Resolved question:
Hi,
I am a 28 year old male who has had constant pressure in my head for approximately 1 year now. The pressure and pain is mainly localised to my forehead and temples and is made significantly worse by bending over, sneezing, coughing and excessive chewing. Other symptoms include severe headache, fatigue, nausea/dizziness and ringing in ears. I also have some blurring in my vision. My blood pressure is ok and averages around 130/70 with a resting heart rate of around 70bpm.
I have tried several pain medication including codeine, ibuprofen, tramadol and endone but none take away the pressure/pain. I have also tried muscle relaxants (norflex) and anti-seizure medication (carbamazepine) but these have had no effect. The only thing that has worked was a short course of prednisone at 25mg/day for 7 days.
I have had several blood tests, as well as CT and MRI scans which have shown nothing abnormal. I have visited a neurologist who determined my headaches may be a result of overusing pain medication. However, after stopping that the pain and pressure has not gone away. I have also had an appointment with an eye specialist, who noted that I had bilateral abnormalities in my optic discs but it was not taken any further.
Through my research I am led to believe that I may have idiopathic intercranial hypertension, but none of my doctors have performed a lumbar puncture to see the pressure of my CSF. I would be grateful if I could have your thoughts on the matter as I am at a loss for what to do next. I have not tried any medication (e.g. diuretics) to remove any excess fluid that may be causing the increased pressure.
Regards,
James
Submitted:
4 Days
Category:
Neurologist, Medical
Hi,
Thank you for posting your query at DoctorSpring.com
I have noted your symptoms. Normal MRI of brain excludes conditions such as brain tumors. I also assume that MR venogram was done to exclude cerebral venous sinus thrombosis (CVST).
In this situation, I would agree that idiopathic intracranial hypertension should be considered and excluded. Eye examination may show papilledema (swelling of optic nerve discs). CSF would be under high pressure. Medications such as prednisolone and acetazolamide reduce the intracranial hypertension and headache/heaviness would subside.
CSF analysis (after lumbar puncture) would also help to exclude meningitis (infection), though the chances are very low.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist