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Suggest Treatment For Headaches On The Outer Part Of The Skull
Question: My husband has a head ache on the outer surface of his scull. This head ache can at times be debilitating but he can work through most of it. He feels better when he lays down. He is very weak after only 15 minutes of being active. These symptoms have been going on for over a month. CT scan, CT Scan with contrast, MRI of brain with contract have been unremarkable. He has drainage from one nostril, clear fluid, more in the morning. The drainage use to be significant but has decreased as of late.
One month ago he had he had a period of vertigo but that has gone away now
He is 74 years old.
Earlier this year (April) he had stem cell injections in his knee and multiple platelet injections in his back.
One month ago he had he had a period of vertigo but that has gone away now
He is 74 years old.
Earlier this year (April) he had stem cell injections in his knee and multiple platelet injections in his back.
Brief Answer:
please give me more details
Detailed Answer:
Hello,
I'll try to help with your husband's symptoms but I'm going to need more information. Please answer the following questions:
- which exactly is the location of the pain? Please describe in detail. Does he ache everywhere on the skull, is it unilateral, does it affect the front or the side or the back of the head, etc.
- does the pain come and go and what do you think affects it (in a good or in a bad way) ?
- please describe the timing of the pain, particularly regarding sleep.
- does the runny nose continue even when the headache is over?
- any redness in the eyes?
- has he done any other tests besides the CT/MRI? Please upload all the reports.
- does he have a history of headaches? Please describe if the answer is yes.
- does he take any drugs? (please clarify what kind of medications he's on, because I can't find enough information about the drug you've mentioned - just tell me the which the active substance is)
- other medical history?
Please answer the aforementioned questions so that I can have a better understanding of his situation and comment on it.
Kind Regards!
please give me more details
Detailed Answer:
Hello,
I'll try to help with your husband's symptoms but I'm going to need more information. Please answer the following questions:
- which exactly is the location of the pain? Please describe in detail. Does he ache everywhere on the skull, is it unilateral, does it affect the front or the side or the back of the head, etc.
- does the pain come and go and what do you think affects it (in a good or in a bad way) ?
- please describe the timing of the pain, particularly regarding sleep.
- does the runny nose continue even when the headache is over?
- any redness in the eyes?
- has he done any other tests besides the CT/MRI? Please upload all the reports.
- does he have a history of headaches? Please describe if the answer is yes.
- does he take any drugs? (please clarify what kind of medications he's on, because I can't find enough information about the drug you've mentioned - just tell me the which the active substance is)
- other medical history?
Please answer the aforementioned questions so that I can have a better understanding of his situation and comment on it.
Kind Regards!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Pain is in right half of forehead going back above the ear to the base of his occiput. When extremely bad it is also behind the eye. No the left side does not bother him.
Only the right described above.
The pain comes and goes at times it is just tingly. Other times severe.
Laying down affects the pain in a good way especially if he lays on his left side.
Lifting or working increases the pain in a bad way. Whenever standing he has the headache about 75% of the time
Pain usually starts after waking up within 30 minutes.
Yes the runny nose continues when the head ache is over . After his nose initially drains out in the morning the running decrease somewhat. His sinuses are always open so he can breathe.
No redness in the eyes
He has had this right side head ache,off and on, for a couple of years. He went to chiropractors for it and thought it helped but as of late it does not do anything. It is much worse now
No drugs except for anti inflamatories diclofenac SOD 75 mg. it is generic for volteran
He has had 2 back surgeries, knee replacement and appendicitis. He had a blood clot following the knee replacement but it has stabilized.
He is very weak now and can only be verticle for 15 to 20 minutes when he starts to sweat and he feels like he is going to collapse. He gets relief out of sitting but when head ache is bad he has to lay down. He is taking 3 hour naps plus sleeps all night.
Only the right described above.
The pain comes and goes at times it is just tingly. Other times severe.
Laying down affects the pain in a good way especially if he lays on his left side.
Lifting or working increases the pain in a bad way. Whenever standing he has the headache about 75% of the time
Pain usually starts after waking up within 30 minutes.
Yes the runny nose continues when the head ache is over . After his nose initially drains out in the morning the running decrease somewhat. His sinuses are always open so he can breathe.
