005 12:00AM
No test can rule something out 100%, there is always a margin of lack of accuracy or error.

MRA is a sufficient screening tool for your clinical history though. Your symptoms do not suggest basiular insufficiency but further testing for this disoder might include a trancranial doppler ultrasound of the posterior circulation.



Basilar insufficiency tends to cause symptoms like drop attacks, loss of vision, eye movement abnormalities, side-alternating weakness, clumsiness of the hands and feet among other symptoms.



Injection angiograms are more detailed than an MRA but are you willing to risk a 0.5-1% risk of stroke from the angiogram for a 0.01% chance of finding an abnoramlity. All these things need to be weighed up when we are talking about screening for abnormalities with tests etc. The pre-test probability to findings something based on teh history and exam is the most important factor in choosing a test and whether is it useful and worth it or not.



Your condition sounds (informally) like chronic daily/intractable headache, and may benefit from seeing a headache specialist and perhaps some joint injections or botox.
Member Comments (4)

by kif5040, Dec 23, 2005 12:00AM
To: PS- doctor
I also would mention that if I try to turn my head but physically stop it from happening with my head, by keeping my head looking strait forward, but still building pressure up against my cervical-cranial junction, this also offers a tremendous amount of relief.  Does this help any?

by no_hands, Dec 28, 2005 12:00AM
How did this problem start Kif?

by Citizen T, Dec 31, 2005 12:00AM
http://www.medhelp.org/forums/FamilyPractice/messages/558.html





I would encourage you all to read this thread. Myself and others have written extensively about this phenominon.
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