Crazy Migraine Pattern then Head Pressure

[TheLastSaneMan]

I'm 33 Male, i've had Migraine since 15, in phases of weeks or months with periods of years in between.  

this most recent started Last November 2007 with 2-3 per week right side  Migraines with aura, lasting 2-6 hours, only at night and would often initiate DURING sleep, about 2 hours after going to sleep, sometimes partial or full blindness  Frequency increased to nightly over the next 3 weeks.  Doctor prescribed Imitrex, which i have always responded well to for immediate aversion.  Maxalt causes no response for me.  I declined to start on topamax at that time.  In late november Migraines stopped abruptly and stayed gone for about a month.

In Late Dec./early Jan. this cycle started again, but on the LEFT side (migraine moved) 2-3 nights per week increasing in frequency to nightly over the next 3 weeks.  No aura, No blindness, pain was milder but the headache "felt" more harmful in nature. ( i dunno if that makes sense but i know it does to you migraine sufferers).  From Jan 14-21 Nightly Migraines stopped abruptly and daily attacks began at a rate of 7-8 attacks per day (almost like cluster headaches, but these did not seem to get very painful before the stopped).  Daily attacks would onset with aura and typical signs of migraine then disappear completely after 15 minutes, followed by the feelings of euphoria i would typically get after a migraine.  On Jan 21 i went back to doctor, and started Topomax 25mg daily then 50, then 75, etc.. standard dosaGe rules...

I'm sorry, that's all backstory, but i think its important somehow.

The Migraines stopped on the same day I started the topamax, and I dont think the topamax is responsible for it, as they have always stopped abruptly. Since the day the migraines stopped I have been feeling a pressure in my head.  It feels like its in the center of my head, and when its strong it radiates towards the temples.  Sometimes it feels like a wave of pressure and sometimes a stab.  but generally its a  dull on and off sensation and its very unsettling.  It does not hurt, but it is there and it is not normal.  I admit i have been in severe pain for months and I may not exactly remember what my "normal" head feels like, but i know it didnt feel like this.  This pressure feels stronger if i lay down.  it feels somewhat like a "head rush" but happens for no apparent reason, last for 5 10 minutes, maybe 20 times a day or more.

I told my doctor i will gladly pay cash for a CT scan and even located and priced one nearby but he must coordinate it and He wont do it.  He thinks i dont need it.  I dont think I have a Tumor, I dont have vision problems, balance issues, nausea, cognitive problems,  vomiting, irritability, ear infection, ive never had sinus problems in my life, i dont have allergies,  I have had blood pressure all over the map the last few months but i believe it tied to pain response and migraines.  For the last week my BP has been very LOW.  averaging 105/70.  I guess what I'm saying is i dont think I'm being one of those people who always thinks they're dying from something.

But ive always heard that when migraine/headache patterns change, you should look into it.

This pressure in my head is not normal and I think my doctor is trivializing my intuition.  I am willing to absorb the cost of CT scan or MRI and can get either for under $500 with no insurance.  Should I be concerned if my doctor is not?  Could this pressure in my head by an aneurysm or a vascular blockage, or could it be neurological?  Should i get a second opinion or see a specialist?

[Vanessa Lacuesta]

Hi,

It's ok, I do understand.Since this is an open forum it is good to hear other people's opinions and also share your own. You are right that there is indeed no substitute for a complete medical evaluation by a physician . However, let me try to answer some of your questions:

Regarding the bleed- it depends on where the bleed is located, how severe the bleed is.If a bleed is present neurologic deficits will show.Again , the type of deficits will depend on what part of the brain is involved.

Build up of intracranial pressure may present with headaches that may be aggravated by coughing or straining, headaches presenting as head fullness in the morning, projectile vomiting, opthalmologic findings ( papilledema), bluring of vision for some. But this may not always apply.

Migraines may present with allodynia ( sensation of pain given an otherwise painless stimuli like light touch).

I do hope this helps.

[TheLastSaneMan]

With all due respect, forget this, i will fire my doctor and begin searching for one who will do what i ask and order the scan.

How much inconvenience can it possibly be to him... my head feels like it is in a compactor.

People, if you have a problem, and you know you have a problem, no internet doctor can do anything for you other than help your fear or denial.  GO GET THE PROBLEM LOOKED AT BY A REAL PERSON.

[TheLastSaneMan]

Dr. Vanessa,

Thanks for the response, I have had no head pain since I started the Topamax three weeks ago, except one.  I am still experiencing the pressure sensations though they do not appear to be getting better or worse.

I was using a Triptan, specifically imitrex, at the peak of my headaches on a nightly basis for about 12 days.  I wasn't aware of an association between the triptans and rebound headache.  Rebound headaches don't have aura or euphoric endings like my little mini-migraines (the final headaches that attacked during the day towards the end of my last bout) did.  During the last hour of a migraine attack I feel amazingly good, these mini migraines had the same euphoria as they ended, 7 or 8 times per day.

The migraine pattern was very erratic and scary, I have not had a cranial CT in 15 years, my doctor is convinced it is not necessary.  I am not convinced.

This sensation of pressure is the only issue I have now.  It feels like a blood rush, seems to be more prevalent in the evening than during the early day.  I am a smoker, and when I smoke a ciggy, it flares up immediately.  This leads me to believe that this is a an issue of blood flow or oxygenation.  There simply isnt any evidence of a neurological issue at work here, aside from some previously concurrent migraines.

I feel at this point, since the Topamax has seemed to take control of the migraines, that the immediate appearance of this "pressure" is not necessarily related to the headaches but perhaps the topamax, or a catalysed side effect.

My apologies, i know i jump all over the place, but i feel the 2 issues of migraines, and head pressure sensations, are seperate, they certainly are distinctly different in nature.

Since this is the neurology forum I guess i should try to help you help me =)

1.  If my brain were bleeding would i be dead now after 3 weeks?

2.  If pressure were building inside my head, would i have more than  just a sensation of pressure, but eye problems, ear problems, nausea, motor function problems, cognitive problems, etc..?

3.  Is it possible that the topamax is making me extremely sensitive to changes in vascular constriction in or around my head? i know it sounds funny, but since i started taking topamax, there are even times when my hair hurts at the roots, as though it were needles sticking into my scalp.

[Vanessa Lacuesta]

Hi,

At this point we can not say exactly if any other underlying condition is present.With the absence of any neurologic deficit aside from your visual symptoms and based on your history that this has been present for years already, a bleed or a tumor seems unlikely. A baseline scan may be needed to ascertain the definite cause of your headaches.   Headaches, especially those accompanied by neurologic presentations ( like visual symptoms) need to  be further evaluated. What you have may be a bout of migraine with aura , however , the diagnosis of migraine is made only when all other underlying conditions have been excluded.In your case, the way i understand it a scan is yet to be done ( is this correct?) .A second opinion may help and your headaches may need to be reclassified. Migraines may transform into chronic daily headaches especially when there is history of drug overuse ( intake of analgesics and other migraine meds for more than 10 days in a month.Does this apply?).

Do keep us posted for anything.