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Having headache, lower back pain. Diagnosed with meningitis. Taking excedrine. Is it sinus infection?

Dec 2012
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Answered by

General & Family Physician
Practicing since : 2012
Answered : 1704 Questions
Hi: Thank you for your time. I am having a huge headache and I want to get rid of it. By way of background, on XXXXXXX 18th, I woke up with a "different" type of headache right in the middle of my forehead. It was horrible. By 10:00 a.m. that morning, it was worse and I had lower back pain with it. By that evening, my lower back pain went into the base of my skull/neck. I went to the ER on Saturday, catscan, and was told it was a migrain. Went back to the ER on Monday, spinal tap done and catscan done again with MRI. White blood cells in spinal tap were 15 with some red blood cells present. (was told everything else was normal.) Spent a couple of days in the hospital on pain relievers, was told it was a very slight case of possible viral meningitis caused by an upper respiratory problem I had earlier that week. The following week, each day I felt just a little better and was getting my strength back. However,after being headache free for two days, I started to have a headache again followed by a lot of drainage in my throat. I went to the dr. got a zpac and a steroid shot to help with the drainage. I finished my zpac and only have minimal drainage now, but I had a reoccurring headache that hits me every day. I have been taking excedrine migraine everyday. That is the only thing that touches it. I have some popping in my right ear and the pain is in my forehead, top of my head and the bridge of my nose. Is it sinus infection? or am I getting the meningitis again? What do I do? My fever has been a constant 99 F. I'm sorry to ramble on but I'm really really hurting and tired of this.
Posted Sun, 3 Mar 2013 in Headache and Migraines
Answered by Dr. Nsah Bernard 2 hours later

Welcome and thank you for posting your query.
Well I read through your post thoroughly, in my humble opinion I feel that our headache is secondary to an infection. Per your description you are having meningoencephalitis (mostly infection of your cerebrum which extends to the meninges). Your MRI not showing any masses rules out possibility of tumor or cerebrovascular diseases or intracranial hemorrhage.
Given the results of your lumbar puncture ( which is very incomplete) which shows elevated white blood cells (but does not show which WBC lineage is elevated like neutrophile or lymphocytes). The specific lineage will tell which type of infection whether viral, bacterial, mycobaceterial, fungal, toxoplasmossi or other atypical germs.
Severe headache due to encephalitis is usually caused by cryptococcal spp. (fungi).
My suggestion is for another CSF analysis (after lumbar tap) be done with indian ink coloration. if confirm then high dose antifungi (specifically fluconazole needs to be started). If actually the infection is viral, then specific virus needs to be determined. Test such as HIV, CMV, Epstein Barr etc should be done. Specific antiviral regimens should also be included. If bacterial encephalitis then high dose antibiotics intravenously needs to be administered. You will require 2nd class analgesia like tramadol to manage the headache.
All the other ENT problems you are manifesting are as a result of the brain infection you are having.
If you had meningitis then you had to manifest with typical signs of meningitis ( neck stiffness, signs of infection and on physical exams brudzinski and kernig signs positive). So your infection might only be cerebral.

In summary, to do away with the headache the infection has to be treated and analgesia given. Upon completion of the treatment you will get a lot of relieve.

Also we can not exclude the fact that a severe upper respiratory tract infection like severe sinusitis can also cause your headache. It has to be treated for the headache to subside.

Hope this helps and write back if you have any follow up questions.
Dr Nsah
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