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unexplained headaches


  I am a 41 yr old male with absolutely no history of previous headaches. In the middle of July 1998 I started to experience fairly severe headache on the top right side of my head daily. I should note they started the day after a lenghty hot day on the golf course with moderate alcohol and fatty foods.I had a CAT scan followed by MRI and MRA which were done at the same time. The results were negative. My problem persisted over the next 3 to 4 months but the headaches were less severe; about a 2 to 4 on scale of 10. But they are always there. This would not concern me so much if I didn't have these other symptoms. I have diminished vision in my right eye where before I never had a problem. Optometrist says I need glassses to correct a difference bwt my right and left eye. The glasses don't really help so he said your problem is not optical its medical. I have had increasing episodes of sudden waking up with tingling in my left arm and on three occasions I couldn't remember my wife's name. This lasts for a few minutes then it passes. It always happens within the first hour and a half after I fall asleep. I have also developed a sensitivity to sound. My doctor says I have an atypical migraine. Questions- Should I have a rpt MRI AND OR MRA-What is the difference between contrast MRI/MRA? I was not given any contrast. If this is an impending stroke is there anything that can be done anyway? Would a visit to and opthomologist be useful? I just don't feel well and I don't buy the migraine theory. I should also mention I had ultrasound on carotid arteries and cardiac ultrasoun- apparently both fine. I do have a strong family history of heart disease. Your thoughts are appreciated. Thank You.
Dear Richard:
Sorry to hear about your headaches and symptoms.  I think that one could conclude from what you have said that these may be headache related.  Especially since your initial CT and MRI were negative.  How long after the headache started was the MRI done?  The MRI looks at brain structure and MRA looks at artery integrity.  Have you had blood work, ANA, sedimentation rate, CBC, vitamin B12, etc?  Likely they were normal but I thought I would ask.  It is unusual that your headache would just start and continue as it did.  I think if I were you, I would gather all the information and seek a second opinion with a good neurologist.  He/She may recommend another MRI with MRA, maybe an EEG, and an opthalmology (not optometrist) consult.  Persistent partial vision loss is something that is really not headache related, and is alittle worrisome.  It may be a better idea to see the neurologist sooner than later.  Let us know what happens.  I hope it turn out to be just a migraine.
Sincerely,
CCF Neuro[P] MD




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