Is CT or MRI required if I get unusual headaches?

Question

Hello doctor,

For the past eight months or so, I have had some problems with unusual headaches and sort of momentary feelings of lightheadedness, vertigo but it is like everything just shifts for a second instead of spinning. I have a background of stable migraine headache. I have had some face pressure as well and some momentary stabbing headaches. Some chronic low-grade nausea that can disappear for weeks at a time and is not usually accompanied by a headache. I went through the gamut with general practitioner (GP), he then referred me to an ear, nose, and throat (ENT), and then to a neurologist. I am still getting some headaches but have had a clear computed tomography (CT) scan of sinuses. A full neurological exam was done and that was normal, and the neurologist did not seem to think that additional imaging (MRI) was needed because my exam was normal. Even though it was a CT scan of the sinuses, they would have seen the brain (particularly frontal lobe) and notified of any abnormalities they could see. I had a clear magnetic resonance imaging (MRI) approximately one year ago for some twitching and muscle pain. Do you agree that further examination is not warranted? In other words, with the above information is a structural problem unlikely?

Answer 1

Hello,

Welcome to icliniq.com. You have been elaborate in providing your medical history and that always helps to form an opinion. Coming to your straightforward query, I really do not see any indication for a fresh brain imaging study like CT (computed tomography) or MRI (magnetic resonance imaging) in view of your transient, very short lasting symptoms and a normal MRI brain, just one year back. Instead, I would suggest here to get one electroencephalogram (EEG) done to look for abnormal electrical discharges in the brain during those episodes. EEG done during the time frame when you are frequently having those episodes will be more rewarding in terms of diagnostic importance. With a normal neurological examination and normal MRI, you should stay calm and assured that it is nothing serious. Lastly and importantly, anxiety is the commonest cause of such symptoms. Please start doing mental relaxation exercises, meditation, yoga and observe for improvement.