Severe headache in teen girl (Internal Medicine)

Dr. Abeer., MBBS


Medical Case Details:

Hi Doctors, I have a patient who has serious headache which last for 3-7 minutes. She is 16 yr old and currently no exams so I ruled out tension headache. No nausea, vomiting or photo phobia so ruled out migraine. Her psychologist prescribe her tricyclic antidepressants and nsaids despite her answers in negative to queries related to depression.o weight loss. No personal issues.
I m thinking of getting CT scan to rule out any mass occupying lesion. I want suggestion from Allopathic point of view.



    Dr. Albana Greca


    Have you checked her teeth? Any x-ray of sinuses?
    What about her eyes? Teens tend to use cellphones or computers on long periods.

    Is the pain continuously? Persisting all the time? Or sometimes worsening (e.g. before exams, or when sit to study? or prior to periods?)

    If still negative, then ct-scan of head I think.

    Hope that helps.

    ▲ 1
    14.Jan, 02:20am

    Dr. Hafiz Muhammad Hassan Shoukat
    Internal Medicine Physician

    Although more detailed history and physical is needed but keepnin mind the possibility of chronic proxsysmal hemicrania, SUNCT syndrome and trigeminal neuralgias.

    ▲ 3
    15.Jan, 12:56pm

    Dr. Hafiz Muhammad Hassan Shoukat
    Internal Medicine Physician

    Also if you want to proceed to imagining for space occpying lesion , would recommend MRI with contrast instead of CT. but its expensive. i believe she might not need at this point of time.

    15.Jan, 01:01pm

    Dr. Robert Hugh Shapiro
    Internal Medicine Physician

    Are the headaches occurring in the same area every time? Given their short length, and a normal neurological exam, I would be highly doubtful of a space occupying lesion on CT scan. Headaches caused by space-occupying lesions usually IMPROVE as the day progresses, due to the decrease in intracranial pressure in the skull as the patient spends time standing up. I agree that this does not sound like a tension headache, but would consider occipital neuralgia, associated neck spasm. In addition, would have the patient keep a "headache diary", noticing location, timing of headaches and any food or other-related triggers. Avoid or cut back on Nutrasweet containing beverages, MSG, chocolate, ripe cheeses. Sleep hygiene: get at least 7 hours of sleep if possible in a quiet, dark, room that is at a temperature that is comfortable for you. Drink at least 5 glasses of water a day. Have small meals frequently to balance blood sugar. Seek counseling if at all possible if there are stress related issues. Take a walk for at least 20 minutes a day

    Hope all is helpful!

    ▲ 2
    23.Jan, 01:48am

    Dr. Rahul Vaswani
    Eye Care Ophthalmologist

    What about refraction...even if her vision is 20/20 one has to go for autorefraction and subjective testing to rule out refractive error

    24.Jan, 12:50pm

    Dr. Jakkula Hemsagar

    You can consider cluster headaches as part of the Ddx. They usually tend to go away after a while, though how long it takes cannot be predicted. You can give her oxygen, triptane injection/nasal spray during the episode and see if she improves.

    ▲ 1
    03.Feb, 05:43pm

    Dr. Abeer
    General Practitioner

    @Dr Rahul Vaswani, her eyesight was rechecked. And it turns out to be distance eyesight weakness. But after glasses, the pain does not go away. She says it's on back of head.

    04.Feb, 07:36am

    Dr. Abeer
    General Practitioner

    @Dr Jakkula Hemsagar, thanks for pointing this out. Considered cluster headache before. But as per site it seems occipital headache

    04.Feb, 07:37am

    Dr. Abeer
    General Practitioner

    @Dr Robert Shapiro, thanks a lot for elaboration on history and diagnostic approach. Occipital neuralgia is one of closest possibility.

    04.Feb, 08:03am

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