What causes severe headache?

Posted on Sat, 13 Dec 2014 in Brain and Spine
Question: Hello, I am struggling with a terrible medical problem that occurred three weeks ago. On Tuesday, Nov. 4, 2014, after having a very heated, angry discussion with a recruiter about a potential job offer, I started having a headache that initially began in the rear of my head during the day. I felt exhausted later that evening and went to bed. While in bed, I experienced possibly the worst headache I've had in my life. (I will mention that a recent blood test has confirmed that I have heterozygous Factor V Leiden, a hereditary hypercoagulation blood disorder.) I fear that I suffered a cerebral venous thrombosis (CVT). I should have rushed to the Emergency Room of a nearby hospital to be examined (don't know if a standard CAT scan would have picked up a CVT) and been treated with heparin, but I didn't. Instead, I endured it until early morning, when the headache seemed to be subsiding after I took two Advil tablets. There were no "focal deficits", or other stroke-like symptoms (e.g., facial numbness or extremity numbness/weakness), other than the severe headache. The headache didn't return after that night. I did consult with a neurologist, and he wrote a script for me to schedule an MRI/MRV. If it was a CVT, is it possible or likely that I didn't suffer any kind of permanent brain damage? I did have a D-Dimer blood test 24 hours after the severe headache episode, and the result was less than .5 ng/ml, which is supposedly normal (not indicative of a blood clot present somewhere in the body). If it was a CVT, would an MRI/MRV show any damage/infarct three weeks after the event?
Answered by Dr. Erion Spaho 3 hours later
Brief Answer:
MR/MRV will show if there is residual damage.

Detailed Answer:
Hi, I had gone through your question and understand your concerns. From prescription of your symptoms, more likely there was a subarachnoid hemorrhage happened than CVT. CVT mostly is accompanied with significant neurologic deficit due to raised intracranial pressure and/or venous hemorrhage. However MR/MRV certainly will show if there was permanent damage to brain due to occluded veins. Hemo sequences of MRI are needed to investigate if there was any minimal hemorrhage.
Hope this answers your question. If you have additional questions or follow up questions then please do not hesitate in writing to us. I will be happy to answer your questions.
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
Follow up: Dr. Erion Spaho 8 hours later
Dear Doctor Spaho:

Thank you for your response and your expert assessment of what occurred. I am feeling despondent and hopeless at this point.

If it was a CVT, would the accompanying headache have resolved so quickly (it seemed to have subsided by the next morning)? Could the clot have already cleared in the course of a day, or would collateral veins have relieved the intracranial pressure without medical intervention so quickly? Does CVT usually usually persist or the course of several days?

Or, for that matter, if it was a subarachnoid hemorrhage that caused the headache, could/would it have resolved itself that quickly without causing further symptoms or progressing?

Is there any hope or possibility that this caused a transient disturbance in the brain without any permanent damage?
Answered by Dr. Erion Spaho 7 hours later
Brief Answer:
CVT less possible cause.

Detailed Answer:
Hi and thanks for asking again. As I mentioned before, CVT is accompanied with serious brain damages and neurologic findings, lasting in time, so in your case is the less probable possibility. More probable than CVT may be minimal subarachnoidal hemorrhage ( worst headache ever ) due to stress and mental overload you had. Most probably it was only a random post stress headache with no underlying cause, since it has resolved quickly. Since you have been programmed to undergo MR, this will clarify better your condition. I recommend you not to worry more than is necessary in this case. Hope this helps. Wishing you good health.
Above answer was peer-reviewed by : Dr. Yogesh D
Answered by
Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 3792 Questions


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