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I’m A 60 Y/o Male Headaches Everyday For 3 Weeks
Question: I’m a 60 y/o male headaches everyday for 3 weeks severe - had million dollar work up - CTA MRI brain neck MRA all negative LP X2 first was with a 25 gauge 1.5 inch needle couldn’t get opening pressure- was a traumatic tap glu53 Pr 157 with 39000 RBC - spun it down then result was 61 ;; no WBC’s no Xanthochromia- neurologist recommended 2nd LP under flouro in prone position to obtain opening pressure he used a 20 gauge 3.5 in needle OP was 14 cm H2O he added the length of the needle 23 was final read. Treated with acetazolamide secondary to above helped with headache about 25% but had to stop it secondary to acidosis and parathesias- had pain in the muscle by the second LP no fevers or other symptoms that was 10 days ago- taking imitrex with about 50% relief but keeps coming back- I have GERD OSA OTHERWISE HEALTHY- 2 major questions what’s the most probable cause and anything to worry about with reference to the pain in the back- TY- XXXXXXX
I’m a 60 y/o male headaches everyday for 3 weeks severe - had million dollar work up - CTA MRI brain neck MRA all negative LP X2 first was with a 25 gauge 1.5 inch needle couldn’t get opening pressure- was a traumatic tap glu53 Pr 157 with 39000 RBC - spun it down then result was 61 ;; no WBC’s no Xanthochromia- neurologist recommended 2nd LP under flouro in prone position to obtain opening pressure he used a 20 gauge 3.5 in needle OP was 14 cm H2O he added the length of the needle 23 was final read. Treated with acetazolamide secondary to above helped with headache about 25% but had to stop it secondary to acidosis and parathesias- had pain in the muscle by the second LP no fevers or other symptoms that was 10 days ago- taking imitrex with about 50% relief but keeps coming back- I have GERD OSA OTHERWISE HEALTHY- 2 major questions what’s the most probable cause and anything to worry about with reference to the pain in the back- TY- XXXXXXX
Brief Answer:
Headaches with diagnostic lumbar puncture
Detailed Answer:
Good evening and thank you for your question regarding your headaches and diagnostic lumbar puncture. I have the response from one of my online colleague and concur with his opinions regarding the benign (though painful) nature of your back pain. These are not uncommonly referred to us by patients undergoing lumbar punctures...especially if the tap is traumatic. My usual recommendation to people after an LP is take Tylenol ES, 2 tablets or capsules every 8 hrs. for a period of about 3-5 days as well as to use a warm compress over the site of puncture for about 20 min. several times per day. Also, avoid heavy lifting as this can slow the process down of the puncture site and cause a small leakage of fluid to occur which can not only induce additional back pain but also contribute to headaches which you already have. Typically, the major elements of pain from the procedure subside over the course of several days to a week but there will be soreness in the lower back, the paraspinous muscles and even radiating a bit into the legs or the hamstrings.
But this is not indicative or suggestive of hemorrhagic complications, infectious abscesses, etc. If you begin to experience fevers, note unusual swellings that were not previously there, feel nauseous, or have redness at the puncture site that begins tracking then, you should call your doctor right away for an examination.
After 2 lumbar punctures with 1 being traumatic I wouldn't be surprised if the entire healing process could last as long 2-4 weeks. Therefore, I would not worry about the symptoms of back pain at this time as you've described your symptoms unless something develops as I've described above in which case you'll need to contact your neurologist for further instructions or simply present to an ER or Urgent Care Center locally.
As far as the CAUSE of your headaches, I can say that based on an opening pressure of 23 cm. H2O that you DON'T HAVE any form of obstructive hydrocephalus (OHC) or IIH (Idiopathic intracranial HYPERTENSION). I'm not entirely sure what these LP's were necessary given normal MRI scans and the very unlikely case of a 60 year old developing such a condition with no antecedent problem or predisposing factor. The use of Diamox is something that may work in cases of IIH but not for acute episodes of cephalgia NOT caused by raised intracranial pressure.
I do not know what other workup was done for you to identify the cause of your headaches but assuming that these headaches were indeed ACUTE ONSET 3 weeks ago and have not subsided under any circumstance using conservative OTC mainstays of initial treatment such as Tylenol ES, Excedrin for migraine, or Ibuprofen then, I would look into things such as THYROID PROFILES, and other endocrinological axes of interest, with your living in the SW United States region, I would think of cryptococcal disease and would've definitely sent CSF fluid for analysis (though I'm not sure I would've done the tap by first intention with completely normal MRI scans and no signs of fever, neck stiffness, or papilledema).
