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Pressure in head - what is this?
by pattig, Apr 18, 2008 08:12PM
My 17 year old daughter has been sick since Oct. of 2007, she had a few months of vertigo caused by a virus that attacked her vestibular nerve. Well she is recovering from but about 2 months ago she started to feel severe pressure in her head, like it is being squeezed or that her head is going to explode. In seeking the cause of the vertigo we saw an ENT, 2 neurologists, endocrinologist and had a brain MRI and CT Scan. All normal. Also extensive bloodwork, all normal. But the"pressure' in the head persists and is ruining her life. Is this migraine? Why wouldn't it be detected by a neurological exam? Anyone have any advice? It was also suggested that she may have anxiety, but she has been to 2 mental health professionals who state she does not have anxiety. Thank you so much for any input/advice.
How is your daughter?
Is the sensation of increased pressure still present ?
Her scans and blood tests were all normal. I suggest that she has a complete examination by an ophthalmologist just to rule out any eye involvement. To further evaluate her case, was a lumbar puncture done? Was there any indication for this?
When all examinations have been performed and they showed within normal results, migraine headaches and tension headaches may be differentials.
Has your daughter been managed with abortive or preventive migraine medications?
If yes, did these in any way relieve her symptoms?
What relieves her symptoms aside from given medications?
What aggravates her symptoms?
The sensation of pressure is constant, sometimes very mild and not that noticable, sometimes very very bad.
She has an appointment with an opthamologist this week... one of the only professionals she has not seen yet. A lumbar puncture was not done..... what would indicate the necessity fo this?
What are abortive or preventive migraine medications? She was prescribed ativan for anxiety and meclizine for the dizziness and nausea.
Nothing relieves the pressure, the only medication she has been given for this is the ativan for anxiety. And that doesn't seem to help.
Nothing in particular seems to aggravate her symptoms, she can be relaxing at home on the couch watching TV and it will get bad, or she could be in school and it will get real bad.
Is a neurologist the best doctor to diagnose migraine or other forms of headache that this could possibly be?
Thank you so much for any help.
A lumbar puncture is usually indicated if an inflammation of the brain covering called meninges is being considered. That is lumbar puncture is used to diagnose meningitis. This may present with fever, vomiting,increased sensation of head pressure, and neck stiffness just to name a few.I believe there is nothing like this in your daughter's case.
"Agents used in abortive migraine therapy treat the intensity and duration of pain, as well as the associated symptoms. New treatment options have been developed, including such newly approved medications as sumatriptan. Sumatriptan is a very effective agent that has joined the ranks of other effective abortive migraine treatments, such as ergotamine, dihydroergotamine, and nonsteroidal anti-inflammatory agents, as well as narcotic analgesics. "(http://www.ionchannels.org/showabstract.php?pmid=7911231).
An underlying anxiety or psychological disorder may still be a differential however.A neurologist is the best person to consult with regards to headaches.
Her primary care doctor believes the symptoms are somatic. How can we get a firm diagnosis of this. As I said previsously a psychotherapist and a neuro psychologist both stated they did not feel anxiety was the issue.
Does your daughter have any other associated symptoms like change in bowel movement, bloatedness, change in the appearance and caliber of stools, frequent burping , vomiting?
A psychologic component should only be considered when all possible organic or physical conditions have been ruled out. In your daughter's case there seems to be no organic focus at this point since examination results came back normal. A psychological cause seems to be a primary working diagnosis while further work up is being done.
Anxiety disorders are not the only disorders that may present with somatic presentations. There are certain classes of somatic or somatoform disorders and each of these follows a criteria before a diagnosis is made.
Let us wait for the neurologic consult. Continue to assure your daughter and communicate with her. At the age 17, we are all vulnerable and there may be some unknown stressors that may be causing her conditions.
Are there any significant changes at school or at home that may be contributing to her condition?
We do communicate regularly, but lately that communication has revolved around health issues and how good/bad she is feeling that day. She is very "hyper-focused" on her health. As far as other issues in her life.... no significant changes at home, at school well she is a high school senior and this did start during the college application process but she is a great student and got accepted to every college that she applied to but one (she was waitlisted there).
I am really worried about not getting her the psychological help that she needs, but don't know where to turn. I am afraid Psychiatrists will just try to medicate, while psychologists/therapists may not be able to understand if her physical symptoms are real or somatic.
Yes, I do understand how you feel. If it may help, I have seen some patients improve with alternative medicine. Some patients request referral for alternative medicine specialists to supplement their medical therapies. You may want to look into acupuncture and reiki (japanese palm healing). You may also want to discuss with your physician if you may be referred to a nutritionist just to look into your child's diet. A diet of vegetables and fruits and good exercise may help. My point here is that, illnesses may not be only explained by organic factors. A person has to be treated holistically. A vacation or a change of environment may even help. If your child