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Continuous heaviness of head with headache since eight months (Neurology)

Dr. Asma Parveen., BACHELOR OF DENTAL SURGERY, CERTIFICATE OF IMPLANTOLOGY

 

Medical Case Details:

Hello doctors,

This is regarding my 50 year old mother, who is suffering from a constant heaviness around the forehead and eyes with a headache for almost eight months now. Initially, it started with a cold water sensation around her head, which later turned into heaviness around her forehead and headache. In the beginning, her doctors said that it is a normal tension headache for which she was taking Escitalopram, Gabapentin+, Nortriptyline, and Clonazepam for three to four months, but no relief was found. Later, the doctors advised her to take Divalproex Sodium, Amitriptyline and Naproxen sodium for pain, along with Felicita OD. She has been taking these for a month now, but her condition is almost the same. In the meantime, we got her CT scan brain done which showed cerebral atrophy with basal cell ganglia calcification. We also got her EEG done, which showed some discrepancies in theta waves. The heaviness around her forehead stays for three to four days, then disappears for a few days and comes back again. This causes her a difficulty in focussing on things. We have consulted an ENT and an ophthalmologist, to rule out sinus and eye problems. All her blood tests including the complete hemogram, electrolyte tests, and typhoid test are normal. This problem is mostly associated with acidity and sometimes with a rise in BP. She has been under medication for hypertension and high cholesterol for the past 10 years. She takes Rabeprazole every morning. I want to know the correct diagnosis and is there anything else we can do to improve her condition? Thanks.

 


    Discussions


    Dr. Vinod Kumar Goyal
    Ayurveda Specialist

    Hi doctor
    It will be better if u take my help directly, so that patient is benefitted.
    any how till then u can do..............
    -- rauwolfia Q-- 1 5 drops in water 3 times a day
    -- nat phos 6x --5 tabs--5-5-5
    squeeze how saline water through nose every morning empty stomach and expel it - daily as routine
    - stop or reduce all other medicines
    - consult me direclty

    21.Sep, 04:57pm

    Dr. Asma Parveen
    Dentist

    Thank you doctor

    I will definitely follow your advice

    22.Sep, 09:38pm

    Dr. Amit Garg
    Psychotherapist

    Hello. i would recommend a MRI Brain to start with. since nothing has helped till date, a re assessment and more investigations are required. at the age 50 a simple headache can be a somatic symptom associated with a number of psychiatric disorder. she also needs to be evaluated for minimal cognitive impairment (MCI).
    in the meantime a beta blocker or calcium channel blocker can be added after discussion with your treating physician.
    best luck

    25.Sep, 07:34pm

    Dr. Shitla Prasad Upadhyay
    Pulmonologist

    As headache is episodic so possibility of migraine is high.MRI is suggested.It is better to stop al medication and start with flunarizine 10 mg 1 tab once at night.


    26.Sep, 06:46pm

    Dr. Asma Parveen
    Dentist

    Thank you Dr Amit and Dr Shitla for your much needed comments.
    I will get her MRI done as soon as possible

    27.Sep, 10:08pm

    Dr. Dipak Sopan Patade
    General Practitioner

    If headache is persistent with or without neck stiffness , vomiting or other signs of meningeal irritation and other focal neurodeficit. I would like you to undergo contrast MRI which will suggest any leptomeningeal enhancement.One may consider CSF exam after that to rule out subacute meningitis which might present in exactly similar way. Chronic daily headache is another possibility

    29.Sep, 08:18am

    Dr. Devavrat Harihar Nene
    Neurologist

    Hello Dr Asma. A little more detail about the headache would be helpful as in how long does it last? Any associated nausea or vomiting? Any associated neck pain or giddiness? Any early morning headache? Any aggrevating or relieving factors? Any family history or past history of headache? Fever?
    These headaches can simply be a part of her hypertension so that has to be dealt with properly. If she does not have fever chronic meningitis would be the last possibility. MRI brain is indeed recommended as its a new onset chronic daily persistent headache, however unlikely to show anything new apart from cerebral atrophy.
    So basically my suggestion would be check BP frequently and treat accordingly. Get MRI BRAIN with Cervical spine screening.

    ▲ 1
    01.Oct, 07:52pm

    Dr. Asma Parveen
    Dentist

    Hello Dr Devavrat ,

    Thanks for the reply
    Here are the details which you asked for

    *The heaviness in the head and forehead once it starts in the morning almost remains through out the day.
    * No associated nausea, vomiting ,neck pain , giddiness
    *The headache and heaviness generally starts in the morning itself but headache and heaviness doesn't occur simultaneously, it's either one of them .
    * It is generally relieved or gets better after sleeping.
    * No past or family history of headache.
    * when the headache started initially she got fever for a few days after that her routine blood test was done and she was fine after taking antibiotics.

    Her hypertension has also increased during this period only , earlier she was the taking antihypertensive once a day but now she has to take it twice.

    But all her heart related tests including ECG , echo, halter ECG , were all normal.

    We are trying to avoid MRI because she has a number of metallic dental bridges in her mouth which is contraindicated in case of an MRI.
    The headache and heaviness comes back after almost every 3-4 days.



    02.Oct, 04:34pm

    Dr. Amiya Kumar Chattopadhyay
    Cardiologist

    Hi Dr Ashma,
    U have done all tests relevant to the disease.
    I think it may be due to migrain.
    Tab Fluner(10)- 1 tab daily for 3 weeks
    Tab Granil-1tab SOS, if headache maximum 2 tabs per day.


    10.Oct, 08:22pm

    Dr. Fazil Shajahan
    ENT Otolaryngologist

    Hi Dr.Ashma
    As you have done all the relevant investigation..can you tell me the status of frontal sinus as it would have come in the brain ct.oderwise you will need to do an mri for further treatement

    07.Nov, 05:47pm

    Dr. Kanj Kumar
    Homeopathic Physician

    You have presented your mother's symptoms very broadly. If your mother is not well till day please use Tarentula hispanica 200 daily morning - evening for 10 days. Stop all other medicines .

    09.Nov, 02:30pm



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