In point of fact, the amount of information you've supplied about your headaches is not sufficient to formulate a precise HEADACHE DIAGNOSIS. It is not even clear that we can classify your headaches as even chronic or not since it's only been 3 weeks (chronic requires minimum 3 months duration). You've not given the specific symptoms to know whether these are migraine episodes or something else. You've not said what makes the headaches better or worse. Essentially, there are a number of gaps of information that prevent the diagnosis.
However, for someone coming with your symptoms I would run a full workup looking for hormonal imbalances, chemistry imbalances, evidence of spontaneous CSF leaks, side effects of medication that you may have only recently started taking up to 6-8 weeks ago (highly overlooked cause of acute headaches), etc.
There is also an entity classified since 1986 called NEW DAILY PERSISTENT HEADACHE (NDPH) that is found typically in men over the age of 50 who have no previous history of headaches but spontaneously and for no identifiable reason begin having headaches. Since you do seem to have some response to your headaches using IMITREX (50% reduction) then, NDPH is probably not as likely a diagnosis.
My best advice to discover the CAUSE of your headaches or at least to get a SOLID NAME attached to these headaches so that more directed treatment can be suggested is to:
1. Find a HEADACHE SPECIALIST at an academic institution (University of Nevada, Las Vegas) and get their opinion. If you cannot find someone of repute in that area you can look to either the Mayo Clinic or the Barrows Institute in XXXXXXX AZ. Both are highly reputable institutions with excellent headache specialists.
2. Download a HEADACHE DIARY from the internet and start actively keeping track of your headaches on a DAILY BASIS according to parameters of the diary that you can then, share with your physician in order to assist them in knowing the intensity, frequency, and types of symptoms you are having so that either migraine, nonmigraine, or other types of headache may be diagnosed. It will also help guide treatment between straight acute vs. preventative (prophylactic).
3. Here is a very interesting link on NDPH and several other articles having to do with different types of headaches you should read by the XXXXXXX Headache Foundation:
https://americanmigrainefoundation.org/resource-library/understanding-migrainenew-daily-persistent-headache/
Once again, many thanks for the opportunity to answer your questions I hope your outcomes are healthy and soon to be pain free ones! If I've provided useful information could you do me the favor of CLOSING THIS QUERY with a 5 STAR rating and positive feedback?
56 minutes total time spent reviewing, researching, and analyzing the present query.
Headaches with diagnostic lumbar puncture
Detailed Answer:
Good evening and thank you for your question regarding your headaches and diagnostic lumbar puncture. I have the response from one of my online colleague and concur with his opinions regarding the benign (though painful) nature of your back pain. These are not uncommonly referred to us by patients undergoing lumbar punctures...especially if the tap is traumatic. My usual recommendation to people after an LP is take Tylenol ES, 2 tablets or capsules every 8 hrs. for a period of about 3-5 days as well as to use a warm compress over the site of puncture for about 20 min. several times per day. Also, avoid heavy lifting as this can slow the process down of the puncture site and cause a small leakage of fluid to occur which can not only induce additional back pain but also contribute to headaches which you already have. Typically, the major elements of pain from the procedure subside over the course of several days to a week but there will be soreness in the lower back, the paraspinous muscles and even radiating a bit into the legs or the hamstrings.
But this is not indicative or suggestive of hemorrhagic complications, infectious abscesses, etc. If you begin to experience fevers, note unusual swellings that were not previously there, feel nauseous, or have redness at the puncture site that begins tracking then, you should call your doctor right away for an examination.
After 2 lumbar punctures with 1 being traumatic I wouldn't be surprised if the entire healing process could last as long 2-4 weeks. Therefore, I would not worry about the symptoms of back pain at this time as you've described your symptoms unless something develops as I've described above in which case you'll need to contact your neurologist for further instructions or simply present to an ER or Urgent Care Center locally.
As far as the CAUSE of your headaches, I can say that based on an opening pressure of 23 cm. H2O that you DON'T HAVE any form of obstructive hydrocephalus (OHC) or IIH (Idiopathic intracranial HYPERTENSION). I'm not entirely sure what these LP's were necessary given normal MRI scans and the very unlikely case of a 60 year old developing such a condition with no antecedent problem or predisposing factor. The use of Diamox is something that may work in cases of IIH but not for acute episodes of cephalgia NOT caused by raised intracranial pressure.
