looking for answer

[billysmom213]

26/f 1 year post op decompression surgery for chiari malformation.  Had a spinal fluid leak after surgery and had a drain inserted in lower back. Ever since I have had headaches behind my eyes and on right side of head.  Gets stronger with coughs sneezes and laying down.  I find myself to be forgetful and spacey.  What could be the cause of this constant pain?  Please help... Currently on Neurontin and its not helping Any ideas would be helpful to bring to the attention of my neuroligist

[Abhijeet Deshmukh, MD]

Hello.

Neurontin is indeed a pain reliever. But it is more useful for neuropathic pain, migraine headaches. I am not sure if Neurontin is appropriate for your headache. You may discuss with your present neurologist, a change of medicine for headache.

I am extremely sorry for not being able to help you with any references in California. It's on the other side of the globe for me!

Regards

[billysmom213]

Well, the headaches are still occuring in the early morning hours 2am-7am... I have an appointment with my neuroligist on 01-09.  I called him to tell him I needed something other than neurontin to manage my pain.  He would like to increase my intake to 600mg 3xday.  Is neurontin a pain reliever?  He wants to refer me to another neurologist.  I feel like I am crazy.  Like there is no diagnosis for the way I feel.  Would you have any recomendations as far as a doctor in California?  Someone who knows Chiari and the like.  Thanks for responding Dr.

[Abhijeet Deshmukh, MD]

Hello.

Just like the blood pressure measurement, there is a CSF pressure manometer. One can not measure if the volume is low, but the CSF pressure gives a fair estimate of it.

Yes, if left unaddressed, this may lead to future complications. Headache may be persistent. But, regular clinical assessment will help avoid those complications. It is indeed important to visit the Neurologist's office regularly.

How is the headache now ?

Regards

[billysmom213]

th.Hello Doctor and Thank You for responding.  Is there a test to determine if ones CSF fluid or volume is low?  A test for intracranial hypovolemia? And is this dangerous if left un-treated? Thanks.  Kelly

[Abhijeet Deshmukh, MD]

Hello.

This headache that you are having is due to intracranial hypovolemia. (volume of CSF is low; pressure may be normal or low ). These headaches typically increase of coughing, sneezing, valsalva maneuver.

Symptomatic treatment usually is short lasting.

Your Neurologist / Neurosurgeon should think of treating the root cause of the headache. ( leak, or other). You need to see if the chiari malformation (descent of brain structures) is increasing. This may also lead to such headaches.

Please keep me posted.

Regards