Q. I feel like every afternoon around the same time I experience a burning sensation that begins at the right side of my forehead and crosses to the left side. It surrounds my eyebrows and eyelids. It’s not dissimilar from the sensation of sunburn, but the best way to describe it is tightness in the forehead. It can cause my eyelids to burn and swell and exacerbate my dry-eye problem. At times, I experience a sharp dagger-like pain in my right eye and under the brow bone. The whole thing lasts about three hours. A CT scan of my sinuses was clear. Is this description consistent with cluster headaches?

To help improve patient care, The American Headache Society (AHS) recently released five practices that health care professionals and patients should avoid or question regarding headache treatment. The guidelines and considerable information about them appeared in the November-December issue of Headache. The list was created as part of the Choosing Wisely initiative of the American Board of Internal Medicine Foundation, which stresses the importance of physician and patient conversations in improving care and eliminating unnecessary tests and procedures. The Choosing Wiselyrecommendations should not be the final word in decisions about treating headache disorders or any other condition, experts say.  Instead, they are intended to foster conversation about what is — and is not — appropriate and necessary treatment.

Q. I had a migraine yesterday morning and took my medication to get rid of it. It got rid of my pounding pain, but about 2 hours later a portion of the right side of my face became numb. Within another 3 hours, the entire right side of my face was numb, my mouth was drooping, and my right arm and leg were heavy. As you can imagine, we thought I could be having a stroke. I am 43. We went to the emergency room, and by the time I arrived, even my speech was affected. All CT scans came back clear. The doctors decided I was having a complex migraine and explained the headaches can present as though the patient is having a stroke. They gave me a migraine "cocktail" and massive steroids and within a half hour, my symptoms were much improved. I am still regaining more control even today. What was so odd was that I had no pain.  Have you heard of this kind of migraine before?

While most individuals who experience a mild traumatic brain injury recover fully, about 15% will suffer long-term neurological issues, including headache. Currently, computed tomography CT scans are used to assess such injuries, but a recent study reveals that magnetic resonance imaging (MRIs) may be the more effective tool for predicting long-term outcomes.

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.

By Edmund Messina, MD, Medical Director of the Michigan Headache Clinic in East Lansing, Michigan While headaches are typically thought to be located around the forehead or back of the head, there are types of headache that strike the face itself. Trigeminal neuralgia is a form of severe facial pain in which patients experience brief volleys of very painful electric shock sensations triggered by mild touch to the face or mouth. This touch can be from washing, shaving, eating, brushing the teeth or even talking. The trigger zones are particularly sensitive in the area between the nose and mouth or on the chin.

By Robert Kunkel, MD, Consultant, Center for Headache and Pain Neurological Institute, Cleveland Clinic, Cleveland, OH THE CASE I first saw George on March 12, 2008. He was 75 years old and had had a headache since December 12, 2007, when he slipped on ice and fell. He said he didn’t hit his head, but he had left-sided neck and head discomfort afterward, which had persisted. He had high blood pressure, which was well controlled, but no other significant medical problems. George described the head pain as “sharp” and constant in character. It was strictly on the left side and involved the left neck and upper shoulder area, the back of the head and spread forward above the left ear into the temple. It was not aggravated by neck motion, coughing or straining. He had a CT scan of the brain in January of 2008, which was negative, and a CT scan of his neck showed only mild degenerative arthritic changes. He was referred for physical therapy, which helped the neck pain but had no effect on his headache. In February, his primary care physician diagnosed him with occipital neuritis and he was put on a dose of prednisone (a cortisone) that was tapered over the course of seven days. His head pain was completely gone for a few days but recurred when he reduced the dose. In addition to the head discomfort, George reported that he felt tired and had a lack of stamina. While taking the prednisone, he “felt like a new man.” When I examined him, he had been off of prednisone for over two weeks. The exam was normal, including his blood pressure, except for mild tenderness with pressure over the left lower neck and at the base of the skull. His neck motion was slightly reduced. On the presumption that this was a form of occipital neuralgia, we injected his occipital nerve with a mixture of an injectable cortisone preparation and a local anesthetic. Following this procedure, he was free of pain for five days. Because this was a new headache for George, and because of his response to the prednisone, the diagnosis of temporal arteritis was also considered. On lab testing, he had an elevated sedimentation rate (sed rate), which reflects inflammation in the body. His sed rate was 70 while a normal level is between 0 and 20. Because of this elevated sed rate, we had a biopsy of the left temporal artery done one week after his first visit. His headache had returned by then and the biopsy showed active inflammation in the artery wall, which is typical of temporal arteritis. He was started on a daily dose of 60 mg. of prednisone along with extra calcium and vitamin D.

Hi my name is Jessica. I am 25 years old. My Migraines started about 4 years ago when I was driving and all of the sudden, I could not see the road ahead of me. I got an eye exam right away and learned that I had swollen optic nerves, and at that time I had no clue what the doctor was talking about? I received an MRI, a CT scan, an X-ray and they were all fine. I finally saw a neurologist and had a spinal tap. My opening pressure was 38, which is three times the normal spinal fluid pressure. The neurologist told me I had Pseudo Tumor Cerebri, which she explained meant that there was too much spinal fluid around my brain. She put me on a diuretic and told me that eventually I would have to have brain surgery to correct the problem. Since that time two years ago, I have endured 10 spinal taps and one major brain surgery in October of this year. 2010. That Did Not Correct The Problem!

Ct-scan A CT Scan is short for computerized axial tomography of the brain. It utilizes x-rays which are combined by a computer into a single picture. This process enables the physician to obtain a series of pictures of the brain without invading the brain itself. It is used primarily to rule out organic disease such as a tumor or bleeding in the brain as a cause of the headache problem. A CT Scan can be performed with or without dye. The dye may enhance the detection of a brain tumor or a blood clot. The dye is iodine based so it must be used with caution in those with allergy to these agents. It is more sensitive than MRI scans for detecting acute bleeding on the brain. However, the MRI scan is useful for looking at other brain conditions and takes pictures at different angles than the CT. The MRI does not use x-ray or iodine dye.