What does this MRI scan report indicate?

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Posted on Sat, 20 Jun 2015 in General Health
Question: I am having burning sensation in the back of the head and persistarnt heavyness in head and sometimes left part of head feels numb including left ear. This headche started after talking antibiotic levofloxin last month. Currently doc is treating my headache as tesnion headache and he doesnt agree if i say relation with antibiotic. Yest he sent me to do MRI and report says some white spots are seen in brain. Report says ''


Actual Symptoms: A tingling sensation and burning sensation at the back of the head mostly on the left and sometimes right also...I feel like skin of head is irritating or feeling like skin is seperated. Sometimes my head will feel numb in the left sides but not always.

My main question is , Is there a relation between these while spots observed in MRI and my pain and numbenss and heaviness in head ?
MRI Report attached.
My doctor checked for Blood pressure and its 80 : 130 and doctors says its absolutely normal. and he also examined the blood flow from vessels in neck and he says no issue with blood flow also.
doctor
Answered by Dr. Dariush Saghafi 1 hour later
Brief Answer:
Possible Occipital Neuralgia

Detailed Answer:
Good afternoon. I am Dr. Saghafi, and a neurologist/headache specialist from XXXXXXX Ohio, USA and I'd like to forward an opinion on your headaches according to the questions you've asked.

The description of your headache is very similar to what we refer to as an occipital neuralgia. Having said that I've also read some of your other consults to colleagues regarding your feeling that the headaches were triggered by antibiotic. In fact, any of the fluoroquinolones can cause headaches of a mild to severe intensity. The manifestation of each person's headaches can be different but generally speaking what is common to all headaches produced as side effects from these drugs is that they will go away after the antibiotics have ceased being used. I don't know if that describes your headache or not but at any rate your description is that of occipital neuralgia more than tension type.

The only definitive way to know WHICH type of headaches you may be suffering from would be to keep a daily log of your headaches and their specific characteristics and then, analyze those headaches and their associated symptoms over a period of time (usually 2-4 weeks).

Now to your questions:

Is there a relation between these while spots observed in MRI and my pain and numbnss and heaviness in head?

ANSWER: There may be a relationship between the lesions seen on MRI and your headaches. There are entities which we call UBO's (Unidentified Bright Objects). However, the relationship is not necessarily that meaningful since UBO's can also be seen in people without headaches. Nobody is quite sure of the actual meaning of UBO's, whether they are specifically caused by the headache condition or vice versa. They are felt to be generally benign and can be seen to change over time and even disappear so again, their absolute meaning or gravity as far as headaches are concerned is far from resolved.

I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?

Also, if there are no other questions or comments, I'd appreciate it greatly if you would CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary.

Please direct more comments and questions to me in the future at:

bit.ly/drdariushsaghafi and I would be honored to answer you and continue this discussion.

All the best.


The query has required a total of 45 minutes of physician specific time to read, research, and compile a return envoy to the patient.



1.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi 9 hours later
Hello Doctor, Thanks for your reply...Ideally headache is almost all the time in day
..it will be more in the morning and also night compardd to aftrrnoon..when i get up in the morning head will be heavy and neck is tight and head pains....and it doesnt reduce witg pain killer ibuprofen and anitidepressant amytriptiline. Sometime pressing neck gives little relaxation. Do you want me to maintain a sheet with evert hour heache pattern for 2 weeks and get back ? or you suggest something ? . I tried some home remedies like head pad at neck and back of head...and accupressure mat with small pokes at the side if face and head to relive and get sleep. I will have nice sleep but i wont feel relaex in the morrning even after sleep of 8 hours
doctor
Answered by Dr. Dariush Saghafi 25 hours later
Brief Answer:
Possible occipital neuralgia vs. Tension type headache

Detailed Answer:
Thank you for your information. Again, the typical way we isolate exactly what type of headache a person is suffering from is by filling out a HEADACHE LOG or DIARY. Such diaries ask patients to document several different parameters of their headaches such as exact start and stop times, quantification of pain and disability using standardized scales from 0-10, specific symptoms associated with the headaches such as nausea, vomiting, numbness, tingling, burning, sensitivity to light/sound/smell, ringing in the ears, hypersensitivity of certain areas of the face/neck/head, and then, miscellaneous parameters such as # hrs. of sleep each night, # cups of coffee/soda pop/tea that a person has in a day, possible triggers that can bring the headaches, etc. Also, very important to document is the type and AMOUNT of each medication a patient takes for their headaches since patients can often times (and maybe unknowingly doctors as well) go down the road of taking far too much medication for their condition which leads to a REBOUND phenomenon known as MEDICATION OVERUSE HEADACHE.

