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OK. I Have A History Of Headaches For 40 Years

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Posted on Mon, 23 Dec 2019
Question: OK. I have a history of headaches for 40 years albiet they have not been so bad the last few years; when I was younger in my 30's I could get Migraine type headaches that would be mild in intensity but long in duration. Not much controlled them...in my 50's and 60's I used Paxel and Topimax which helped but caused kidney stones twice. The Maxalt, etc type drugs never helped. Sometimes Id get a visual aura sometimes not....more recently I get a little light headed with the headaches. I've used Toradal and prednisone...sometimes the prednisone aborts the headache but sometimes not.

This time some of the headache components are a like some new....headache pain 3-4 but today 5 and I have had the headache for 7 weeks...tried toradol and 3 separate dose packs of prednisone. Now the dr has started me on a shot once a month of egallity or something thats name is simila to prevent migraines but takes 3 months to become fully effective. I also take Cymbalta 2 x daily. My headache is mostly right side which is typical and it comes around into my right cheek bone and sometimes right ear. My neck aches about equal to my head and I get light headed some. Need to abort headache. Please see MRI which my Neurologist says is ok for 70 but she has not seen MRI of cevical which my neuro surgeon friend reviews because I have some stuff going on which appears to have slightly gotten worse at C 3 AND C 4 as they had never used severe before this report....I'm wondering if my head pain is coming from the neck and thats why its not aborting? Any ideas?
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Follow up: Dr. Sudhir Kumar (0 minute later)
OK. I have a history of headaches for 40 years albiet they have not been so bad the last few years; when I was younger in my 30's I could get Migraine type headaches that would be mild in intensity but long in duration. Not much controlled them...in my 50's and 60's I used Paxel and Topimax which helped but caused kidney stones twice. The Maxalt, etc type drugs never helped. Sometimes Id get a visual aura sometimes not....more recently I get a little light headed with the headaches. I've used Toradal and prednisone...sometimes the prednisone aborts the headache but sometimes not.

This time some of the headache components are a like some new....headache pain 3-4 but today 5 and I have had the headache for 7 weeks...tried toradol and 3 separate dose packs of prednisone. Now the dr has started me on a shot once a month of egallity or something thats name is simila to prevent migraines but takes 3 months to become fully effective. I also take Cymbalta 2 x daily. My headache is mostly right side which is typical and it comes around into my right cheek bone and sometimes right ear. My neck aches about equal to my head and I get light headed some. Need to abort headache. Please see MRI which my Neurologist says is ok for 70 but she has not seen MRI of cevical which my neuro surgeon friend reviews because I have some stuff going on which appears to have slightly gotten worse at C 3 AND C 4 as they had never used severe before this report....I'm wondering if my head pain is coming from the neck and thats why its not aborting? Any ideas?
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Follow up: Dr. Sudhir Kumar (12 minutes later)
Patient Name: HALE,DUKE XXXXXXX DOB: 10/25/1949
Account #: AV0000 Age/Sex: 70/M
Unit #: AR0000 Location: SMLMRI

Admitting Dr:
Ordering Dr: Benner, XXXXXXX O MD
Admit Date/Time: 11/01/19 1419

Exam Performed: MRI Brain wwo IV
Exam Date/Time: 11/01/19
Date of Service: 11/01/19 1445
Req #: 1101-0158
Accession #: 0000.001SMM
Dictating Dr: XXXXXXX XXXXXXX MD
Primary Dr: Benner XXXXXXX O
HISTORY: Migraine syndrome.

COMPARISON: MRI pituitary dated September 15, 2018

TECHNIQUE: MRI of the brain performed with T1, T2, gradient-echo, and
diffusion weighted images/ ADC maps. Postcontrast sequences were also
performed.

FINDINGS:

There is mild cerebral volume loss and ex vacuo dilatation of ventricular
system. There are scattered punctate foci of increased signal intensity within
the periventricular and deep subcortical white matter on the T2/FLAIR sequences
which are nonspecific; however, they are most likely secondary to chronic small
vessel disease. There is no evidence of restricted diffusion to suggest an
acute infarct, midline shift or mass effect. There are no blood products on the
gradient echo images. Normal intracranial flow-voids are seen.

The visualized paranasal sinuses are clear.

There is no pathologic enhancement identified.

Degenerative changes are noted within the upper cervical spine.

