Headaches and Mysterious Lump

May 7, 2024 10:47 AM

I have a big, painful lump on the back of my head. I'm also having bad headaches and I'm dizzy. I can get in to see my least favorite doctor tomorrow or I can go to urgent care. Or I can do nothing. What do I do?

The illness: I think this is what it would feel like if someone clocked me on the back of the head with a baseball bat, but nobody did and in fact I have no memory of bumping my head at all. The lump is like a goose egg; it is egg sized. It is incredibly tender to the touch and painful. My whole head hurts. I woke up out of a sound sleep last night with a headache so bad I seriously considered the ER. 2 tylenol and an hour of reading and it subsided to just a dull roar normal headache; I went back to sleep. I'm dizzy and exhausted, more so than usual, and despite sleeping. For the last week or so I've been feeling exceptionally brain foggy. I was chalking it up to stress and depression but now I don't know. Possibly connected: I was recently diagnosed with severe osteoarthritis in my neck. Nothing has been done about that; I was supposed to get a referral to a pain clinic (several hours away) but it never happened. Then the pain in my shoulder and neck mostly stopped after 6 weeks on meloxicam so I didn't bother to call the orthopedist and ask about it again. I am no longer taking meloxicam.

The doctor: I live in a rural area that has been hit hard by the health care crisis. I made an appointment for June 5 with my primary care doctor last week (somewhat related to the headaches, which were just starting) and the person on the phone made sure I knew just how incredibly lucky I was to be getting this cancellation. Her next available was in August. She is the only MD in the practice; there are two nurse practitioners. I like one of them very much; she's not available either.

And then there is the guy I'm supposed to see tomorrow. He's the reason my osteoarthritis didn't get diagnosed for months. Mild bursitis, he said last fall when I was first in excruciating pain. There was another incident last fall with what turned out to be a pretty severe sinus infection that eventually took antibiotics to clear up: a cold, he said. Have some steroids, he said. I feel strongly that he is dismissive of me and refuses to listen to my concerns.

My question, I guess, is threefold: 1) what's wrong with my head? 2) Should I go see Dr. Dismissive tomorrow or go to . . where? Urgent care? ER? or 3) should I just keep hanging on until June 5 and hope it doesn't get worse?

posted by mygothlaundry to Health & Fitness (41 answers total)

IIWY, I would go to urgent care today. Not sure what your insurance situation is, but they at least can provide on opinion on whether your situation is stable enough to wait until June.
posted by wenestvedt at 10:49 AM on May 7 [9 favorites]

I would go to ER, not urgent care ER, real ER. And go asap. Hope it's nothing, but don't wait.
posted by jraz at 10:49 AM on May 7 [61 favorites]

It's infected, so you should go to the ER or urgent care. Likely an infected cyst; they can blow up really fast. Treatment would be lancing it, packing it, and giving you antibiotics. Less likely is a venomous insect bite; I'd expect an ulcerated wound rather than a swollen bump in that case.
posted by seanmpuckett at 10:49 AM on May 7 [10 favorites]

You gotta go to the ER. Don't fuck around with big potential infections near the brain.
posted by We put our faith in Blast Hardcheese at 10:54 AM on May 7 [40 favorites]

I love some good old American home surgery and ignoring my medical problems and I would at least go to Urgent care but ideally the ER.
posted by raccoon409 at 10:58 AM on May 7 [3 favorites]

Urgent care or ER! And report back, long time mefite mygothlaundry, so that we know that you are okay! This seems like one of those things that could move from "treatable with antibiotics" to "in the ICU" in a couple of days if you don't act.
posted by Frowner at 10:59 AM on May 7 [40 favorites]

If you have no recollection of bumping your head it does not mean you did not bump it. Rather the lack of recollection can be a symptom of concussion. Go to the emergency room.

Source: a school nurse at the school i worked at many years back. It was often my job to discern if i needed to page the nurse for an emergency, or send the student to her waiting room. She said If they have a bump, headache etc but cannot tell me what happened to page her right away.
posted by 15L06 at 11:00 AM on May 7 [17 favorites]

ER now please.
posted by tzikeh at 11:01 AM on May 7 [7 favorites]

Do you need more people to tell you to go to the ER, right now, immediately? Because you need to go to the ER right now, immediately.

If you haven't already gone, I would strongly consider calling someone to drive you, either a taxi or a friend, or calling an ambulance, because I also don't advise that you drive with this going on. Keep us updated if you can but, yes, ER. This is serious!
posted by fight or flight at 11:16 AM on May 7 [5 favorites]

I would go to the ER or the urgent care, depending on what is more accessible to you, but either way I'd go today. Big bump on the head with a source you can't remember isn't anything I'd mess around with.

