Mysterious-headache-filter

February 11, 2010 6:09 PM

What's with my wife's headache? I'm beginning to get concerned.

Mrs. Mastershake has been suffering for a couple of months from a progressively worsening headache in her right temple and I'm beginning to worry it could be something serious.

Her symptoms:

• Increasingly severe headaches in the right temple with an occasional feeling of pressure behind her eye.
• No neuro symptoms (weakness, confusion, slurring, etc.)
• Originally brought on by cough but now seems to show up on its own

It began after a bought of the flu and originally only hurt when she coughed. It would last for a few minutes to a couple of hours and then go away. We were concerned but not overly so. My opinion was that it was just leftover from the flu and would pass on its own.

In any case, not too long after the headaches started, she went to urgent care to have it looked into. The doctor there thought there was a slim possibility that it could be temporal arteritis. This seems patantly absurd to me as my wife is only 31 and the incidence among people of her age is practically nil. Her primary care physician seems to have latched on to this diagnosis and has sent her for bloodwork which came back normal. Sedimentation rate was normal. No sign of anti-nuclear antibodies. CBC normal.

Since then, he has resisted sending her for a CT or an MRI. He sent her for a sinus x-ray which came back normal but that's about it. He sent her for the same bloodwork again and says he'll give a neurology referral if it comes back normal again.

My worry is that this could be something more serious like cancer or a vascular problem that could become very serious very fast. I feel like we need some kind of imaging work done asap to rule out the most serious possibilities. Then we can fool around with other possible diagnoses.

My questions:

• Is this something that needs to go to the ER? She had a bout today that she rated an 8 out of 10 in pain.
• What possibilities are there for such a headache
• Is this a panic type situation or something where we can let the doctor take his time

posted by MasterShake to health & fitness (22 answers total)

You mentioned that she feels occasional pressure behind her eye in conjunction with the headaches. She should make an appointment with her optometrist or opthalmologist to rule out any ocular health issues (which can sometimes be present without any visual disturbances).
posted by amyms at 6:16 PM on February 11, 2010

I've recently had similar symptoms. I saw my GP and he ordered a Cat Scan which I had the next day. All clear for me, but now I take migraine medication every night and some other stuff when I feel one coming on.

You need to get a CT or MRI. It will answer more questions and but your mind at ease. It is easier to deal with stuff when you know what it is, rather than what it might be. I guess that the doctor is concerned about the cost (they are expensive) and you should press for the referral.
posted by dantodd at 6:21 PM on February 11, 2010

The dilemma to me seems to be that you think she needs certain tests and your doctor disagrees with you. This is the ideal criteria for a second opinion. You will not be satisfied with what your doctor says and he does not believe your suggestions are appropriate. Rather than practicing medicine or asking us to do it, tell her doctor that you want a second opinion. He should be willing to allow this in the interest of testing his theory and also as "proof" he was "right."

This is called a Win/Win situation.
posted by Old Geezer at 6:29 PM on February 11, 2010 [1 favorite]

Pain that is eight out of ten is definately worth a trip to ER. Hopefully she would then get thorough diagnostic tests.
posted by saucysault at 6:29 PM on February 11, 2010

First of all, is there nausea, light/sound sensitivity, or tearing of the eye?
It could very well be migraines or cluster headaches.

Second, what you want is a second opinion - either from a different primary care physician or from a neurologist.

To get this you have several options.
1) Just go to another pcp. Check and see if your insurance allows this.
2) Just go to a neurologist. Check and see if your insurance allows this.
3) Beg and plead with your current pcp for a referral. He/she is most likely not a heartless monster. Let him/her know that you're terrified. You can't sleep or concentrate on work because you and your wife are just sick with worry. Please, just let us go see a neurologist so we can get on with our lives.

I'm not suggesting that you ought to be terrified. Just that if you want a second opinion then it might help to present yourself to your pcp that way.

For what it's worth, and remembering that I am not your doctor, masses or aneurysms are more likely to present as neurogical symptoms (weakness, speech problems, seizures, etc.) than as pain.
posted by Quizicalcoatl at 6:29 PM on February 11, 2010

This could be many, many things. I had a constant headache for months in seventh grade: turned out to be Lyme disease. I'd keep pushing for testing and treatment.
posted by PhoBWanKenobi at 6:34 PM on February 11, 2010

Pain that is eight out of ten is definately worth a trip to ER. Hopefully she would then get thorough diagnostic tests.