Such HEADACHE LOGS or HEADACHE DIARIES can be found online in different formats. If you would like to try this method of documenting your symptoms for a period of time then, taking the results of what you document to a local headache specialist where you live or by UPLOADING HERE for me to specifically look at I'd be happy to do that.

By putting all this data into tabular form and analyzing it over a period of 30-45 days we can usually clearly classify the different types of headaches that a patient is having. It is not unusual at all for a patient to even XXXXXXX themselves by noticing that they may be having as many as 2, sometimes 3 different types of headaches at the same time.

As you've described things in your past couple of questions the one type of headache I believe is possible that you have is referred to as OCCIPITAL NEURALGIA which is typically described as burning in the back of both sides of the head and sometimes the neck as well. These headaches tend NOT to get better using ibuprofen but they very nicely respond to steroid treatments (usually trigger point injections) involving the trajectory of what is known as the OCCIPITAL NERVE which runs in the back of the head. Other medications to try in patients of mine who have this type of headache could be INDOMETHACIN which I generally start very slowly and titrate over time as tolerated by patients. There can be side effects though which limit the utility of the drug but sometimes people will tolerate these medications adequately and get rid of their headaches over a period of time then, be able to come off of them in about 6-12 months and be headache free.

As far as the use of amitriptyline is concerned I believe that medications from that class of drug are EXCELLENT in terms of prophylaxing daily headaches which is what it sounds like you have at this point, however, my choice has always been to try NORTRIPTYLINE first in patients because there tends to be many less intolerable side effects that amitriptyline tends to confer on most people such as dry eyes, dry mouth, constipation, low blood pressure feelings, and at times restlessness at night sleeping so that patients don't really feel very refreshed. That certainly sounds like a possibility in your case. Therefore, one thing you may consider to ask your doctor to switch you to nortriptyline. Then, you should ask for a slow upward titration schedule where you would be started at a low dose and then, perhaps on a weekly or biweekly basis go up a little bit at a time until you reach a dose where either the headaches go away completely or side effects develop.

All the while though you are keeping track of events using the HEADACHE LOG and that way one can track the efficacy of the medication or even if there are changes in the medications over time and the effect this may be having on the headaches. You see how there is method to the madness?

Please consider some of what I've written and browse around the internet to see what you may find in terms of a headache diary or a log that allows you to keep data such as what I discussed. Perhaps, your doctor knows of such a tool. Also, you may seek out a HEADACHE SPECIALIST such as myself because a problem like this (as you can see) is often a process that requires time and patience. There are often several different approaches that have to be used in order to bring the headaches under control so it's not an overnight process by any means. Many patients and doctors become impatient with headaches and as a result miss opportunities to detect other bodily problems which are important to think about such as thyroid function, Vitamin D levels, Magnesium levels, cortisol levels, the presence of anemia, or other bodily ailments that could cause headaches and as you mentioned possible side effects from medications given for infections, hypertension, diabetes. We also need to remind patients that smoking, drinking excessive alcohol, and other less than optimal lifestyle habits can and do contribute to headaches and need to be considered and confronted such as depression, nightmares, PTSD (if applicable), generalized anxiety, and more.

So much to consider in headache patients. It is challenging to manage such a patient on a network like this....wanna catch a plane to XXXXXXX Ohio....we can take care of all of this while you take a nice (probably well deserved vacation) break in one of America's Up and Coming towns on the beautiful shores of Lake Erie! Things are hopping here in C-town! Do you like basketball? Right now the XXXXXXX Cavaliers are in the Professional Basketball championship tournament starting tomorrow. I guarantee MANY PEOPLE will have MANY HEADACHES over the outcome of these next few games...hopefully, nobody of those will be from XXXXXXX and we will reign victoriously! LOL......

I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?

Also, if there are no other questions or comments, I'd appreciate it greatly if you would CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary.

Please direct more comments and questions to me in the future at:

bit.ly/drdariushsaghafi and I would be honored to answer you and continue this discussion.

All the best.


The query has required a total of 90 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2474 Questions

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