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Neurology (Expert Forum)
Head Pressure or headache that won't go away PLEASE ANSWER DOC
Answered by
Joanna Fong, MD - Stroke/NICU, multiple sclerosis, sleep, EEG, General Neurology
Cleveland Clinic
Cleveland - OH
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
Head Pressure or headache that won't go away PLEASE ANSWER DOC
by soho, Dec 18, 2007 09:03AM
HELP PLEASE GETTING DESPERATE. First Ill tell you I've tried ALL the typical meds, and don't know what to do...
I am a 30 y/o male who has had a headache for almost 3 years now that won't go away. I feel very "depersonalized", plus:
I have a severe sensation of dull, diffuse pressure deep in my forehead, nose bridge, and somewhat the top of my head. My head feels very heavy. Sometimes so heavy that I feel like I may collapse but I don't. I feel like I have extreme tension in my forehead (hard to raise eyebrows). Pressing on my head with my hands makes everything feel so much better including the "tension" sensation. The most disabling part of this is that it NEVER goes away. I also frequently awake with intense morning throbbing headaches that last half the day.
Sometimes if I'm laying down it feels like pressure builds up in my nose and eyes and I get violent vertigo. This improves upon rising. The vertigo lasts 1-4 days at a time and may go into remission for months.
I have begun having a painless yet very intense throbbing in my head upon standing, and the same pressure I always feel greatly intensifies, spreads deep through my head into my inner ear regions and I experience hearing loss bilaterally as if under water. Interestingly, this follows the same pattern as "syncope" so it occurs upon standing but resolves in short order
The workup:
Very extensive Neuro and Eye exam, all the Imaging you can think of (except no LP) was normal except for 3.5 x 2.5 cm benign osseous tumor (left supraorbital). Vision not affected. Mild brain compression. Some bone erosion noted. Abuts frontal sinus. No papaledema. What is your feeling? Are symtoms from tumor, or high CSF pressure, something different alltogether? Is LP recommended? Contraindicated? Other thoughts?
For reference here's images of the tumor (i know this is incomplete but maybe it can give you a general idea):
http://img443.imageshack.us/img443/553/mri1zk4.jpg
I am a 30 y/o male who has had a headache for almost 3 years now that won't go away. I feel very "depersonalized", plus:
I have a severe sensation of dull, diffuse pressure deep in my forehead, nose bridge, and somewhat the top of my head. My head feels very heavy. Sometimes so heavy that I feel like I may collapse but I don't. I feel like I have extreme tension in my forehead (hard to raise eyebrows). Pressing on my head with my hands makes everything feel so much better including the "tension" sensation. The most disabling part of this is that it NEVER goes away. I also frequently awake with intense morning throbbing headaches that last half the day.
Sometimes if I'm laying down it feels like pressure builds up in my nose and eyes and I get violent vertigo. This improves upon rising. The vertigo lasts 1-4 days at a time and may go into remission for months.
I have begun having a painless yet very intense throbbing in my head upon standing, and the same pressure I always feel greatly intensifies, spreads deep through my head into my inner ear regions and I experience hearing loss bilaterally as if under water. Interestingly, this follows the same pattern as "syncope" so it occurs upon standing but resolves in short order
The workup:
Very extensive Neuro and Eye exam, all the Imaging you can think of (except no LP) was normal except for 3.5 x 2.5 cm benign osseous tumor (left supraorbital). Vision not affected. Mild brain compression. Some bone erosion noted. Abuts frontal sinus. No papaledema. What is your feeling? Are symtoms from tumor, or high CSF pressure, something different alltogether? Is LP recommended? Contraindicated? Other thoughts?
For reference here's images of the tumor (i know this is incomplete but maybe it can give you a general idea):
http://img443.imageshack.us/img443/553/mri1zk4.jpg
Doctor's Answer
by Joanna Fong, MD, Dec 23, 2007 05:34PM
, Dec 23, 2007 05:34PM
To: soho
Hi soho,
I am glad that you had an extensive workup, including neuroimagings (MRI). For chronic headache, we need to rule out all the serious diseases that can cause chronic headache. Examples are tumor, vascular malformation (need MRA), vasculitis (MRA and CTA are noninvasive, but gold standard is still angiography), hydrocephalus (extra fluid in brain). If everything is ruled out, then your chronic headache can be what we called "chronic daily headache", tension headache, migraine, or mixed type. For treatment, it's best to see a headache specialist (neurologist). We typically start with intravenous medication to try to abort the headache. Preventive medication is often indicated to prevent further onset of headache. We discourage patient to use too much over the counter NSAID (e.g. tylenol, ibuprofen, advil, aleve, motrin, etc) as it can exacerbate headache. This is called rebound headache or medication overuse headache.
Lumbar puncture can be useful if your headache is due to pseudotumor cerebri, hydrocephalus (both from too much fluid in the brain), or chronic meningitis.
Good luck. Thanks for using MedHelp Forum.
THIS INFORMATION IS PROVIDED FOR GENERAL MEDICAL EDUCATION PURPOSE ONLY. PLEASE CONTACT YOU PHYSICIAN FOR DIAGNOSTIC AND TREATMENT OPTIONS OF YOUR SPECIFIC MEDICAL CONDITIONS.
I am glad that you had an extensive workup, including neuroimagings (MRI). For chronic headache, we need to rule out all the serious diseases that can cause chronic headache. Examples are tumor, vascular malformation (need MRA), vasculitis (MRA and CTA are noninvasive, but gold standard is still angiography), hydrocephalus (extra fluid in brain). If everything is ruled out, then your chronic headache can be what we called "chronic daily headache", tension headache, migraine, or mixed type. For treatment, it's best to see a headache specialist (neurologist). We typically start with intravenous medication to try to abort the headache. Preventive medication is often indicated to prevent further onset of headache. We discourage patient to use too much over the counter NSAID (e.g. tylenol, ibuprofen, advil, aleve, motrin, etc) as it can exacerbate headache. This is called rebound headache or medication overuse headache.
Lumbar puncture can be useful if your headache is due to pseudotumor cerebri, hydrocephalus (both from too much fluid in the brain), or chronic meningitis.
Good luck. Thanks for using MedHelp Forum.
THIS INFORMATION IS PROVIDED FOR GENERAL MEDICAL EDUCATION PURPOSE ONLY. PLEASE CONTACT YOU PHYSICIAN FOR DIAGNOSTIC AND TREATMENT OPTIONS OF YOUR SPECIFIC MEDICAL CONDITIONS.
I really do think my next move will be to have my deviated septum fixed and turbinates reduced to see if that helps any, but I'm not getting my hopes up. If that doesn't work, I might try chiropractics for a while, and if that doesn't work I'll push for tumor removal. I dunno, how are things going with your symptoms?