Pain for several months is an emergency?
posted by gramcracker at 6:35 PM on February 11, 2010

Gramcracker, if you re-read you will see it was a "bout" today that was more severe pain than normal. Cronic pain is one thing, sudden escalation of low-level pain indicates SOMETHING is up and diagnosing is best left to professionals.
posted by saucysault at 7:09 PM on February 11, 2010

Think about it being TMJ or a jaw thing. The muscles for your jaw go all the way up there. Are they hard or tight there? TMJ pain is often asymmetrical, stress makes it worse, and it can hurt like a bitch. The fact that it started while she was coughing, maybe she pulled, minorly dislodged something up there. The problem is that once there is a little irritation/inflammation in that joint or area it tends to keep getting worse because you have to keep using the joint to eat, talk, yawn, etc.

It seems like your doc is already on top of things, a CAT scan or MRI can be pricey and completely unnecessary and if a neurologist wants one, she'll order them. Ask your primary doc why he's not doing them, at the very least, maybe he'll be able to quell your fears.

My (non-doc) impression is that headaches are frightening to people but only very rarely serious or life-threatening. Everyone I've known who has had a stroke or brain cancer (5 people) noticed neuro symptoms, in one case basically forgetting how to speak, in another losing motion in one side, etc.
posted by kathrineg at 7:39 PM on February 11, 2010

Also--you didn't mention what makes it better. What makes it better? What makes it worse?

If it is muscle/joint related, an anti-inflammatory/painkiller like Advil might make it better. Eating pickles, chewy things, talking a lot might make it worse.

Good luck
posted by kathrineg at 7:41 PM on February 11, 2010

Do whatever you can to get her checked for a brain tumor; an acquaintance I went to high-school with had many of the same symptoms as your wife (a headache behind her eye that kept flaring up but no other problems) and it turned out to be a brain tumor. She was only 23 or so at the time, but she got it operated on and (to my knowledge) is now fine.
posted by Nattie at 7:55 PM on February 11, 2010

Uh, saucysault I hate to be like this but gramcracker is (was?) an ER resident doctor thing.
posted by kathrineg at 7:57 PM on February 11, 2010

A friend had similar symptoms, namely intense and persistent headache with some cold/flu-like symptoms. With no history of migraines and days of conservative treatment of her own (i.e. NSAIDs, bed rest, etc.) she went to the ER. They gave her a spinal tap. It turned out to be viral meningitis. They started her on anti-virals even before the tests came back. I think she was back near 100% about a week later.

This isn't medical advice, but I'd get to a doctor as soon as you are able. Good luck!
posted by KevCed at 8:36 PM on February 11, 2010

katrhrineg: NSAIDs seem to take care of the pain by and large.
posted by MasterShake at 8:46 PM on February 11, 2010

My mom was having nasty headaches for a couple of months straight and found out the pressure in her eyes was too high. She had laser surgery to unplug the ducts and it solved the headaches.
posted by IndigoRain at 9:09 PM on February 11, 2010

IMHO, if NSAIDS help it's almost certainly not a migraine. If they do help a lot then it might be something swelling and putting pressure on that area of her face. I'd look into a lingering sinus infection, ear infection, tooth problem, eye problem etc.
posted by fshgrl at 9:19 PM on February 11, 2010

I am not a doctor. The standard practice in the USA for chronic headaches without evidence of neurological progression is to avoid imaging and treat symptomatically. That may be why you are finding it difficult to get imaging done. Daily NSAID use can convert an occasional headache into a daily NSAID-induced headache. You need to go see a neurologist that specialises in headaches. There are several categories of headache, of which migraine is just one, and each tends to respond differently to different prophylactic and rescue medications
posted by meehawl at 9:24 PM on February 11, 2010

wouldn't be a bad idea to get her eyes checked. i had killer headaches (in the temple and eye area) for about a year before i happened to get my eyes checked and discovered that my left eye, whose nearsightedness had not changed in a decade, had suddenly gotten a bit worse. a new prescription worked wonders. it was just eyestrain, but man, it sucked.
posted by thinkingwoman at 12:30 AM on February 12, 2010

The CT is a good idea...a sinus xray cannot entirely image problems in the sinus which
could be the problem, especially if its in the ethmoid sinus this could cause pressure behind the eye as well as pain radiating from aother sinuses.
posted by manwoo at 2:05 AM on February 12, 2010

Good point that it could be a sinus infection from the flu...one of the most common problems and treatable with safe antibiotics.

If she hasn't seen a dentist in the last 6 months, might be a good time to go. She can ask about the potential jaw thing there and they can check her teeth.

The problem with scans is that they involve a lot of radiation and radiation is not good for your brain.
posted by kathrineg at 7:15 AM on February 12, 2010

Seconding thinkingwoman. It could easily be eye strain, or even something like her glasses (if she wears them) becoming too tight and pressing on that side of her head. I've noticed in the last year or so that I get intense headaches if I use the computer for too long, which I put down to eye strain.
posted by vickyverky at 11:10 AM on February 12, 2010

I had terribles headaches for a while and just realized that they went away after I cut sugars...
posted by 3dd at 12:44 PM on February 12, 2010