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Suggest Treatment For Intermittent Headaches At Various Points On The Right Side Of Head
Question: I need a "second opinion" here...
I've been having intermittent headaches at various points on the right side of my head, ranging from the top of my head above my ear, down to the right side of my neck. They usually last a few seconds to an hour.
I went to my GP, took X-rays and blood work. Initially the thought was muscle strain and I was placed on anti-inflammatory and muscle relaxant. Then GP noticed that I had a high "ESR In" The suspicion is temporal arteritis, so I was placed on Prednizone. A week later I was re-tested and had ESR at 80 mm/hr. (I don't know what it was the first time). Lyme and auto-immune disorder were ruled out and it's suggested that I have a biopsy. I'm not sure about this, since if it is arteritis, the treatment is just the Prednizone. I also understand that these biopsies have a high "false negative" rate. I have gone through so many tests lately that I'd rather avoid this but wanted to get a 2nd opinion.
I did have major surgery about a month ago (multiple hernias and bowel resection to repair intestinal blockage). I wonder if these are related.
I've been having intermittent headaches at various points on the right side of my head, ranging from the top of my head above my ear, down to the right side of my neck. They usually last a few seconds to an hour.
I went to my GP, took X-rays and blood work. Initially the thought was muscle strain and I was placed on anti-inflammatory and muscle relaxant. Then GP noticed that I had a high "ESR In" The suspicion is temporal arteritis, so I was placed on Prednizone. A week later I was re-tested and had ESR at 80 mm/hr. (I don't know what it was the first time). Lyme and auto-immune disorder were ruled out and it's suggested that I have a biopsy. I'm not sure about this, since if it is arteritis, the treatment is just the Prednizone. I also understand that these biopsies have a high "false negative" rate. I have gone through so many tests lately that I'd rather avoid this but wanted to get a 2nd opinion.
I did have major surgery about a month ago (multiple hernias and bowel resection to repair intestinal blockage). I wonder if these are related.
Brief Answer:
temporal artery biopsy is advisable
Detailed Answer:
Dear XXXXXX,
Greetings from health care magic!!! I am Dr Thakker and shall be answering your question.
I can understand your concern about the biopsy and need for a second opinion.
Given your current symptoms I would suggest the following differential diagnosis:
1) Temporal arteritis
2) Trigeminal neuralgia.
3) Cluster headache
4) Atypical migraine headache.
The treatment for each of these is different and hence clinching the right diagnosis is very important. Temporal arteritis can be diagnosed with surety only by biopsy. If not treated on time it can lead to blindness in one eye. Hence it is very important to have a timely diagnosis.
The other differentials are diagnosed on clinical criteria alone. They do not respond to prednisolone.
Hence to conclude, I would recommend you to go for the biopsy. There are risks involved including bleeding but the procedure is necessary.
I hope this helps you out. If you have any more questions, please do not hesitate to write back to me.
Yours sincerely,
Dr Thakker.
temporal artery biopsy is advisable
Detailed Answer:
Dear XXXXXX,
Greetings from health care magic!!! I am Dr Thakker and shall be answering your question.
I can understand your concern about the biopsy and need for a second opinion.
Given your current symptoms I would suggest the following differential diagnosis:
1) Temporal arteritis
2) Trigeminal neuralgia.
3) Cluster headache
4) Atypical migraine headache.
The treatment for each of these is different and hence clinching the right diagnosis is very important. Temporal arteritis can be diagnosed with surety only by biopsy. If not treated on time it can lead to blindness in one eye. Hence it is very important to have a timely diagnosis.
The other differentials are diagnosed on clinical criteria alone. They do not respond to prednisolone.
Hence to conclude, I would recommend you to go for the biopsy. There are risks involved including bleeding but the procedure is necessary.
I hope this helps you out. If you have any more questions, please do not hesitate to write back to me.
Yours sincerely,
Dr Thakker.
Above answer was peer-reviewed by :
Dr. Yogesh D
Hi Dr. Thakker:
Thank you for your fast reply. My concerns about going for the biopsy are that the ESR "sed rate" could be caused by ANY inflammation. I wonder if there's anything in the blood test results I posted that would make temporal arteritis a suspect, i.e. what is the basis for ordering the biopsy. I don't want to just take stabs in the dark while they're figuring this out. The original suspect (based on x-ray) was muscle inflammation. Also, the two blood tests (both showing ESR at 80 mm/hr) were done too close together, and if I might benefit from some more time and give the Prednisone a chance to work.
Also, what do you mean by "differential diagnosis"?
Thanks again!
Thank you for your fast reply. My concerns about going for the biopsy are that the ESR "sed rate" could be caused by ANY inflammation. I wonder if there's anything in the blood test results I posted that would make temporal arteritis a suspect, i.e. what is the basis for ordering the biopsy. I don't want to just take stabs in the dark while they're figuring this out. The original suspect (based on x-ray) was muscle inflammation. Also, the two blood tests (both showing ESR at 80 mm/hr) were done too close together, and if I might benefit from some more time and give the Prednisone a chance to work.
Also, what do you mean by "differential diagnosis"?
Thanks again!
Brief Answer:
Please read response
Detailed Answer:
Dear XXXXXXX,
Differential diagnosis means the possible causes of your clinical condition.
Currently there are no specific blood tests to diagnose temporal arteritis. ESR is very non - specific and biopsy is the only way out.
If we wait more for prednisolone to act, the findings on biopsy may diminish and we may not be able to clinch the diagnosis on time.
Hence I would recommend you a biopsy in time.
I hope this helps you out. If you have any more questions, please do not hesitate to write back to me.
Yours sincerely,
Dr Thakker.
Please read response
Detailed Answer:
Dear XXXXXXX,
Differential diagnosis means the possible causes of your clinical condition.
Currently there are no specific blood tests to diagnose temporal arteritis. ESR is very non - specific and biopsy is the only way out.
If we wait more for prednisolone to act, the findings on biopsy may diminish and we may not be able to clinch the diagnosis on time.
Hence I would recommend you a biopsy in time.
I hope this helps you out. If you have any more questions, please do not hesitate to write back to me.
Yours sincerely,
Dr Thakker.
Above answer was peer-reviewed by :
Dr. Yogesh D
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