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What Causes Pain In The Right Side Of The Head?
Question: hello
I am having pain on the right side of my head starting below my ear to just above the temple. Its been over a month. Pain is always there to varying degrees. Worse in the morning, eases through the day almost gone by night then the cycle starts again. No infection, no other symptoms, no neurological symptoms, consulted an ENT, nothing from that end, dentist, nothing form that end, clean CT scan, waiting to see a neuro but it will be weeks before I get in. Often I will fell a heartbeat in my ear. My GP called it possible cluster headache??
I am having pain on the right side of my head starting below my ear to just above the temple. Its been over a month. Pain is always there to varying degrees. Worse in the morning, eases through the day almost gone by night then the cycle starts again. No infection, no other symptoms, no neurological symptoms, consulted an ENT, nothing from that end, dentist, nothing form that end, clean CT scan, waiting to see a neuro but it will be weeks before I get in. Often I will fell a heartbeat in my ear. My GP called it possible cluster headache??
Brief Answer:
Head pain- Cannot be Cluster Headache
Detailed Answer:
Good afternoon. The diagnosis of Cluster headache requires a number of other features to the presentation of your pain that you have not mentioned but the bigggest reason this CANNOT be a cluster headache is based on the duration of the pain. According to your description it is always there with the exception of fluctuations during the day. This is not what a cluster headache does. It is a very special type of headache that lasts between 15-180 minutes with very specific types of symptoms that you've not mentioned either. But it clearly GOES AWAY after either a very short time or at most 3 hrs. It may restart later but it clearly GOES AWAY completely. Therefore, I don't believe you are describing a cluster headache in the least.
If the dentist does not believe this can be temporomandibular joint dysfunction (TMJ) and ENT doesn't believe there is anything IN THE EAR CANAL or in the middle ear itself that could be pressing on a nerve then, I believe a high resolution imaging study should be done of both the temporal region of the head (specifically the INNER ACOUSTIC CANAL)/IAC as well as the blood vessels of the neck on the right side using an MRA study. I would also get a general MRI of the entire head to see if there were some type of remote location mass lesion that could be causing turbulence of blood flow in the right temporal region and pain.
For the IAC study I would request this MRI of the right IAC be done WITH GADOLINIUM contrast so that in the event a small mass lesion were present it would be more easily seen. Before having gadolinium contrast injected for contrast purposes we always recommend getting a blood test referred to as an EGFR (estimated glomerular filtration rate) which assesses kidney function. We always require patients be >60 before submitting them for XXXXXXX studies.
The whooshing sound you describe also makes me wonder about either a fistula (abnormal connection between blood vessels) or other type of vascular malformation.
Of course, ,the strange thing about this description as far as hypothesizing the presence of a mass or vascular lesion of some sort is to recognize that you say the whole thing seems to subside completely and on its own by nighttime. If there were as a results of something compressing any inner or middle ear structures or if this were an abnormal connection between blood vessels that one would not be able to get rid of it at night only just to have it return in the morning, make sense? One would expect it to be present around the clock in one way or another and maybe even awaken you from sleep at times if intense enough.
For the vascular study I would ask for an MRA of the head and neck and specify to the neuroradiologist that we are looking for some type of vascular malformation or aneurysmal swelling in the more proximal portions of the carotid artery (carotid bulb) or the right cavernous sinus (has NOTHING TO DO with sinus cavities in the head connected to nasal congestion or allergies). I would ask that the MRA be obtained not only of the neck but of the head as well. Initially, I would not ask for contrast to be injected on that study unless we actually find something suspicious.
I would follow this plan of imaging studies. If images turned out to be unremarkable then, the neurologist could still make sense out of things by doing an excellent history of the pain to see if these pains don't represent some type of odd presentation of a migraine type of headache which can sometimes be referred to as an ATYPICAL MIGRAINE but I'm less impressed with the symptoms you relate for this diagnosis rather than something else causing this problem.
If I've provided useful and helpful information to your questions and satisfaction 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? 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.
This query has utilized a total of 28 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Head pain- Cannot be Cluster Headache
Detailed Answer:
Good afternoon. The diagnosis of Cluster headache requires a number of other features to the presentation of your pain that you have not mentioned but the bigggest reason this CANNOT be a cluster headache is based on the duration of the pain. According to your description it is always there with the exception of fluctuations during the day. This is not what a cluster headache does. It is a very special type of headache that lasts between 15-180 minutes with very specific types of symptoms that you've not mentioned either. But it clearly GOES AWAY after either a very short time or at most 3 hrs. It may restart later but it clearly GOES AWAY completely. Therefore, I don't believe you are describing a cluster headache in the least.
If the dentist does not believe this can be temporomandibular joint dysfunction (TMJ) and ENT doesn't believe there is anything IN THE EAR CANAL or in the middle ear itself that could be pressing on a nerve then, I believe a high resolution imaging study should be done of both the temporal region of the head (specifically the INNER ACOUSTIC CANAL)/IAC as well as the blood vessels of the neck on the right side using an MRA study. I would also get a general MRI of the entire head to see if there were some type of remote location mass lesion that could be causing turbulence of blood flow in the right temporal region and pain.
For the IAC study I would request this MRI of the right IAC be done WITH GADOLINIUM contrast so that in the event a small mass lesion were present it would be more easily seen. Before having gadolinium contrast injected for contrast purposes we always recommend getting a blood test referred to as an EGFR (estimated glomerular filtration rate) which assesses kidney function. We always require patients be >60 before submitting them for XXXXXXX studies.
The whooshing sound you describe also makes me wonder about either a fistula (abnormal connection between blood vessels) or other type of vascular malformation.
Of course, ,the strange thing about this description as far as hypothesizing the presence of a mass or vascular lesion of some sort is to recognize that you say the whole thing seems to subside completely and on its own by nighttime. If there were as a results of something compressing any inner or middle ear structures or if this were an abnormal connection between blood vessels that one would not be able to get rid of it at night only just to have it return in the morning, make sense? One would expect it to be present around the clock in one way or another and maybe even awaken you from sleep at times if intense enough.
For the vascular study I would ask for an MRA of the head and neck and specify to the neuroradiologist that we are looking for some type of vascular malformation or aneurysmal swelling in the more proximal portions of the carotid artery (carotid bulb) or the right cavernous sinus (has NOTHING TO DO with sinus cavities in the head connected to nasal congestion or allergies). I would ask that the MRA be obtained not only of the neck but of the head as well. Initially, I would not ask for contrast to be injected on that study unless we actually find something suspicious.
I would follow this plan of imaging studies. If images turned out to be unremarkable then, the neurologist could still make sense out of things by doing an excellent history of the pain to see if these pains don't represent some type of odd presentation of a migraine type of headache which can sometimes be referred to as an ATYPICAL MIGRAINE but I'm less impressed with the symptoms you relate for this diagnosis rather than something else causing this problem.
If I've provided useful and helpful information to your questions and satisfaction 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? 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.
This query has utilized a total of 28 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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