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Atypical Headache: A Case Study
An atypical headache may or may not be a migraine. If migraine symptoms are not present this may be a headache type that is an emergency headache. Case StudyA 26 year old overweight female with a 4 month history of new headaches came to our office this week. Mom has migraines; the patient's are different..no throbbing, no light sensitivity, no nausea. The headaches start about 10AM and are relieved by sleeping. They are also worse if she coughs or has a bowel movement. Vision is normal, no weakness, no other symptoms. She works in a doctor's office so he put her on Topamax. None of the triptans (Imitrex,etc) affected the headache. She was also put on a one week course of steriods which DID help the headache. Her examination was normal except for some pulsating veins on her retina. Diagnosis? Intracranial Hypertension vs Chiari I malformaion. Unusual headaches should be investigated further by a headache specialist. Even primary care physicians may misdiagnose migraines and other headaches. This could have easily become an emergency, and probably should have had an MRI of the brain done LONG before 4 months went by. We put her on a higher dose of steriods to relieve the pressure in the brain and did the MRI of the brain. Fortunately this was a very mild case.
While the diagnosis of intracranial hypertension is rare, any headache that is new and "weird" should be investigated and an MRI ordered. Don't ignore an unusual headache symptoms.
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