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What is the best diagnosis for regular headache with fever ?

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General & Family Physician
Practicing since : 2011
Answered : 243 Questions
I have had a headache daily for the past 8 months. In addition to this I have pain and spasms almost daily on the left side of my neck. I had an MRI and MRA without contrast 7 months ago. Both were normal. All of my blood work also came back normal. I had all the normal tests done as well as tests for stuff life Lyme disease, Lupus, and inflammatory disorders. I've been given several medicines for migraines, tension headaches, and depression. None of them have relieved my symptoms. I have also been having pain when I move my eyes from left to right, and up and down. Ophthalmologist said my write exam was normal. Now I have developed what my ENT said is pulsatile tinnitus and it only happens when I stand, bend over, strain, or look too far to the right. I have also began having a low grade fever every evening for the past two weeks. I don't even know what to do from here. Any ideas would be appreciated.
Fri, 27 Apr 2012 in Headache and Migraines
Answered by Dr. Sapan J. Pandya 1 hour later

Thanks for your query.

You seem to have undergone all the tests for diagnosis of your headache.

After being through your history i do consider some of the probable diagnosis , though rare, I see a need to be rule out these possibilities in your case.

INTERNAL CAROTID ARTERY DISSECTION causes all the symptoms similar to what you have described that is unilateral headache, pulsatile tinnitus and low grade fever. It is collection of fluids in between layers of XXXXXXX Carotid Artery. It can be diagnosed by Carotid Angiography (You have undergone MRI Angiography of Brain, but I do not know whether Carotid Artery was checked or not).

TEMPORAL ARTERITIS IS an auto-immune disorder that causes chronic inflammation of the large and medium arteries of the head, which supply oxygenated blood to portions of the head and brain. This inflammatory disease results in an inadequate supply of oxygen and nutrients in the brain and head areas. Biopsy of the blood vessels can give the perfect diagnosis.

IDIOPATHIC INTRACRANIAL HYPERTENSION (Pseudotumor cerebri) is a process affecting the brain that behaves like a tumor, but is not a tumour. Here as the name suggests there is increase the pressure of Cerebro-Spinal Fluid (CSF), The condition occurs more frequently in women than men, particularly in obese women. Diagnosis can be by checking the fundus of eye for papilloedema & MRI (Your MRI is normal, but in initial stage Intracranial Hypertension can be missed).
You have Obesity (BMI: 31.6). So try to reduce your weight slowly to a target weight of 150 pounds.

Discuss the above with your treating doctor and proceed.

Hope I have answered your query. If you have any follow up queries I will be available to answer them.
Above answer was peer-reviewed by
Follow-up: What is the best diagnosis for regular headache with fever ? 54 minutes later
I have a neurologist, cardiologist and family doctor...which one might be the best to talk to first?
Answered by Dr. Sapan J. Pandya 15 minutes later
Hi again,

All the three are related, But Neurophysician would be better to start with.

Hope this answers your query.
Above answer was peer-reviewed by
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