Brief Answer:
Possible Severe Tension Headache vs. Migraine vs. MIXED

Detailed Answer:
Good evening. My name is Dr. Saghafi and I am an adult neurologist and headache subspecialist.

The symptoms you are presenting with have some features that are common for tension headaches and some which are seen in migraine types of headaches. In order to get a really solid idea of what sort of headache this are a number of questions that need to be asked and a detailed history must be obtained which describes how your headaches started as far back as you can remember and how they've evolved throughout time.

It also requires tracking your headaches on a diary or a daily log so that we can make long term plans for treating you as necessary with medications that can PREVENT headaches coming on as opposed to simply treating your headaches AS they come on. In addition, other things need to be known about you such as whether or not headaches are associated with your menstrual period, if you are taking any medications that can possibly CAUSE headaches as a side effect and perhaps as importantly what medications have you received or tried for similar headaches which have given you relief.

Have you ever seen someone for these headaches and if so what do they think is causing them. Do you drink caffeinated beverages, do you eat or drink things that seem to be related to triggering these headaches, and how well do you sleep at night or are you waking up with headaches, do you have nightmares, do you suffer with any psychiatric illnesses such as anxiety, depression, PTSD, physical, verbal, or sexual abuse as a child or any other time?

This is a sampling of the information that I obtain on all my headache clinic patients that I obtain before making any decisions on what kind of headaches they have or what would be the best way to approach these headaches (whether it be by medication or other interventions). If you are interested in filling out a headache diary to start tracking these and compiling a list of them for us to analyze so we can develop a definitive plan to get rid of them then, let me know, send me your email and will return to you a HEADACHE DIARY that you will begin filling out. I would have you fill out 30 days worth of headaches that you have before making any recommendations for medications or other interventions.

Perhaps, you can answer by return message on this website/platform the questions that I've asked above as well as send me back your decision if you want a headache log sent by email that you can start filling out.

I would recommend we have a bit of a session together to explain the details of the headache diary before you actually fill one out since we need specific information.

I await to hear back from you on your next message.

Regards,
Dariush Saghafi, MD

---

Brief Answer:
Unlikely to be a serious condition

Detailed Answer:
Thank you for the follow up information.

May I clarify for you that veins do not pulsate in the way you describe but arteries do so are you perhaps referring to a pulsation feeling in the left neck of an arterial nature? Is it in synch with your heartbeat? You mention that apparently this pulsation was not apparent to you until 3 weeks ago after a catheterization procedure. You also complain of chest tightness.

You would need to provide a bit more history on this pulsation as to when it actually began with respect to the catheter procedure. Was it truly AFTER the procedure or is it possible that it existed prior to getting catheterized. Also, were you being catheterized because of among other things, chest tightness or shortness of breath? What were the results of the catheterization?

Have you been taking your blood pressure at home to check on things since the procedure? What has your doctor said about what you've been feeling?

Also, what other medical or psychological issues are you being followed or treated for?

My overall feeling from what you're describing is that there is not likely to be a medical problem of great importance with the pulsations you are feeling especially since you've just recently been catheterized and I'm assuming everything was found to be normal. Having said that, if you have not gone back to see your doctor since these additional symptoms began then, I think it would be a good idea, if not for anything but reassurance, that things are in order. This may help alleviate some of the stress and tension you may be feeling which could be causing some of your symptoms as well.

I would also recommend getting a home blood pressure monitor and checking your numbers at different times of the day to see what they are and if they are unusually high for you to report this to your physician.

Please feel free to write any followup questions you may have including requesting a headache log or diary to fill out if the headaches you are having are of import to you. Otherwise, if your questions have been satisfactorily answered I'd very much appreciate your closing the query on your end so that the system may process this question and also a bit of written feedback with a STAR RATING would be appreciated as well.

You may always look me up again at bit.ly/drdariushsaghafi for future questions related to this or any other problem medically you may encounter.

This query required 23 minutes of physician specific review, research, and final response compilation for patient envoy.

---