I'm sorry you're having such a rough time and I hope they can patch you up and you can come back and let us know you're okay / being treated.
posted by Stacey at 11:18 AM on May 7 [3 favorites]

Speaking as one goth to another, please look after your skull.

Hope you can get to the ER swiftly and that you'll soon be recovered.
posted by Pallas Athena at 11:27 AM on May 7 [6 favorites]

is Urgent Care reasonably competent? Go there Now, or ER. Could be any number of non-horrible things, but you're in pain.
posted by theora55 at 11:38 AM on May 7

Urgent Care or ER, and yes to finding someone to drive you if at all possible.
posted by Lyn Never at 11:56 AM on May 7

ER now. Please.
posted by Dolley at 12:06 PM on May 7 [1 favorite]

I don't know if the folks weighing in above are doctors who know you need hospital-level technology, or just caring individuals who want you to be seen right away. Personally, I'm wondering if ER = 16 hours of waiting and exposure to God knows what infectious diseases that whole time whereas Urgent Care might mean an appointment time 2 hours from now, thereby getting you seen more quickly and with lower risk of ending up with a second problem to worry about. Does your insurance card have a nurse hotline on the back that could give you a professional opinion? I'm not trying to minimize -- just trying to get you the fastest appointment and wondering if urgent care might be a faster way to get the level of care you need.
posted by slidell at 12:12 PM on May 7 [4 favorites]

I would also advise ER rather than urgent care - if it's a cyst it probably won't matter either way, but on the chance you need imaging, you'll almost certainly need a full hospital.
posted by restless_nomad at 12:25 PM on May 7 [2 favorites]

The reason to suggest an ER over an Urgent Care in a situation like this is simply because Urgent Cares are typically limited in what they can do. Better for a situation where you have a pretty good grasp of what is happening and a sense that it's within an Urgent Care's purview, which is not the case here. If the OP can be seen quickly at the UC but all they do is tell them "yeah you better go to the ER" then they're still looking at ER waits but now they're a couple hours further into whatever is happening.
posted by We put our faith in Blast Hardcheese at 12:30 PM on May 7 [6 favorites]

Urgent care near me is reluctant to do anything more than take a temp and maybe give a flu test - they missed a pretty serious infection I had once by mistaking it for something viral and saying antibiotics wouldn't help.

Another vote for the ER!
posted by Lawn Beaver at 12:35 PM on May 7 [1 favorite]

Good luck, mygothlaundry!
posted by NotLost at 12:35 PM on May 7

ER. Urgent care in rural areas is usually a shitshow with really great docs moonlighting who have no access to imaging equipment.
posted by notjustthefish at 12:37 PM on May 7

I will add to the chorus -

If this were me, and I know I am privileged because it wouldn't be a significant financial burden, I would have gone to the ER the instant I realized there was a goose egg type bump on the back of my head with no apparent cause.

Go to the ER.
posted by kbanas at 1:06 PM on May 7 [1 favorite]

Unless it's growing from the inside, not remembering how it happened means it could have totally been a baseball bat! Or falling out of bed, or any number of causes from the scripts of "House" and "Bones."

For whatever reason I don't ever care whether I see the same doctor as always, so for that reason I'm also gonna suggest ER/UC.
posted by rhizome at 1:19 PM on May 7 [1 favorite]

Joining the chorus - go see a doctor now! I hope it turns out to be minor and all goes smoothly - please come back and let us know.
posted by maleficent at 2:42 PM on May 7 [1 favorite]

ER!
posted by Ursula Hitler at 3:08 PM on May 7

Please go to the ER, and let us know how it goes!
posted by limeonaire at 3:18 PM on May 7 [2 favorites]

I have taken a Wilderness First Aid class with NOLS and learned some criteria for how to handle serious head injuries and related stuff.

The guidelines said, regarding brain-related injuries:

Rapidly evacuate if the patient has:
....
Persistent vomiting, lethargy, excessive sleepiness, seizures, worsening headache, [or] vision disturbances

"Rapidly evacuate" means "call for a helicopter to get paramedics to the patient ASAP."

You have more than one of those symptoms associated with a weird unexplained painful lump on your head.

I strongly suggest you get to the Emergency Room, as soon as you can.
posted by brainwane at 5:06 PM on May 7 [1 favorite]

Hey mygothlaundry, I'm sure you've gone *somewhere* by now, and are hopefully being seen and cared for! Please update us when you can. Fingers crossed it's easily treatable!
posted by JuliaIglesias at 5:16 PM on May 7 [34 favorites]

Please go to the ER. Speaking from experience, if it's all to possibly related to the brain Urgent Care will examine you and then forward you on to the ER.
posted by champers at 2:56 AM on May 8 [1 favorite]

Response by poster: Hello, I'm fine. Thank you everyone, but I wish I had not gone to the ER.

