Bloodwork and other tests for severe, persistent headache?

August 8, 2020 9:15 PM

A male family member in his 20s has had about two weeks of a debilitating headache and fatigue. The ER today ruled out meningitis and he's had two negative COVID tests. What should his GP test for on Monday?

The family member's symptoms include a severe headache with photophobia and neck pain, dizziness, and extreme fatigue (can't stay up for more than 5 hours without going back to sleep again).

The family member works in a bank and has been exposed to a positive COVID case, but has tested negative twice. He did have one day he couldn't taste his tuna, but his taste and smell have returned to normal. He has no cough, shortness of breath, or sore throat.

The ER did some bloodwork (presumably a CBC, not sure what else) and a head CT to rule out meningitis. They did not repeat a COVID test. They sent him home with pain meds and muscle relaxers.

What other tests should he ask his GP to perform?

Thank you!

posted by bananacabana to Health & Fitness (11 answers total)

The doctor should check his iron/ferritin. When I had low ferritin, I had severe, persistent headaches, dizziness, and fatigue—all of which you mention he has had.

Other symptoms I had: being uncharacteristically out of breath from even low grade activity, like walking short distances; feeling uncharacteristically cold; brittle nails; hair loss; minor wounds taking an abnormally long time to heal.
posted by hurdy gurdy girl at 9:29 PM on August 8, 2020 [1 favorite]

It could be a migraine. A referral to a neurologist could provide a prescription for something like sumatriptan/imitrex.
posted by amaire at 12:04 AM on August 9, 2020 [2 favorites]

Neurologist here. This is not medical advice.

A head CT does not evaluate for or against meningitis. Only a lumbar puncture (spinal tap) can do that.

I'm glad your family member does not have a brain bleed (what a CT does evaluate for).
posted by basalganglia at 12:32 AM on August 9, 2020 [4 favorites]

There should be an MRI in case there are any Glandular abnormalities on the pituitary or tumors. He should have his eyes checked too
posted by The_imp_inimpossible at 2:13 AM on August 9, 2020

Mono should be ruled out.
posted by DarlingBri at 2:39 AM on August 9, 2020

Headaches and fatigue can be symptoms of Lyme disease.
posted by gnomeloaf at 2:44 AM on August 9, 2020

Does his house have a working carbon monoxide detector?

Also as a data point, my friend presented similar symptoms with 2 negative Covid tests a couple months ago, but now tests positive for antibodies, so . . .
posted by ananci at 6:56 AM on August 9, 2020 [2 favorites]

COVID tests are notoriously unreliable. I did one test that had a 30% false negative rate! At my workplace, we had four individuals come down with symptoms but test negative. A fifth person who had been around them tested positive, so we had to proceed as if they all were positive.

Absolutely get further testing for everything mentioned above, but this may be COVID and they may just need to ride it out.
posted by Amy93 at 9:16 AM on August 9, 2020 [3 favorites]

get a test for for Lyme infection. (i had a lyme infection ..yr listed symptoms were same as mine, except i also had a fever)
posted by The_Auditor at 11:32 AM on August 9, 2020

I had terrible headaches, aches in my hands, and generally felt old and tired. Getting a dental abscess I wasn't aware of taken care of, including a root canal, seems to have cured it. Dental problems can present in all kinds of weird ways. Trip to the dentist?
posted by The corpse in the library at 2:44 PM on August 9, 2020

He could try a COVID antibody test, though it might be too early. My spouse had fatigue and headache for ten weeks, tested negative for COVID twice, then tested positive for antibodies. (I had similar symptoms with a shorter duration.)
posted by yarntheory at 4:00 PM on August 9, 2020