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daily intermittent short duration head pain

by Paula
(Wahoo, Nebraska)

I am a 52 year old female, non-smoker with history of anxiety, perimenopause, high blood pressure, osteoarthritis, seasonal allergies and cervical disc herniation.

My main symptoms are daily intermittent short duration head pain that occur predominately on the left side. The pain occurs in different areas and is not debilitating. Other symptoms include occasional scalp tenderness and itching, mild tinnitus, mild tingly/prickly feeling in hands and feet, discomfort around left eye (temporal area) and in around left ear (sometimes feels full but does not plug up), pain in my cheek, neck pain, shoulder pain, pain above left eyebrow and sometimes across the forehead (sometimes it will hurt when I press on the area above my eyebrow), and occasionally when I bend over it feels like my nose plugs up and it will hurt across the bridge of my nose.

About a month ago I was treated for what the doctor thought was a sinus infection because I had the typical sinus symptoms on the left side. I took omnicef for 10 days and my sinus symptoms improved dramatically. About 4 days after finishing the antibiotic, the symptoms started to come back. Two weeks after that I started getting the tingling, tinnitus, cheek pain, and pain around the eye.

I have had the head pain through all of this. I have had headaches off and on my entire life, just not everyday. Certain things will bring on the head pain or aggravate it. Those things are sometimes standing up from a sitting postion, sitting and doing sewing or computer work, housework, stressful situations, extreme heat and humidity, moving or turning my head quickly. Each time I experience the pain it only lasts a few seconds to maybe a few minutes. It is hard to describe the pain, but sometimes it feels similar to a tension headache. I dont have any nausea, vomiting, or difficulty walking or speaking. Appetite is good and I have not lost any weight. Rest alleviates all of the symptoms including the head pain and I do not wake up with a headache. The pain gets worse throughout the day.

Lab tests:
CBC - normal
Cholesterol - 227
Thyroid - normal
Sedrate - normal
Rheumatoid factor - slightly elevated
CCP - slightly elevated
Chest x-ray (done Dec. 2011) normal
Chest CT - normal
The chest scans were done because of the shoulder pain

I have been taking extra strength tylenol (500 mg 4 times a day), and naproxen. Neither of them give me much relief. I am so worried about a possible brain tumor. Are my symptoms characteristic of a brain tumor? Any help you could give me would be appreciated.

Thank You!

Paula

Answer:

Hi Paula,

Your symptoms are not really consistent with brain tumor headaches but I would recommend that you speak to someone about getting neuroimaging performed. Headaches in someone over the age of 50 should be further evaluated with an MRI of the brain.

Your ESR and CRP are normal so I do not thing you are dealing with temporal arteritis.

What could be happening is either chronic tension type headache fueled by spasming in the neck, or a rarer type of headache known as paroxsysmal hemicrania. Frankly, it most probably is the tension type headache. Cervical disc herniation with arthristis may be the underlying cause.

Talk to your primary care about the headaches, if no relief from their treatment then consider seeing a neurologist. Amitriptyline at night would be a good choice if it is indeed the neck/spasming/ headache triad which we see often in our clinic.

Good luck!

Mary Kay Betz MS RPA-C

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