Dr. Hitesh Kumar
Neurology
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Patient's Query
Hi doctor,
I am a 31-year-old female. I have a severe headache, which is more at night time, and it sometimes feels pressurized for the past three months along with few symptoms like blurry vision due to some fluids, numbness sometimes, and a few days back started to have a few days back pricking feel near both of my wrists. I also feel tingly near my forehead and eyes. It feels very weird and not good, and there is ringing inside my ears. Sometimes I close my eyes. I feel like spinning or shaking. I am unable to get good sleep at night. For the past one week, I observed frequent urination. I had already taken an MRI in the brain with the same complaint one and half years back, and the reports were fine. Can I develop a tumor in the brain within one and a half years? Is the MRI taken one and half years back valid, or should I repeat the test (MRI)? I am attaching the reporsts. I am under medication for thyroid and PCOD. Kindly give your opinion.
Hello,
Welcome to icliniq.com.
I would like to know some further details about headache:
1) Since when you started to have these headaches? How many years?
2) In which part of the head you feel headaches? (You can attach your photo, clicked from a little distance, with hand-kept over part of the head, where you feel headache. Can attach two to three photos from front or sides if headache area is large).
3) What kind of headaches you feel? Heaviness or pressure or bursting or squeezing or stretching or throbbing or some other kind?
4) One episode of headache lasts for how long duration (without pain killer tablet)?
5) Do you feel any nausea or vomiting during headache episodes?
6) Is headache associated with any redness in eyes or watering from eyes or nasal blockage?
7) Have you noticed any specific trigger factor or timing for this headache till now?
8) How frequent are these headaches nowadays? and how frequent been before? How many times in a month?
9) How is the intensity of headaches mild, moderate, or severe?
10) Do you take some medicine for your headaches? If yes, please tell the name of medicines, dosage, and how many times you take them? Also, please tell other medications dose and timings which you are on (for thyroid and polycystic ovarian disease)? Also, tell since how long you have thyroid and PCOD (polycystic ovarian disease)?
11) How is your vision for distant objects or near objects?
Other information:
1) How is your sleep routine? Do you get sleepy soon after lying in bed? or it takes a long time? Once got sleepy, do you have frequent awakenings during sleep? Do you feel fresh on awakening from sleep in the morning?
2) How is your usual mood in day-to-day activities? Happy or toward the sad side (thinking about past events) or worrying side (thinking about future things, irritable or something else)?
3) How is your appetite?
Your MRI (magnetic resonance imaging) brain and MRI screening spine one and half years back (attachments removed to protect the patient's identity) are not showing any significant abnormality. If your symptoms of headache are of the same character, possibly no need to get a new MRI. But if there is a change in the character of headache, it is better to get a repeat MRI brain. Regarding developing a tumor in the brain with time, no one can predict. Brain tumors are of many types, some can develop quickly also, and some develop slowly. But it seems you over-anxious. There are many more causes (other than brain tumors) for headaches. Brain tumors account for very few percent of cases of headache.
Also, get these blood test done:
1) T3, T4, and TSH (thyroid-stimulating hormone).
2) Serum Vitamin B12.
3) Serum Vitamin D3.
4) CBC (complete blood count).
5) LFT (liver function test).
Please get back with the reports and answers to the above questions.
Regarding follow up
Patient's Query
Hi doctor,
Thank you.
1) After the tests that were done one and half years ago, I did not take up any medication, and the pain went off, and I suddenly started having these headaches for four months and continuous till now.
2) Pain is there in both temples, sometimes at the back (left and right). Top of the head and feels like dull and throbbing sometimes. I feel my ears blocked sometimes and hear ringing.
3) I felt pain sometimes, pressurized and dull, which does not let me sleep.
4) I have not taken any pills for that headache, and only once I consumed Saridon, and it was of no use. Sometimes the dull pain lasts for more than four hours, and sometimes if squeezing, it lasts for a few minutes and recurs after some time.
5) Only once I felt nausea other than none and no vomit.
6) No nose blockage. But sometimes my eyes become a bit red and watery many times.
7) I have not noticed any trigger points, but I see that when I lie down, it starts, and I have become sensitive to light and too much noise.
8) I did not have any such symptoms till four months back. But then, it all started suddenly, and this head pain and sometimes weird symptoms started, and even till now, I have this pressure in my head.
9) Sometimes, it is moderate, and I will not say severe but bearable and not allowing me to sleep.
10) I am not having any medicines for headaches because I have not had these issues till four months back. I have Thyroxine 25 mg in the morning empty stomach, and for PCOD, I have homeopathy, and I am yet to meet my gynecologist by next week to start my courses.
11) Vision of the near objects is fine but distant object is slightly getting bad sometimes. Sometimes I get to see these green fluorescent lines. A new symptom is sometimes when I close my eyes at night, I feel shaking, and there is a jerk, and it stops after a few.
Other information:
1) I take a long time to sleep after this work from home. I started watching too many series and films at night after work. I have not had any awakenings from sleep, but my sleep pattern has changed a lot. I feel tired because I sleep very late at night.
2) I overthink about the past and future as well. I tried many times to be positive, and I am working towards it. Usually, I wake up and start my daily work with my laptop, and not always sad. I agree that I have been depressed, overthinking that I have a brain tumor again because that is how I felt one and half years ago and took the test.
3) Appetite is pretty normal. But suddenly, I see myself having frequent urination for the past one week, and I feel a prick in my wrists at night mostly.
I believe few symptoms are different from the last time, and psychologically speaking, I will feel better if I see the test results. Please guide me.
Hello,
Welcome back to icliniq.com.
As per your description, there may be a possibility that it may be a tension-type headache associated with mood and sleep changes. But we also should try to rule out other causes of headaches. As you mentioned that intermittently have reddish eyes and watering from eyes and sometimes have ringing in the ears, I would suggest consulting an ophthalmologist and ENT (ear, nose, and throat) specialist physically. By your description, I am not clear whether this redness, watering in the eyes and ringing, and blocked ear are felt during the headache episode or apart from a headache episode.
Do the following tests:
1) MRI brain and MR Venogram with contrast.
2) T3, T4, and TSH.
3) Serum Vitamin B12.
4) Serum Vitamin D3.
5) CBC.
6) LFT.
7) KFT (kidney function test).
8) ECG (electrocardiography).
9) Ophthalmology consultation to look for refraction, IOP (intraocular pressure), and fundus.
10) ENT consultation for ringing and blocked ears.
I suggest you follow:
1) Daily jogging 20 to 30 minutes in the morning.
2) Maintain regularity in sleep and wake and meal timings.
3) Try meditation or yoga and deep breathing exercises daily.
4) Maintain a headache diary.
5) Continue medications for hypothyroidism and PCOD.
Review after two weeks. I hope this was helpful.
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