Resolved question:
Please DO NOT POST this online.
61 yo cauc male with 3 week hx of new type of throbbing head pain in one side of back of head. comes and goes. most prevalent in evenings, ocasionally mornings and has happened pretty much every day with varying severity. I have been careful on posture, doing neck rotations (gently), etc in attempt to determine if referred neck pain. generally healthy with recent cbc/cmp with normal crp and sed rate. I did have a high latex turbid Rheumatoid Arthritis Factor but negative ANA test. Bun/Creatine ratio was elevated but likely high protein diet, or a bit dehydrated that day...was not elevated one month before. I am used to having swelling over eyes a few times each month with headache, likely sinus...so this is something different. I generally have extreme stiffness getting up if get down on floor for a few minutes. also have creaky joints in neck, if rotate it fully...and in shoulders if do a pushup. REgular gym visitor 4 times weekly for aerobic and resistance training, but not aware of causing an injury. Torn between going to a neurologist (is this a rear head migraine or cluster type headache, or occipital neuralgia?) or a Rheumatologist. Wondering if structures in neck changing, or if just a back of head headache. When happening, the spot is tender on the rear of head about one inch left of centerline and 2 inch's in from ear on rear. Sometimes feel a bit tender on side of neck as well. My question is what specialist type should i sit an appointment with and do you have any impressions of probable causes of conditions. I know a tension headache, and this isn't one. No aura as for what i understand a migraine to be however. When on travel last week, could achieve some improvement with repeated dose of 400 mg ibuprofen and at least 500 mg of methocarbamol (was in canada) otc. This was only temporary and partial relief...with condition returning next day. At times, no pain. When flares up can be moderate to severe throbbing pain for 2-6 hours, then tends to end on its own.
No major illness's. Healthy lipid profile with extremely low cardio risk.
To summarize, what type of specialist should I go see for the primary complain of recently developed rear head pain? (neurologist, rheumatologist, or some other type) Have you any useful clinical impressions? Would taking daily ibuprofen, methacarbamol make sense for a while (only tried for a day). I would prefer to get at this initially without costly MRI CT etc.....and think the presenting symptoms make it conceivable but low probability of things like tumor etc. If i should consider one of those imaging tests, which is most cost effective, if any at this stage. I see a lot of research suggesting that clinical evaluation without imaging is often all that is needed to start. Seems more likely that muscles or nerves involved to me and something clinical evaluation can handle, IF i go to the right type of specialist.
Submitted:
4 Days
Category:
Neurologist, Medical
Hi,
Thank you for posting your query at DoctorSpring.com
I have noted your symptoms and detailed description.
You should see a Neurologist. The possible causes for vascular headache are migraine and brain ischemia (lack of blood flow to brain).
Clinical examination by a neurologist would be helpful. After that, if there are any abnormalities on clinical examination or something unusual, then a brain scan, preferably MRI brain with angiogram may be done.
At this stage, you can take Ibuprofen tablets for a few days to see if it helps you.
I hope it helps.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist