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Reader's Mail: Unusual Headache Presentation Calls for Expert Help

Q. I develop a severe headache at the back of my head behind my ears when I laugh too much. My skull gets tightened and pressurized so much that it feels that if the pressure doesn’t stop, my head will explode. It also happens when I get nervous. Is this normal, and what kind of headache is this?

A. The description of your symptoms may be due to several causes. Above all, it must be determined if there is something anatomically wrong inside your head. An MRI scan is needed to determine that there is no abnormality, especially in the area known as the posterior fossa. Another condition to be excluded includes a Chiari malformation. It may also be necessary to do an MRA (magnetic resonance angiogram) and MRV (magnetic resonance venogram) to observe the vascular structures inside your head.

Once an abnormality has been ruled out, the differential diagnosis would include primary headaches; perhaps the strain of laughing would place it in the category of “primary exertional headache.”

I recommend that you see a headache specialist to explain this unusual headache pattern.

Edmund Messina MD, FAHS
Medical Director
Michigan Headache Clinic
East Lansing, Michigan

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