I went to urgent care. They sent me to the ER for a CT scan. I was at the ER for hours. They did the CT scan and bloodwork and everything was completely normal. They cut a big chunk of my hair off and examined my lump and said, "well, it might be the beginnings of an abscess. Or it might be a cyst. But we don't actually know." They wrote me a prescription for some antibiotic cream, told me to use hot compresses and call a dermatologist and sent me on my way. I went back to work for another four hours (it was a late meeting day for me, so until 8 pm.)

My head still hurts, I'm still dizzy but I just have to get on with it. Probably I now will have to get on with it while paying off this visit for years to come, sigh, and/or battling insurance for days and days on end. They don't like paying for expensive tests that turn out negative. I very much appreciate all the good wishes and I know, better safe than sorry, but I wish wish wish I lived in a sane country where yesterday's ER visit didn't mean almost certain financial disaster.
posted by mygothlaundry at 9:04 AM on May 8 [19 favorites]

I too hate paying for good news when it comes to health stuff, but the alternatives can be worse. If you need help, please let me know if there is a Venmo or something where I can kick in a few bucks. You are worth it. Hugs.
posted by terrapin at 9:08 AM on May 8 [13 favorites]

sent MeFi Mail.

Immediately ask the ER for financial assistance. I went to the ER once, they assured me I was covered, I wasn't, and by the time I found out, the window for assistance had closed. So, ask about it and apply.
posted by theora55 at 9:30 AM on May 8 [7 favorites]

Re your new headache.
posted by oceano at 10:29 AM on May 8 [4 favorites]

Do you have paypal linked to the email address in your profile? I'd be willing to chip in a little.
posted by Larry David Syndrome at 11:24 AM on May 8 [5 favorites]

If this experience has given you any lesson for moving forward, it should be that soliciting advice from random, albeit good-meaning, folks on the internet is no substitute for even the most dismissive professional.
Upthread I noted too many instances of "it's infected" and the like, when a differential diagnosis for a painful lump would include many less dire seeming conditions (like a cyst) that don't require a visit to the ER.
I say this as a long-time commenter on ask, who is also a provider, and I shake my head at the wildly off-base advice I see in threads relating to my expertise. Personal anecdotal experience is just no substitute for actual expertise, no matter your feelings on the profession or any given doctor you've had.

I agree that contacting the ER for assistance sooner rather than later is your best shot at reducing the cost. Rural healthcare centers also often offer a sliding scale, so you could inquire about that as well.
posted by OHenryPacey at 1:46 PM on May 8 [2 favorites]

Be sure to get the documentation from the urgent care part of the visit - you can use it to justify the medical necessity in that a real medical professional at urgent care recommended that you go to the ER.
posted by metahawk at 4:07 PM on May 8 [8 favorites]

You saw a doctor, and that doctor thought this was worth sending you to the ER. Your symptoms were concerning and you weren't being a hypochondriac. I don't think the lesson you should take from this is, "When in doubt, just wait it out." Sometimes you can just wait it out, but a great big, unexplained lump on your head (with dizziness and a bad headache!) is definitely not one of those times. You were very fortunate they didn't find anything serious.
posted by Ursula Hitler at 4:34 PM on May 8 [20 favorites]

Oceano has given some good advice here.
Insurance companies don't like to pay for stuff, but the most important thing you can do is stick it out. They will try to outlast you. They know a certain number of people will just give in and pay. Don't be one of them. Persist. Make contemporaneous notes of each interaction. If you are denied, appeal.
And my brother once said "remember, there is no debtors' prison, so they can't come take you away."
posted by mmf at 5:13 PM on May 8 [4 favorites]

The fact that Urgent Care sent you to the ER could make a difference in the coverage by your insurance. That wasn't a decision you made on your own.
posted by Winnie the Proust at 4:55 AM on May 9 [7 favorites]

Mygothlaundry, I am glad you are well.
posted by NotLost at 6:18 AM on May 9 [7 favorites]

Response by poster: Hey all, thank you again so much and thank you for the very kind offers of financial assistance. It has not yet come to that - I wont' even know how much I owe the rapacious capitalist bastards hospital for, probably, months. But you are all incredibly kind to offer and if I do need help, I will reach out. But I think I will be okay. I'm mostly just mad.
posted by mygothlaundry at 10:22 AM on May 9 [11 favorites]

So glad you are OK.

My encounters with UC->ER->Hospital have been more fraught.
posted by Windopaene at 6:00 PM on May 9