IMPRESSION:

1. No acute intracranial process.

2. Mild cerebral atrophy and mild chronic small vessel disease, similar to
2018.

3. No pathologic enhancement identified.




Authenticated By:
11/01/19 1658
__________________________________ XXXXXXX XXXXXXX MD




Report #: 1101-2099
Dictated date/time: 11/01/19 1651
Transcription date/time: 11/01/19 1651
Transcriptionist: POWERSCRIB

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Follow up: Dr. Sudhir Kumar (0 minute later)
Patient Name: HALE,DUKE XXXXXXX DOB: 10/25/1949
Account #: AV0000 Age/Sex: 70/M
Unit #: AR0000 Location: SMLMRI

Admitting Dr:
Ordering Dr: Benner, XXXXXXX O MD
Admit Date/Time: 11/01/19 1419

Exam Performed: MRI Brain wwo IV
Exam Date/Time: 11/01/19
Date of Service: 11/01/19 1445
Req #: 1101-0158
Accession #: 0000.001SMM
Dictating Dr: XXXXXXX XXXXXXX MD
Primary Dr: Benner XXXXXXX O
HISTORY: Migraine syndrome.

COMPARISON: MRI pituitary dated September 15, 2018

TECHNIQUE: MRI of the brain performed with T1, T2, gradient-echo, and
diffusion weighted images/ ADC maps. Postcontrast sequences were also
performed.

FINDINGS:

There is mild cerebral volume loss and ex vacuo dilatation of ventricular
system. There are scattered punctate foci of increased signal intensity within
the periventricular and deep subcortical white matter on the T2/FLAIR sequences
which are nonspecific; however, they are most likely secondary to chronic small
vessel disease. There is no evidence of restricted diffusion to suggest an
acute infarct, midline shift or mass effect. There are no blood products on the
gradient echo images. Normal intracranial flow-voids are seen.

The visualized paranasal sinuses are clear.

There is no pathologic enhancement identified.

Degenerative changes are noted within the upper cervical spine.

IMPRESSION:

1. No acute intracranial process.

2. Mild cerebral atrophy and mild chronic small vessel disease, similar to
2018.

3. No pathologic enhancement identified.




Authenticated By:
11/01/19 1658
__________________________________ XXXXXXX XXXXXXX MD




Report #: 1101-2099
Dictated date/time: 11/01/19 1651
Transcription date/time: 11/01/19 1651
Transcriptionist: POWERSCRIB

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Follow up: Dr. Sudhir Kumar (2 minutes later)
Admitting Dr:
Ordering Dr: Benner, XXXXXXX O MD
Admit Date/Time: 11/21/19 1705

Exam Performed: MRI Cervical Spine wo IV
Exam Date/Time: 11/21/19
Date of Service: 11/21/19 1715
Req #: 1121-0195
Accession #: 0000.001SMM
Dictating Dr: XXXXXXX XXXXXXX MD
Primary Dr: Physician Not On Staff
HISTORY: Neck pain, spinal stenosis.

COMPARISON: December 19, 2018

TECHNIQUE: Multiplanar, multisequence MRI were acquired of the cervical spine
without intravenous contrast.

FINDINGS:

There are multilevel degenerative endplate changes and moderate disc height
loss from C3 through C7. There is chronic mild height loss of the C6 vertebral
body. There is no acute marrow edema. The cervical cord is normal in signal and
caliber.

C2-C3: Small slightly left eccentric broad-based disc osteophyte complex
without spinal canal stenosis. Patent bilateral neural foramina.

C3-C4: Large broad-based disc osteophyte complex and bilateral uncovertebral
joint osteophytes resulting in mass effect upon the ventral spinal cord and
moderate spinal canal stenosis. Moderate bilateral facet arthropathy. Severe
left and moderate right neural foraminal narrowing.

C4-C5: Moderate broad-based disc osteophyte complex and right uncovertebral
joint osteophyte. Effacement of the ventral thecal sac without spinal canal
stenosis. Moderate right and mild left facet arthropathy. Moderate right and
mild left neural foraminal narrowing.

C5-C6: Large broad-based left eccentric disc osteophyte complex and bilateral
uncovertebral joint osteophytes effacing the ventral thecal sac without spinal
canal stenosis. Mild bilateral facet arthropathy. Moderate left and mild to
moderate right neural foraminal narrowing.

C6-C7: Small broad-based disc ossific complex and bilateral uncovertebral
joint osteophytes. Patent spinal canal. Mild bilateral facet arthropathy.
Moderate right and mild left neural foraminal narrowing.

C7-T1: No disc protrusion, neural foraminal narrowing or spinal canal stenosis.


IMPRESSION:

1. Multilevel moderate to severe degenerative changes, most pronounced from
C3 through C7, similar to December 2018

2. Multilevel disc osteophyte complexes, most pronounced at C3-C4 and C5-C6
resulting in mass effect upon the ventral spinal cord and moderate spinal canal
stenosis at C3-C4.

