Brief Answer:
Possible 2nd Headache syndrome

Detailed Answer:
Good morning XXXX. My name is Dr. Saghafi.

I'm a neurologist from the XXXXXXX OH area and would like to give you some thoughts on this important and well described question.

You mention 2 things that can and do go together into one entity and that is your MIGRAINE and VERTIGO. You said that symptoms don't "always go together but often do." I don't know whether your're talking about the twitching not going together with the other things, or it's just simply that NONE of the symptoms necessarily accompany the other 2 all the time.....but no matter.

Migraine headaches (assuming of course, your headaches truly fit the definition of migraines) and vertigo are often seen in an entity known as MIGRAINOUS VERTIGO. The reason it's not thought of in many instances is precisely because of the fact that the headaches and the vertigo can often be spaced apart from one another by much as hours to days so patients (and doctors) never really think of them as a single problem. But it can be and should be looked for. Treatment for that would be according to standard protocols we have for migraines and for the vertigo as a separate issue. I would not use narcotics or meclizine (Antivert).

As far as the twitching you say you've been having on the right? WHERE on the right? Right face? Right arm? Right eye?, Entire right side? And what's the "twitching like?" Does it cause the eyelid for instance to flutter or get tight then, relax quickly, or is there "trembling" in the cheek, forehead, eyelid flutter, etc.?

Have you had MRI scans of the brain? With or without contrast? If only a CT scan that's fine but I would imagine that if a neurologist has seen you they will have wanted to get the MR.

I hope this information is of some help and provides you with more directions that you may pursue with your doctor for your problem.

If you agree with me then, I'd very much appreciate your sending back a brief critique of our conversation with a STAR RATING.

And if there are no further questions to ask would you also do me the favor of CLOSING THE QUERY on your end? This alerts the network that the case has been satisfactorily addressed and ready for filing and future reference.

I wish you the best and hope you find some answers and RELIEF.

This case required 55 minutes of physician specific directed time for review, research, and final draft documentation for envoy.

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