Q. Though I experience pain on my head, why is my MRI normal?

Answered by
Dr. Rajyaguru
and medically reviewed by iCliniq medical review team.

Hello doctor,

I am 27 years old and have been experiencing pain for almost a year. I have developed anxiety and at times lead to panic attacks. My doctor put me on Sertraline 25 mg. I took it once and never again. After this, I experienced weird symptoms with my head. I feel an electric shock like zap on the right side of my head, sometimes, rarely on the left and constant nerve pain on the right side of my head in one spot. I have the sensation like something is stuck in there and I cannot get it out as it is weird. The pain on the right side of my head started when I was driving home from work and my inner ear became really hot for some apparent reason and it has been going on for a year. Sometimes, it feels like my nerve is sizzling or hardening and the pain is worse with stress. Sometimes, I feel the pain in my upper gums, pressure on the bridge of my nose and above my eyebrow gets numb. I have had a normal brain MRI and now I am waiting for an appointment with a neurologist. What is your opinion?

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Dr. Rajyaguru

MBBS., DNB NEUROSURGERY., FELLOW ENDOSCOPIC BRAIN AND SPINE SURGERY
Neuro Surgery Neurology Spine Surgery

Hi,

Welcome to icliniq.com.

I understand most of your symptoms.

  • You said constant nerve pain in the right side of your head on one spot. I would like to know the spot exactly. The best would be if you can attach a line diagram of human head and mark the area on it to avoid confusion.
  • The rest of your symptoms fit into the pattern of a vascular headache and migraine is one of the vascular headaches.
  • Only atypical part here is numbness over the forehead and pain in the gums and this is suggestive of a trigeminal nerve involvement most likely in the form of mild vascular compression. As it is not constant, it is very significant to be picked up by MRI.
  • When you are stressed, the mean pressure goes a bit high and the compression is more temporary and so your symptoms. This is one of the hypothesis behind this sort of symptoms when MRI is normal.
  • Very rarely the lesion involves the dura or nerves in very early stage. When it is not seen on MRI, please do not think too much about it at this stage.
  • This can be treated using medicines, which act on the vessels. We usually start with tablet Flunarizine 5 mg at bedtime. Later on, we adjust the dose and add medicines on SOS (as and when needed basis).
  • If your autonomic system stabilizes, then your symptom would improve. Again, this is a hypothesis, which is waiting to be proved. This is the reason, if you start meditation on a regular basis, your symptoms will improve over a period of time. I have witnessed this.

For further information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

Thank you doctor,

I put two blue dots and the green line to the best of my ability to show you where the pain is. I would also like to note that this pain causes headaches and tender spots on my head like a bruised feeling on different places of my head. So, if this could be a lesion, then how did I get this? Will it enlarge? Also, the gum pain comes and goes along with the forehead pressure, which is mild. But, the nerve pain is always there in my head. I was thinking of getting the steroid shot that numbs the pain.

Dr. Rajyaguru

MBBS., DNB NEUROSURGERY., FELLOW ENDOSCOPIC BRAIN AND SPINE SURGERY
Neuro Surgery Neurology Spine Surgery

Hi,

Welcome back to icliniq.com.

It is good that you sent the picture (attachment removed to protect patient identity).

  • The pain localized to the area, which you have shown and associated tender spots on your head and if you are very sure of this symptom, then it is not a lesion causing this.
  • It is the hypersensitive scalp and is associated with migraine, a vascular headache.
  • Steroids help in the condition called temporal arteritis, in which there are similar symptoms. Pain in the indicated area along the temporal vessels, tenderness of the scalp in the same area, but associated with this would be many other symptoms like generalized weakness, neck pain, pain in muscles, pain in jaw while chewing, etc., which you do not have right now.
  • Also, temporal arteritis is rare at the age of 27. Still, if you have any of the above mentioned symptoms, then you can go for a short course of steroid. But, that is advisable only under direct medical observation.

For further doubts consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

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