Strange Headaches - Neurological?

[kolmedo]

I have some sort of connective tissue disease, i have regurgitation in 3 heart valves and a dilation in my aorta. With that said my concern is headaches.

Starting around mid-May (for about 3 weeks now) I got strange headaches (the sensation is different then a migraine), i would bend over or some other sort of effort would spring a throb near my right temple. It seemed very dull in the morning and the as the day progressed it would be sharper. The pain would throb for maybe a few seconds and then go away. After a few days of this i noticed i had a patch of skin that  was around my forehead/right temple area that seemed sensitive after these painful occurrences. It happened maybe 15 times a day. It felt metallic, if that makes sense, like metal touching metal in your mouth - but in your head.

My doc had my take motrin regularly for a few days then call him if pain returned. When the pain returned it was different. Not sharp, more dull and didnt happen as often. I have been having more "regular" headaches in that same right temple area as well. But they aren't like me migraines, they will eventually go away without ibuprofen assistance. My doc is now sending me to a neurologist.

Last night I had something strange happen, after a particularly long and tiring day i got out of my car at night and the second i stood up both my arms felt like they were burning, it felt like that contrast stuff that was in my body for my heart CT scan, but just in my upper arm area. It lasted a few seconds, it felt very hot. Then after that my skin felt like it was cold sweat but i wasn't sweating. That sensation lasted a few minutes and then it was gone.  Is this connected?

I had a CT scan (no contrast) of my head done about a year a half ago - would anything causing something like this have been seen on that or would i have needed a MRI? Is this all normal head pain? I wasn't having any pain then, i had alot of scans done when i was first diagnosed with connective tissue disease.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Your description as you mention is different from your typical migraines. I will not talk about migraines here other than the symptom you had of burning sensation through the arms may be an aura; rather I’ll try to describe a few other causes of unilateral headaches.

A concerning cause of unilateral headache, usually with neck pain, is a dissection: a small tear in the blood vessels that travel up the neck to the brain. I mention this because of your history of vascular disease because this can occur spontaneously in people with certain conditions that affect the blood vessels, after neck trauma, or after chiropractic manipulation of the neck. The pain is often but not always associated with some sort of neurologic deficit as a dissection can often lead to a stroke. A dissection is diagnosed with a specific type of MRI test (MRA with fat saturation) or a CT angiogram.


Other causes of unilateral headache, particularly if you are older than 55 years of age, is a condition called giant cell arteritis or temporal arteritis. This condition is due to an inflammation in the temporal artery and other arteries in the body. Symptoms include one sided headache pain in the temple and jaw that may be triggered by chewing, touching of hair, combing of hair, etc. This condition can be diagnosed by a blood test called an ESR and a biopsy of the artery. It is very important to rule this diagnosis out as it is highly treatable and if left untreated it can lead to vision loss. It is exceedingly rare in people younger than 55, and is more common in even older age groups.

Another potential cause of temple pain is inflammation or arthritis of the temporo-mandiublar joint, commonly called the TMJ. This can sometimes occur due to bruxism, biting down at night or during the day, and other stresses to the joint. This is best diagnosed/managed by an orthodontist or an ENT, and treatment includes braces and other dental fixtures and sometimes muscle relaxants, depending on the exact cause.

I should also mention that there are some other forms of headaches that are unilateral that may be associated with autonomic findings such as tearing of eye, redness of eye, running nose, or facial flushing. These types of headaches usually respond to a medicine called indomethacin.

I suggest that if your neck pain/ headache persists and/or becomes more severe, and/or if you develop neurologic signs like weakness on one side of the body, slurring of speech, double vision, difficulty speaking, and so on that you be seen immediately by a doctor. You should keep your appointment with the neurologist. He/she will decide if you have a primary headache disorder (such as migraine or a migraine variant) or a secondary headache (such as the conditions discussed above, but also including tumors, vascular disease, or medication induced). An MRI would be helpful in some cases, but it will depend on the examination findings the neurologist uncovers when you visit him/her.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[kolmedo]

I should add that when i called my doc back i told him that i wanted to wait it out, see if either the pain became intolerable or a new symptom appeared (nausea or something like that). Is that not a safe thing to do? I didnt like going to the doctor for it in the first place, i felt silly, but i wanted to be sure it wasnt blood pressure (my bp was a tad higher than normal but not "high") - and now that i know its not i feel like just letting it be. I suffer from migraines, these are more tolerable.... annoying, but tolerable. I know the pain in the head is nothing to mess with it, but i know alot of it is fairly normal. I don't want to seem like im thinking something is there when it simply isnt. At the same time, im a single mom of two girls and if it something i want to be sure i do everything to catch it if it is something. haha.