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Persistent headache, bad taste, illness, tinnitus and fatigue. Could it be cerebrospinal fluid leak?

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I am 33 years male. I have been having continous headache for the last 3 years or so. The headache is permenant, which means i have it continously, and of course i gets worse with stress. There are also other symptoms of my strange illness, metallic or bad taste in the mouth, tinnitus and fatigue. Nowadays, the headache is severe. The headache for some reasons starts to get worst in the afternoon in daily basis. I have done several checkups including blood tests, MRI, stomach check and also been treated for Sinus infection, but has not helped at all. Although I have some gastrology digestive disorders, the tests I have done show there are no reason from this system to induce the bad headache. I have recently come across the Cerebrospinal fluid leak that may cause almost the same symptoms. It really clicked especially I just remembered I had really bad knock on the back of my head while playing football on the beach. So, doctors, please help as this issue has been nagging me for really long time.
Posted Tue, 1 May 2012 in Headache and Migraines
 
 
Answered by Dr. Shiva Kumar R 4 hours later
Hello,

Thanks for the query.

From the information submitted to me, I personally feel you have a combination of migraine and tension type headache (TTH). The described symptoms do not fit in to the diagnosis of spontaneous intracranial hypotension which occurs with CSF leak. Moreover, headache in spontaneous intracranial hypotension occurs in sitting or standing position and subside on lying down postures. Also, a magnetic resonance imaging (MRI) of the brain will have typical findings to suggest the diagnosis of spontaneous intracranial hypotension.

So I personally feel you should fix an appointment with your treating physician or neurologist and get yourself started on medications for migraine and TTH. Rarely, analgesic abuse can also cause daily headache and needs to be excluded. Medications like tryptomer, flunarizine and topiramate will be of benefit.

I thank you again for submitting your question. I hope you find my response to be both helpful and adequate. If you have any additional concerns regarding your question, I would be happy to address them.

Sincerely,

Dr Shiva Kumar R
Consultant Neurologist & Epileptologist

Above answer was peer-reviewed by
 
Follow-up: Persistent headache, bad taste, illness, tinnitus and fatigue. Could it be cerebrospinal fluid leak? 1 hour later
Many thanks for your answer.

1. Have you considered the fact that i get the headache to be more severe in the afternoon which corresponds to similar symptom of the fluid leak? In the same time I di get regular Nausea feeling?
2.Doyou think that the fall I had may caused a fracture in the skull not detectable in the MRI?
3. Migraine I understand is something comes and goes, in my case the headache is ccontinous severe one and when I press my head it is painful.
4. If I get treated for migraine, how long I should wait till I look for another advise?

Thank you again Doctor.
 
 
Answered by Dr. Shiva Kumar R 2 hours later
Hello and Thanks for the query,

Regarding the more severe headache in the afternoon with nausea; both TTH and CSF leak headache can become more severe as the day progresses with nausea.

Most common cause of CSF leak is trauma to the nose, sinus and the ear. MRI is very sensitive in picking up the CSF leak. CT scan is more sensitive for picking the fractures of the skull.

Migraine in the initial stages is episodic. As time goes on and if not treated adequately it can become a daily headache and is termed as chronic daily headache. Stress is the most common cause of chronic migraine. Most common cause of chronic daily headache is a combination of chronic migraine and tension type headache.

So I personally feel, we do not have any evidence for CSF leak and most CSF leaks regress spontaneously without treatment. Hence treating you as a case of migraine and TTH is more sensible at this point of time. At least 6 week treatment is required for adequate treatment of migraine and TTH before we conclude it as refractory to treatment.

I thank you again for submitting your question. I hope you find my response to be both helpful and adequate. If you have any additional concerns regarding your question, I would be happy to address them.

Sincerely,
Dr Shiva Kumar R
Consultant Neurologist & Epileptologist
Above answer was peer-reviewed by
 
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