I do not know what other workup was done for you to identify the cause of your headaches but assuming that these headaches were indeed ACUTE ONSET 3 weeks ago and have not subsided under any circumstance using conservative OTC mainstays of initial treatment such as Tylenol ES, Excedrin for migraine, or Ibuprofen then, I would look into things such as THYROID PROFILES, and other endocrinological axes of interest, with your living in the SW United States region, I would think of cryptococcal disease and would've definitely sent CSF fluid for analysis (though I'm not sure I would've done the tap by first intention with completely normal MRI scans and no signs of fever, neck stiffness, or papilledema).
In point of fact, the amount of information you've supplied about your headaches is not sufficient to formulate a precise HEADACHE DIAGNOSIS. It is not even clear that we can classify your headaches as even chronic or not since it's only been 3 weeks (chronic requires minimum 3 months duration). You've not given the specific symptoms to know whether these are migraine episodes or something else. You've not said what makes the headaches better or worse. Essentially, there are a number of gaps of information that prevent the diagnosis.
However, for someone coming with your symptoms I would run a full workup looking for hormonal imbalances, chemistry imbalances, evidence of spontaneous CSF leaks, side effects of medication that you may have only recently started taking up to 6-8 weeks ago (highly overlooked cause of acute headaches), etc.
There is also an entity classified since 1986 called NEW DAILY PERSISTENT HEADACHE (NDPH) that is found typically in men over the age of 50 who have no previous history of headaches but spontaneously and for no identifiable reason begin having headaches. Since you do seem to have some response to your headaches using IMITREX (50% reduction) then, NDPH is probably not as likely a diagnosis.
My best advice to discover the CAUSE of your headaches or at least to get a SOLID NAME attached to these headaches so that more directed treatment can be suggested is to:
1. Find a HEADACHE SPECIALIST at an academic institution (University of Nevada, Las Vegas) and get their opinion. If you cannot find someone of repute in that area you can look to either the Mayo Clinic or the Barrows Institute in XXXXXXX AZ. Both are highly reputable institutions with excellent headache specialists.
2. Download a HEADACHE DIARY from the internet and start actively keeping track of your headaches on a DAILY BASIS according to parameters of the diary that you can then, share with your physician in order to assist them in knowing the intensity, frequency, and types of symptoms you are having so that either migraine, nonmigraine, or other types of headache may be diagnosed. It will also help guide treatment between straight acute vs. preventative (prophylactic).
3. Here is a very interesting link on NDPH and several other articles having to do with different types of headaches you should read by the XXXXXXX Headache Foundation:
https://americanmigrainefoundation.org/resource-library/understanding-migrainenew-daily-persistent-headache/
Once again, many thanks for the opportunity to answer your questions I hope your outcomes are healthy and soon to be pain free ones! If I've provided useful information could you do me the favor of CLOSING THIS QUERY with a 5 STAR rating and positive feedback?
56 minutes total time spent reviewing, researching, and analyzing the present query.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Headaches with diagnostic lumbar puncture
Detailed Answer:
Good evening and thank you for your question regarding your headaches and diagnostic lumbar puncture. I have the response from one of my online colleague and concur with his opinions regarding the benign (though painful) nature of your back pain. These are not uncommonly referred to us by patients undergoing lumbar punctures...especially if the tap is traumatic. My usual recommendation to people after an LP is take Tylenol ES, 2 tablets or capsules every 8 hrs. for a period of about 3-5 days as well as to use a warm compress over the site of puncture for about 20 min. several times per day. Also, avoid heavy lifting as this can slow the process down of the puncture site and cause a small leakage of fluid to occur which can not only induce additional back pain but also contribute to headaches which you already have. Typically, the major elements of pain from the procedure subside over the course of several days to a week but there will be soreness in the lower back, the paraspinous muscles and even radiating a bit into the legs or the hamstrings.
But this is not indicative or suggestive of hemorrhagic complications, infectious abscesses, etc. If you begin to experience fevers, note unusual swellings that were not previously there, feel nauseous, or have redness at the puncture site that begins tracking then, you should call your doctor right away for an examination.