No redness in the eyes
He has had this right side head ache,off and on, for a couple of years. He went to chiropractors for it and thought it helped but as of late it does not do anything. It is much worse now
No drugs except for anti inflamatories diclofenac SOD 75 mg. it is generic for volteran
He has had 2 back surgeries, knee replacement and appendicitis. He had a blood clot following the knee replacement but it has stabilized.
He is very weak now and can only be verticle for 15 to 20 minutes when he starts to sweat and he feels like he is going to collapse. He gets relief out of sitting but when head ache is bad he has to lay down. He is taking 3 hour naps plus sleeps all night.
Brief Answer:
I'll suggest some possibilities to consider with your doctor
Detailed Answer:
Hello,
although not a typical case, that could be easily identified - obviously, otherwise you wouldn't ask - I'll try to provide some ideas to consider with your doctor.
Cluster headaches is the first diagnosis that came to my mind. The unilateral insult and the nasal symptoms are consistent with this diagnosis. The same applies for the wax and wane nature of the pain. Some elements are missing though but it seems like a possible diagnosis. The acute treatment may include oxygen with a 100% mask or drugs for the migraine like sumatriptan. There are other choices also and they include preventive measures or treatments.
Pheochromocytoma is another thought, although I would expect some notions about high blood pressure from time to time. This is a disease that may cause weakness, orthostatic hypotension (and the inability to stand for long, particularly if you've just got up from the recumbent position), tachycardia, etc. Headaches is another 'feature' of the disease. Pheochromocytoma can be detected with hormonal and radiological tests.
Migraine is my 3rd suggestion. Unilateral pain that comes and goes, although the rest of the history are not suggestive. This is a clinical diagnosis.
Finally, my last suggestion is anxiety or depression related headaches, which may have migrainous character and also cause other symptoms like weakness, etc. This is diagnosis of exclusion, that is when the investigation fails to reach a reasonable alternative diagnosis.
Now let me say a few words about the reports, although I couldn't read the left part of the biochemical report. I could guess most of them though!
First of all, sinusitis does not seem like the cause of the headaches because the findings on the CT are unimpressive. No malignancy and no intracranial bleeding are related since there is no evidence in the CT.
So the most serious etiologies can be safely excluded. Taking painkillers, starting from the most mild ones (paracetamol/acetaminophen) and then escalating to NSAIDs (like diclofenac) seems like a reasonable choice. Mild opioids could be added to the regimen to enhance its effects.
I hope you find my comments helpful!
You can contact me again, if you'd like any clarification or further information.
Kind Regards!
I'll suggest some possibilities to consider with your doctor
Detailed Answer:
Hello,
although not a typical case, that could be easily identified - obviously, otherwise you wouldn't ask - I'll try to provide some ideas to consider with your doctor.
Cluster headaches is the first diagnosis that came to my mind. The unilateral insult and the nasal symptoms are consistent with this diagnosis. The same applies for the wax and wane nature of the pain. Some elements are missing though but it seems like a possible diagnosis. The acute treatment may include oxygen with a 100% mask or drugs for the migraine like sumatriptan. There are other choices also and they include preventive measures or treatments.
Pheochromocytoma is another thought, although I would expect some notions about high blood pressure from time to time. This is a disease that may cause weakness, orthostatic hypotension (and the inability to stand for long, particularly if you've just got up from the recumbent position), tachycardia, etc. Headaches is another 'feature' of the disease. Pheochromocytoma can be detected with hormonal and radiological tests.
Migraine is my 3rd suggestion. Unilateral pain that comes and goes, although the rest of the history are not suggestive. This is a clinical diagnosis.
Finally, my last suggestion is anxiety or depression related headaches, which may have migrainous character and also cause other symptoms like weakness, etc. This is diagnosis of exclusion, that is when the investigation fails to reach a reasonable alternative diagnosis.
Now let me say a few words about the reports, although I couldn't read the left part of the biochemical report. I could guess most of them though!
First of all, sinusitis does not seem like the cause of the headaches because the findings on the CT are unimpressive. No malignancy and no intracranial bleeding are related since there is no evidence in the CT.
So the most serious etiologies can be safely excluded. Taking painkillers, starting from the most mild ones (paracetamol/acetaminophen) and then escalating to NSAIDs (like diclofenac) seems like a reasonable choice. Mild opioids could be added to the regimen to enhance its effects.
I hope you find my comments helpful!
You can contact me again, if you'd like any clarification or further information.
Kind Regards!
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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