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Suggest Treatment For Persistent Localised Pain In Head
Question: I have had localized pain in my head for two week. The only way to make it bearable is to take over the counter pain relievers. I saw the PA at my doctor's on Monday. She thinks it is Masoiditis. She is giving me heavy doses of steroids (4 for 3 days, 3 for 3 days, 2 for 2 days and 1 for 1 day). I felt fine Mon thru Wed. Thurs I forgot to take the steroids and the headache came back during the night. I took the prescribed steroids Fri. morning at 8:30 along with 2 Motrin. It took quite a while to get the pain under control. The pain is on the right side of my head - from my temple over the side of my head and down into the bottom of my skull. I don't take any other prescribed medicine except for calcium and vitamin D. What do you think. I am going back to her XXXXXXX 22 for a recheck. Thank you
Brief Answer:
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Detailed Answer:
I read your query carefully and I am sorry about the symptoms that you are experiencing.
Since a diagnosis of mastoiditis has been made I suppose the pain is present mainly in or behind your ear. I am hopping they did check your ear for signs of middle ear infection and also that you had a blood work up. Often when there is some doubt for the diagnosis, a CT scan is made which is the chosen exam when mastoiditis is suspected.
As for the medication I am a little perplexed as for mastoiditis usually antibiotics are used. Steroids can be used, but as an addition (and usually local drops), not the only therapy.
One other diagnosis that given the location of your pain I hope has been excluded is giant cell arteritis (otherwise called temporal arteritis) which might cause similar pain and is treated with steroids. If you had blood tests that diagnosis can be evaluated through routine testing of erythrocyte sedimentation rate and c-reactive protein (might have been considered already, but thought I'd mention just in case).
I hope to have been of help.
Read below
Detailed Answer:
I read your query carefully and I am sorry about the symptoms that you are experiencing.
Since a diagnosis of mastoiditis has been made I suppose the pain is present mainly in or behind your ear. I am hopping they did check your ear for signs of middle ear infection and also that you had a blood work up. Often when there is some doubt for the diagnosis, a CT scan is made which is the chosen exam when mastoiditis is suspected.
As for the medication I am a little perplexed as for mastoiditis usually antibiotics are used. Steroids can be used, but as an addition (and usually local drops), not the only therapy.
One other diagnosis that given the location of your pain I hope has been excluded is giant cell arteritis (otherwise called temporal arteritis) which might cause similar pain and is treated with steroids. If you had blood tests that diagnosis can be evaluated through routine testing of erythrocyte sedimentation rate and c-reactive protein (might have been considered already, but thought I'd mention just in case).
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
She didn't do any blood work or check my ear for signs of infection. Only asked me questions. I don't have any pain in or behind my ear. She said, "We don't want to do any imaging until we see if this treatment works." Is it okay to wait to have tests when I go back on the 22 of June? I am a normally a very healthy person so this has left me quite nervous. I just needed another motrin. My B/P was 164 over 98 which she attributed to the pain. Thank you
Brief Answer:
Read below.
Detailed Answer:
Your worry is understandable. To be honest I am a little puzzled of her being so confident about the diagnosis, apart from the antibiotic issue which I mentioned. So since you aren't feeling any better I believe imaging and treatment choice should be discussed, possibly at an earlier date.
As for temporal arteritis diagnosis which I mentioned, it is a diagnosis which must be considered in any new onset localized headache after the age of 50. ESR test should have been done before therapy because if steroids are used the erythrocyte sedimentation rate (ESR) test could normalize in a few days and be of no value. Since you started treatment I am not sure how much it would be of value now. However if you haven't improved from steroids that would speak against that diagnosis.
I hope things work out for the best.
Read below.
Detailed Answer:
Your worry is understandable. To be honest I am a little puzzled of her being so confident about the diagnosis, apart from the antibiotic issue which I mentioned. So since you aren't feeling any better I believe imaging and treatment choice should be discussed, possibly at an earlier date.
As for temporal arteritis diagnosis which I mentioned, it is a diagnosis which must be considered in any new onset localized headache after the age of 50. ESR test should have been done before therapy because if steroids are used the erythrocyte sedimentation rate (ESR) test could normalize in a few days and be of no value. Since you started treatment I am not sure how much it would be of value now. However if you haven't improved from steroids that would speak against that diagnosis.
I hope things work out for the best.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Can I add one more thing? When this started the pain would sometimes be on my right temple, top of my head, down a little farther and then at the bottom of my skull. The pain was a burning pain not what I could call a typical headache.
Thanks again.
Thanks again.
Brief Answer:
Read below.
Detailed Answer:
Thank you for bringing some more info. That would make mastoiditis a little less likely, however pain often irradiates so can't be excluded based on that.
It is of course difficult for me to point to an exact diagnosis without being able to examine you myself and in the absence of any tests. I wouldn't want to overworry you and call for futile tests. But I think that a new headache in an individual after the age of 60, with no prior history of headache should be taken with a lot of caution and I would recommend at least a careful physical exam for signs of stroke, infection, tumor etc, possibly with tests like head imaging and blood tests.
Read below.
Detailed Answer:
Thank you for bringing some more info. That would make mastoiditis a little less likely, however pain often irradiates so can't be excluded based on that.
It is of course difficult for me to point to an exact diagnosis without being able to examine you myself and in the absence of any tests. I wouldn't want to overworry you and call for futile tests. But I think that a new headache in an individual after the age of 60, with no prior history of headache should be taken with a lot of caution and I would recommend at least a careful physical exam for signs of stroke, infection, tumor etc, possibly with tests like head imaging and blood tests.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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