Dr. Prakashkumar P Bhatt
Neurology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have been suffering from a constant headache for over five years. An magnetic resonance imaging (MRI) done roughly 2 to 3 years ago showed pineal cysts but the report stated they were of no significance. Since then further investigations have been done to find the cause of my headaches. A neurologist I was seeing ordered an magnetic resonance venography (MRV) and it showed significant stenosis in the left transverse sinus. I had a lumbar puncture done and my initial opening pressure was 21 but went down to 19 after a little while. This procedure was done last year, back then I had the majority of my headache in the frontal lobe with symptoms such as vertigo, tinnitus and visual disturbances. Roughly six months ago, I started developing pain in the back of my head on the left side. This pain is absolutely excruciating and goes from the base of my skull up into my head. My quality of life is severely deteriorating due to being in so much pain constantly. I wake up in pain and I go to sleep in pain. I have been prescribed numerous medications from different neurologists over the years and nothing is working. I am currently taking 1000 mg of Sodium Valproate daily. It is taking a slight edge off the pain in the front of my head but it is doing absolutely nothing to help with the back of my head on the left side. I am getting desperate in trying to get relief. Any help if possible would be very much appreciated.
Hello,
Welcome to icliniq.com. I am fine. Through your case summary, you are suffering from persistent daily headache which is disabling your daily activities. You were completely evaluated for yourheadache initially where magnetic resonance venography (MRV) showed left transverse sinus stenosis 2 to 3 years ago. Chronic fatigue syndrome (CFS) pressure was 21 and then 19 one year ago. And you are already on multiple medications for headache (attachment removed to protect patient identity). Now my suggestion is that please go for new magnetic resonance imaging (MRI) brain with MRV imaging to look for recanalization of left transverse sinus and to look for pineal cyst size. There is possibility of one new entity for headache is medication overuse headache if you are taking self-medication like non steroidal antiinflammatory drugs (NSAIDs) or Acetaminophen. I wants to see your erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) reports. Option of treatment in your case: 1. Onabotulinum toxin injection for symptomatic relief. 2. Trial of occipital nerve block as more on left side back of head. 3. Last but best and newly approved drug by FDA is Erenumab (Aimovig) 70 mg once monthly injection.
Patient's Query
Hi doctor,
Thank you very much for your response. My main question now is do you think the stenosis is causing my pain? Can venous stenosis cause intense pain? If the opening pressure is still average can I look into getting a stent just to relieve the pain if it is still narrowed?
Hello,
Welcome back to icliniq.com. If your cerebrospinal fluid (CSF) opening pressure is high, I will suggest you go for CSF manual drainage 25 to 30 ml of CSF daily for three days and if your headache is fading away, then you will definitely be benefited with stenting otherwise stent is not an option.
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Neurology
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