Reader’s Mail: What to do if Your Headache Symptoms Don’t Meet Specific Criteria

Question:

“My 21 year old son has frequent headache. Actually he describes that as head heaviness. It normally increases during the course of the day. It is also accompanied by shoulder pain and general upper body pain. Wearing some T-Shirts also increase the heaviness. He really needs to wear loose shirts. Hitting the gym and doing some specific workouts help reduce pains and generally he feels good after such session. Cold temp also helps. It is not clear upright position invariably causes headache. His sleep is not affected much by this. His MRI brain scan and cervical spine scans are normal, except reduced C-curve. We considered CSF leak as a possibility. But not all symptoms match. Can anyone help if these symptoms give a clue?”

Answer:

Since there was no mention if there are other associated symptoms associated with the daily headache such as light and/or sound sensitivity, nausea, vomiting, dizziness, nasal drainage, tearing from one eye, droopiness of one eye, etc. and the headache sometimes improves with exercise, we will assume that your son does not have migraine, cluster headache or hemicrania continua.

Patients with new daily persistent headache (NDPH) can have symptoms that do not fit the specific criteria for migraine or tension-type headache. You have stated that the MRI of the brain and cervical spine were reported as “normal” so a tumor, Arnold-Chiari malformation, or cervical spine etiology is not likely. An additional search for a secondary cause of the headache is possibly warranted. Sometimes a slow spontaneous cerebrospinal fluid (CSF) leak may not have the traditional worsening of headache with changes in position that is seen with most CSF leaks. Also, it may be beneficial to do a work up for cerebral venous sinus thrombosis (MRV of the head) and a detailed neuro-ophthalmology examination to check for signs of idiopathic intracranial hypertension/pseudotumor cerebri (which includes a finding of elevated opening spinal fluid pressure on lumbar puncture). It is important to review pertinent family history and symptoms directly with the neurologist/ headache specialist.

George R. Nissan, DO
North Texas Institute for Neurology and Headache
Plano, Texas

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