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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes persistent headaches despite negative MRI scan results?

Answered by
Dr. Dariush Saghafi


Practicing since :1988

Answered : 1616 Questions

Posted on Sat, 2 Jun 2018 in Brain and Spine
Question: my 22 year old daughter gets headaches when she studies or is in class. she has had an mri and there is nothing wrong. we have had here eyes checked and nothing is wrong. pain medicine does not help. any suggestions?
Answered by Dr. Dariush Saghafi 2 hours later
Brief Answer:
Buy a house: LOCATION, LOCATION, LOCATION! Treat a Headache?

Detailed Answer:

Thank your for your question. As you can see from the summary answer....I look at Headache Patients much the same way as we are told about how to BUY A HOUSE....You've probably heard it said that the most important things to consider in buying are: LOCATION, LOCATION, LOCATION! In my opinion, efficiently treating a headache patient means getting: HISTORY, HISTORY, HISTORY!

And that's much more important than labs, tests, or imaging studies...there are always exceptions to that rule....but your daughter has already shown that she is NOT one of those exceptions since as you said, "nothing is wrong." The solution to her problem is going to be in the HISTORY and evolution of her problem....from its INCEPTION to CURRENT DAY.

As a headache specialist I can tell you that solving the problem of headaches in any person is a process which can take some time to sort out since HISTORY IS PIVOTAL. Based on your brief description it is very difficult to diagnose the type of headaches your daughter is suffering from since they can be anything from migraines, tension type, stress/anxiety driven, or they can be related to menstrual problems, hormonal fluctuations, thyroid problems, or nutritional deficiencies such as Magnesium or Vitamin D deficiencies.

The point of the list above is not to suggest that she has had any of those problems although the likelihood she has at least ONE of those problems is extremely high. Rather, my point is that in order to narrow things down she needs to be seen by someone (A good headache specialist or at least a neurologist with an interest in headache) who can or is willing to take the time to get a solid history before launching off into tests and imaging studies such as MRI's of the brain which are overwhelmingly NEGATIVE in the vast majority of patients as it was in your daughter.

In my practice patients will fill out a HEADACHE DIARY for no less than 4 weeks with special attention to specific attributes of the headache such as DURATION of the headache, presence of NAUSEA, VOMITING, PHOTO/PHONO/OSMOPHOBIA, presence of PHOSPHENES, TINNITUS, VERTIGO, ALLODYNIA, and other medical terms which I carefully explain to patients so that we can accurately characterize the headache...OR in many cases the DIFFERENT TYPES of headaches that the patient may have without assuming any particular single type. In my experience as a headache specialist most of my patients have at least 2 different types of headaches and sometimes lifestyle issues are very contributory such as lack of sleep, hypoglycemia, extreme stress/anxiety, undiagnosed or untreated PTSD, alcohol/drug usage, medication side effects, oral contraceptive use and other things that can be best teased out using a headache log or diary.

There are many diaries/logs that can be found online and even in APPS that can be obtained from the iTunes or APPS store. Parma Neurology has developed its own specific diary/log that we distribute to our patients and then, review with them when they return in order to design the best approach possible which may or may not involve the use of medication since the goal should always be the discovery of the root cause.

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This query has utilized a total of 26 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

The User accepted the expert's answer

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