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vascular relation to chronic headache syndrome
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vascular relation to chronic headache syndrome

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.
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Avatar_n_tn
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.
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Avatar_n_tn
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?
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How did this problem start Kif?
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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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