After 2 lumbar punctures with 1 being traumatic I wouldn't be surprised if the entire healing process could last as long 2-4 weeks. Therefore, I would not worry about the symptoms of back pain at this time as you've described your symptoms unless something develops as I've described above in which case you'll need to contact your neurologist for further instructions or simply present to an ER or Urgent Care Center locally.
As far as the CAUSE of your headaches, I can say that based on an opening pressure of 23 cm. H2O that you DON'T HAVE any form of obstructive hydrocephalus (OHC) or IIH (Idiopathic intracranial HYPERTENSION). I'm not entirely sure what these LP's were necessary given normal MRI scans and the very unlikely case of a 60 year old developing such a condition with no antecedent problem or predisposing factor. The use of Diamox is something that may work in cases of IIH but not for acute episodes of cephalgia NOT caused by raised intracranial pressure.
I do not know what other workup was done for you to identify the cause of your headaches but assuming that these headaches were indeed ACUTE ONSET 3 weeks ago and have not subsided under any circumstance using conservative OTC mainstays of initial treatment such as Tylenol ES, Excedrin for migraine, or Ibuprofen then, I would look into things such as THYROID PROFILES, and other endocrinological axes of interest, with your living in the SW United States region, I would think of cryptococcal disease and would've definitely sent CSF fluid for analysis (though I'm not sure I would've done the tap by first intention with completely normal MRI scans and no signs of fever, neck stiffness, or papilledema).
In point of fact, the amount of information you've supplied about your headaches is not sufficient to formulate a precise HEADACHE DIAGNOSIS. It is not even clear that we can classify your headaches as even chronic or not since it's only been 3 weeks (chronic requires minimum 3 months duration). You've not given the specific symptoms to know whether these are migraine episodes or something else. You've not said what makes the headaches better or worse. Essentially, there are a number of gaps of information that prevent the diagnosis.
However, for someone coming with your symptoms I would run a full workup looking for hormonal imbalances, chemistry imbalances, evidence of spontaneous CSF leaks, side effects of medication that you may have only recently started taking up to 6-8 weeks ago (highly overlooked cause of acute headaches), etc.
There is also an entity classified since 1986 called NEW DAILY PERSISTENT HEADACHE (NDPH) that is found typically in men over the age of 50 who have no previous history of headaches but spontaneously and for no identifiable reason begin having headaches. Since you do seem to have some response to your headaches using IMITREX (50% reduction) then, NDPH is probably not as likely a diagnosis.
My best advice to discover the CAUSE of your headaches or at least to get a SOLID NAME attached to these headaches so that more directed treatment can be suggested is to:
1. Find a HEADACHE SPECIALIST at an academic institution (University of Nevada, Las Vegas) and get their opinion. If you cannot find someone of repute in that area you can look to either the Mayo Clinic or the Barrows Institute in XXXXXXX AZ. Both are highly reputable institutions with excellent headache specialists.
2. Download a HEADACHE DIARY from the internet and start actively keeping track of your headaches on a DAILY BASIS according to parameters of the diary that you can then, share with your physician in order to assist them in knowing the intensity, frequency, and types of symptoms you are having so that either migraine, nonmigraine, or other types of headache may be diagnosed. It will also help guide treatment between straight acute vs. preventative (prophylactic).
3. Here is a very interesting link on NDPH and several other articles having to do with different types of headaches you should read by the XXXXXXX Headache Foundation:
https://americanmigrainefoundation.org/resource-library/understanding-migrainenew-daily-persistent-headache/
Once again, many thanks for the opportunity to answer your questions I hope your outcomes are healthy and soon to be pain free ones! If I've provided useful information could you do me the favor of CLOSING THIS QUERY with a 5 STAR rating and positive feedback?
56 minutes total time spent reviewing, researching, and analyzing the present query.
Headaches with diagnostic lumbar puncture
Detailed Answer:
Good evening and thank you for your question regarding your headaches and diagnostic lumbar puncture. I have the response from one of my online colleague and concur with his opinions regarding the benign (though painful) nature of your back pain. These are not uncommonly referred to us by patients undergoing lumbar punctures...especially if the tap is traumatic. My usual recommendation to people after an LP is take Tylenol ES, 2 tablets or capsules every 8 hrs. for a period of about 3-5 days as well as to use a warm compress over the site of puncture for about 20 min. several times per day. Also, avoid heavy lifting as this can slow the process down of the puncture site and cause a small leakage of fluid to occur which can not only induce additional back pain but also contribute to headaches which you already have. Typically, the major elements of pain from the procedure subside over the course of several days to a week but there will be soreness in the lower back, the paraspinous muscles and even radiating a bit into the legs or the hamstrings.
