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Reader's Mail: Headache Symptoms May Requite Further Tests

Q. I am writing from the United Kingdom and hope you may be able to give help or advice.

My neurologist consultant has diagnosed my condition as “benign cough headache,” and I have undergone a CT scan, which showed no abnormalities. The symptoms I have I first noticed some 10 months ago, and they came on suddenly. Whenever I bent down, sat down, stood up, coughed, sneezed, blew my nose, lay down or did anything that put any pressure on my body, I would get severe head pain and extreme pain at the back of my eyes.

I have suffered from migraine for many years, but with this new condition I do not get any aura or other signs that I got before a migraine.

I have been prescribed amitriptyline and pizotifen, but these have not proved to remove the head pain conditions.

I am now at the stage where I have differing extremes of both head and eye pain continually all day every day, and therefore am hoping you might be able to give some advice as to how I can either get rid of this condition or able to manage it, as it is now affecting my daily life.

A. I am uncomfortable calling these benign cough headaches, which typically last minutes to a few days. Your headaches have been going on for months. You should undergo a more extensive neurological evaluation. MRI scanning is a better test in this setting compared to CT scanning, as it detects structures in the back of the brain, like Chiari malformations, with much higher accuracy. A spinal tap is often needed as well to measure the pressure, but only after the first scan is done.

If nothing is found, your doctor might prescribe indomethacin first. Other medications may also be effective, but they take some trial and error.

Mark W. Green M.D., FAAN
Professor of Neurology, Anesthesiology and Rehabilitation Medicine
Director of Headache and Pain Medicine
Mount Sinai School of Medicine
New York, NY

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