Dr. Seyedaidin Sajedi
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,
Since elementary school, I have had a history of severe migraine attacks with aura, accompanied by nausea and vomiting. In high school and college, the attacks occurred yearly, sometimes monthly, and even weekly or thrice a week. During these attacks, I experience intense throbbing and pulsating pain, so severe that at times, I find myself bumping my head into the wall. The pain is so excruciating that I would cry for hours and vomit repeatedly. I have noticed vision problems, with black spots in my peripheral vision when I look to the left, right, up, or down with only my eyes moving. This has been happening for more than five years now. I am also sensitive to light, and exposure to bright lights often worsens my headaches. The intensity of my headaches varies, ranging from 4/10 to 9/10, but during severe migraine attacks with aura, nausea, and vomiting, it can reach unbearable levels (1000/10).
For the past two months, in addition to the symptoms mentioned above, I have been experiencing tiny twitches throughout my body, sometimes on my scalp. Persistent nausea is a constant issue for me, and I often suffer from stiff neck and neck pain. I experience either clusters, thunderclaps, or tension headaches every day. I am highly sensitive to noise, and loud noises can trigger my headaches. Additionally, I hear a very tiny noise in my ears oftentimes. (Right now, I can hear it louder than any sounds I try to listen to). I frequently feel pain behind my eyes and experience double vision.
Throbbing, pulsating, and tightening pain are common features of my headaches. Sometimes I can feel a sudden flicking sensation, possibly in a vein in my brain (I am not so sure). My memory has been declining, and I now struggle to remember minor details such as terms or names of things. My blood pressure is 112/77 mmHg.
As of now, I am preparing for my exams. While I have not experienced any severe migraine attacks with aura recently, I am continuously suffering from persistent daily headaches since the start of my review. These headaches are characterized by pain behind either the left or right eye, discomfort in the eyebrows, pain between my eyebrows, pain in the front and back of my head, and discomfort in my scalp. Additionally, I experience pulsating pain on the left, right, or top side of my head, often accompanied by twitching in my scalp and other parts of my body. Moreover, I tend to get headaches immediately when I do not understand a topic, even if it is a simple problem. Currently, I am not taking anything for my headaches, but I am drinking tea, specifically chamomile and honey infusion tea. I am also considering trying ginkgo biloba as a potential remedy. Last month, I tried taking paracetamol for relief, but it did not have a significant effect. So far, only an eye test has been performed.
I have consulted various doctors, but they have only prescribed pain relievers, which I believe I should not take every day. Financial constraints have made it challenging for me to seek further medical attention, and I genuinely feel that there is something significantly wrong with me. I always have a sense that there might be an underlying issue within my brain that requires treatment. I am seeking your help as I have been increasingly overwhelmed by depression, and it is disheartening that no one seems to believe in my symptoms. It is so hard to find a neurosurgeon here in my province, and my only resort is to get consultation online. Please suggest what to do next, whether I need to have a scan or not. I do not want to suffer from these things for the rest of my life.
Thank you.
Hello,
Welcome to icliniq.com.
I have read your detailed description of your headache, and I understand that such chronic suffering has deeply affected your quality of life. Your headache exhibits all the manifestations of chronic migraine with aura. However, there are two notes in your history that warrant the need for further evaluation. Firstly, the non-stop resistant daily headache requires an imaging workup. Secondly, you mentioned hearing tinnitus in your ears, which is not a typical feature of migraine and is not a prevalent complaint for your age.
Accordingly, I would recommend a brain MRI (magnetic resonance imaging), a brain MRV (magnetic resonance venography), and an LP (lumbar puncture) to evaluate your cerebrospinal fluid, including its composition and pressure. The latter is particularly important as there is a condition where intracranial pressure exceeds normal levels, leading to resistant headaches that may resemble migraine or chronic tension headaches, but with one of three distinctive features: it may worsen with a reclined position, cause tinnitus, or result in transient visual loss, a temporary blurry vision that may occur when standing from a sitting position or during straining for any cause.
I strongly advise you to schedule an appointment with a neurologist. As I mentioned earlier, brain MRI, MRV, and LP are necessary in your case.
Best regards.
Patient's Query
Thank you doctor for the reply,
Apologies for the incorrect statement in my previous messages. Whenever I try to look at or focus on an object on either my left or right side, and then I move my head in the opposite direction while keeping my eyes fixed on the object, I experience black or blind spots. I have been dealing with this issue for an estimated five years. One of my teachers suggested that it might be due to excessive stress from my board exam review.
Currently, these are the consistent problems I have been facing daily: pain behind the eyes, constant nausea, muscle twitches throughout my body, and tension headaches. Unfortunately, I do not have the financial means yet for an MRI, MRV, and LP (lumbar puncture), and it is also challenging to book an appointment with a Neurologist in my area.
Can I directly proceed with an MRI without first obtaining permission from a local neurologist? I would appreciate your advice on this matter.
Hello,
Welcome back to icliniq.com.
The blind spots in your visual field can be another indirect evidence of high intracranial pressure. It is critical to understand that the worst and irreversible side effect of chronic high intracranial pressure is optic nerve damage that can progress up to total irreversible blindness. I understand that the economic issue is an obstacle; however, the potential price of delay for you might be your eyesight.
If the price of conducting a brain CT is more affordable in your area, it can also provide essential data. If the result turns out normal, it would be sufficient to proceed with a lumbar puncture (LP) to check your intracranial pressure. In response to your last question: I do not know the health regulations in your country. In some countries, it is possible; in others, it is not. However, theoretically, you can do a brain MRI ahead of visiting your neurologist because it is a safe, non-invasive imaging method without ionizing radiation.
I recommend you show my consultations to your family or local area physician; maybe he or she can find a way to refer you to a governmental hospital with attending neurologists. Your resistant headache is a case that needs prompt evaluation.
Hope this information helps you.
Thank you.
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