But this is not indicative or suggestive of hemorrhagic complications, infectious abscesses, etc. If you begin to experience fevers, note unusual swellings that were not previously there, feel nauseous, or have redness at the puncture site that begins tracking then, you should call your doctor right away for an examination.
After 2 lumbar punctures with 1 being traumatic I wouldn't be surprised if the entire healing process could last as long 2-4 weeks. Therefore, I would not worry about the symptoms of back pain at this time as you've described your symptoms unless something develops as I've described above in which case you'll need to contact your neurologist for further instructions or simply present to an ER or Urgent Care Center locally.
As far as the CAUSE of your headaches, I can say that based on an opening pressure of 23 cm. H2O that you DON'T HAVE any form of obstructive hydrocephalus (OHC) or IIH (Idiopathic intracranial HYPERTENSION). I'm not entirely sure what these LP's were necessary given normal MRI scans and the very unlikely case of a 60 year old developing such a condition with no antecedent problem or predisposing factor. The use of Diamox is something that may work in cases of IIH but not for acute episodes of cephalgia NOT caused by raised intracranial pressure.
I do not know what other workup was done for you to identify the cause of your headaches but assuming that these headaches were indeed ACUTE ONSET 3 weeks ago and have not subsided under any circumstance using conservative OTC mainstays of initial treatment such as Tylenol ES, Excedrin for migraine, or Ibuprofen then, I would look into things such as THYROID PROFILES, and other endocrinological axes of interest, with your living in the SW United States region, I would think of cryptococcal disease and would've definitely sent CSF fluid for analysis (though I'm not sure I would've done the tap by first intention with completely normal MRI scans and no signs of fever, neck stiffness, or papilledema).
In point of fact, the amount of information you've supplied about your headaches is not sufficient to formulate a precise HEADACHE DIAGNOSIS. It is not even clear that we can classify your headaches as even chronic or not since it's only been 3 weeks (chronic requires minimum 3 months duration). You've not given the specific symptoms to know whether these are migraine episodes or something else. You've not said what makes the headaches better or worse. Essentially, there are a number of gaps of information that prevent the diagnosis.
However, for someone coming with your symptoms I would run a full workup looking for hormonal imbalances, chemistry imbalances, evidence of spontaneous CSF leaks, side effects of medication that you may have only recently started taking up to 6-8 weeks ago (highly overlooked cause of acute headaches), etc.
There is also an entity classified since 1986 called NEW DAILY PERSISTENT HEADACHE (NDPH) that is found typically in men over the age of 50 who have no previous history of headaches but spontaneously and for no identifiable reason begin having headaches. Since you do seem to have some response to your headaches using IMITREX (50% reduction) then, NDPH is probably not as likely a diagnosis.
My best advice to discover the CAUSE of your headaches or at least to get a SOLID NAME attached to these headaches so that more directed treatment can be suggested is to:
1. Find a HEADACHE SPECIALIST at an academic institution (University of Nevada, Las Vegas) and get their opinion. If you cannot find someone of repute in that area you can look to either the Mayo Clinic or the Barrows Institute in XXXXXXX AZ. Both are highly reputable institutions with excellent headache specialists.
2. Download a HEADACHE DIARY from the internet and start actively keeping track of your headaches on a DAILY BASIS according to parameters of the diary that you can then, share with your physician in order to assist them in knowing the intensity, frequency, and types of symptoms you are having so that either migraine, nonmigraine, or other types of headache may be diagnosed. It will also help guide treatment between straight acute vs. preventative (prophylactic).
3. Here is a very interesting link on NDPH and several other articles having to do with different types of headaches you should read by the XXXXXXX Headache Foundation:
https://americanmigrainefoundation.org/resource-library/understanding-migrainenew-daily-persistent-headache/
Once again, many thanks for the opportunity to answer your questions I hope your outcomes are healthy and soon to be pain free ones! If I've provided useful information could you do me the favor of CLOSING THIS QUERY with a 5 STAR rating and positive feedback?
56 minutes total time spent reviewing, researching, and analyzing the present query.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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