Brief Answer:
Likely a type of headache called TAC...please read on

Detailed Answer:
Good evening and thank you for reaching out on this channel for advice. Though you've not provided many details I would typically ask from my patients you have described the major clinical features of a type of headache referred to as: TAC

or......Trigeminal Autonomic Cephalgia (TAC).

This type of headache can sometimes be the result of a concussive force blow to the head or even a heavy strike to the head that does not necessarily result in a concussion. It can occur to people who suffer facial trauma as well. It can also come on without any antecedent event or apparent headache history out of the blue.

If you've had the headache continuously for 5 weeks without any let up, had a CT scan of the head, and have been seen by a neurologist who has found your NEUROLOGICAL EXAM to be normal then, I do not believe an MRI of the brain will likely add useful information to make a difference to how this should be managed. If on the other hand there is a family history of intracranial vasculature anomalies (AVM's), aneurysms, or other neurological problem then, I would not disagree with an MRI of the brain. I would also add an MRA of the brain as well as of the neck.

Because your stability or balance also seems to be an issue upon standing I might even ask for the MRI study to include what is referred to as a HIGH RESOLUTION study of the INTERNAL AUDITORY CANAL (IAC) with gadolinium contrast. You should be also cleared renally first before injecting the XXXXXXX as there can be a risk if kidney function is not at a certain level. Typically, we get serum CREATININE and and EGFR (Estimated Glomerular Filtration Rate) and look for that value to be >60 cc/min.

Independent of getting the MRI and MRA of the head and neck I would make certain to look at the PONTOCEREBELLAR ANGLE (PCA) for any evidence of what is called either an acoustic schwannoma (AS) or an acoustic meningioma. Suspicion for an AS can also be heightened if there is any RINGING IN THE EARS (tinnitus) or actual/perceived hearing loss which could even be mild by doing an AUDIOGRAM. This recommendation is based on symptoms you included in another recent question to Dr. Spaho about feeling UNSTABLE upon standing....not necessarily the symptoms you wrote in the PRESENT question.

Whether imaging studies are performed or not I would definitely also send you for lab analyses (blood work) to include the following entities (FT4, TSH, ESR, CRP, VITAMIN D, D2, AND D3, Mg (total and FREE) ).

If everything were perfectly clean (and again, I wouldn't necessarily order the MRI studies prior to doing a complete neurological examination) then, I would consider solidifying the evolution and history of these headaches thinking in terms of TAC's as being most likely and going from there.

Primary treatment of these headaches sometimes can be with STEROID PACKS. If I do treat with one it is usually some type of 14 or 21 day taper. However, most of the time the first drug of choice for such headaches is with INDOMETHACIN on a taper UP schedule. The trouble with indomethacin is its high rate of SIDE EFFECTS of a significant nature in its users. And this is why I tend to UPTITRATE or taper UP the dosing on this medication to see if minimal doses can control the condition so as not to push the envelope on the side effects.

Melatonin would be another option for these types of headaches if unresponsive to the indomethacin or if you didn't tolerate the drug. However, I would not use melatonin without a specific instruction for uptitration from the doctor. There are protocols that have been shown to work better than others.

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating if you feel so inclined? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others. I'm very interested in knowing how things evolve for you- especially if you get any testing done so drop me a line please and I'm hoping all the best for you.

This query has utilized a total of 49 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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