3. Multilevel mild to moderate neural foraminal narrowing which is moderate
to severe at C3-C4.

4. Mild to moderate multilevel facet arthropathy.



Authenticated By:
11/22/19 1503
__________________________________ XXXXXXX XXXXXXX MD




Report #: 1122-2052
Dictated date/time: 11/22/19 1453
Transcription date/time: 11/22/19 1453
Transcriptionist: POWERSCRIB

CC: XXXXXXX O Benner MD

default
Follow up: Dr. Sudhir Kumar (0 minute later)
Admitting Dr:
Ordering Dr: Benner, XXXXXXX O MD
Admit Date/Time: 11/21/19 1705

Exam Performed: MRI Cervical Spine wo IV
Exam Date/Time: 11/21/19
Date of Service: 11/21/19 1715
Req #: 1121-0195
Accession #: 0000.001SMM
Dictating Dr: XXXXXXX XXXXXXX MD
Primary Dr: Physician Not On Staff
HISTORY: Neck pain, spinal stenosis.

COMPARISON: December 19, 2018

TECHNIQUE: Multiplanar, multisequence MRI were acquired of the cervical spine
without intravenous contrast.

FINDINGS:

There are multilevel degenerative endplate changes and moderate disc height
loss from C3 through C7. There is chronic mild height loss of the C6 vertebral
body. There is no acute marrow edema. The cervical cord is normal in signal and
caliber.

C2-C3: Small slightly left eccentric broad-based disc osteophyte complex
without spinal canal stenosis. Patent bilateral neural foramina.

C3-C4: Large broad-based disc osteophyte complex and bilateral uncovertebral
joint osteophytes resulting in mass effect upon the ventral spinal cord and
moderate spinal canal stenosis. Moderate bilateral facet arthropathy. Severe
left and moderate right neural foraminal narrowing.

C4-C5: Moderate broad-based disc osteophyte complex and right uncovertebral
joint osteophyte. Effacement of the ventral thecal sac without spinal canal
stenosis. Moderate right and mild left facet arthropathy. Moderate right and
mild left neural foraminal narrowing.

C5-C6: Large broad-based left eccentric disc osteophyte complex and bilateral
uncovertebral joint osteophytes effacing the ventral thecal sac without spinal
canal stenosis. Mild bilateral facet arthropathy. Moderate left and mild to
moderate right neural foraminal narrowing.

C6-C7: Small broad-based disc ossific complex and bilateral uncovertebral
joint osteophytes. Patent spinal canal. Mild bilateral facet arthropathy.
Moderate right and mild left neural foraminal narrowing.

C7-T1: No disc protrusion, neural foraminal narrowing or spinal canal stenosis.


IMPRESSION:

1. Multilevel moderate to severe degenerative changes, most pronounced from
C3 through C7, similar to December 2018

2. Multilevel disc osteophyte complexes, most pronounced at C3-C4 and C5-C6
resulting in mass effect upon the ventral spinal cord and moderate spinal canal
stenosis at C3-C4.

3. Multilevel mild to moderate neural foraminal narrowing which is moderate
to severe at C3-C4.

4. Mild to moderate multilevel facet arthropathy.



Authenticated By:
11/22/19 1503
__________________________________ XXXXXXX XXXXXXX MD




Report #: 1122-2052
Dictated date/time: 11/22/19 1453
Transcription date/time: 11/22/19 1453
Transcriptionist: POWERSCRIB

CC: XXXXXXX O Benner MD

doctor
Answered by Dr. Sudhir Kumar (13 hours later)
Brief Answer:
Your symptoms are related to severe migraine.

Detailed Answer:
Hi,

Thank you for posting your query.

I am Dr Sudhir Kumar, Neurologist, and would try my best to help you.

I have noted your clinical details and as well as treatment details. I have also seen the reports of MRI brain and cervical spine.

The symptoms are typical of severe migraine. Emgality is a recently approved treatment for migraine and has good efficacy. For aborting migraine headaches- options include rizatriptan or sumatriptan tablets OR combination of sumatriptan and naproxen tablets.

MRI brain findings are not significant and can be seen in people with chronic migraine.

MRI Cervical spine shows disc prolapse at multiple levels with pressure over neck nerves. This can cause neck pain and pain in the arms. Headache is not related to this.

I sincerely hope my reply has helped you.

I would be pleased to answer, if you have any follow up queries or if you require any further information.
     
Best wishes,     
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Sudhir Kumar (0 minute later)
Brief Answer:
Your symptoms are related to severe migraine.

Detailed Answer:
Hi,

Thank you for posting your query.

I am Dr Sudhir Kumar, Neurologist, and would try my best to help you.

I have noted your clinical details and as well as treatment details. I have also seen the reports of MRI brain and cervical spine.

The symptoms are typical of severe migraine. Emgality is a recently approved treatment for migraine and has good efficacy. For aborting migraine headaches- options include rizatriptan or sumatriptan tablets OR combination of sumatriptan and naproxen tablets.

MRI brain findings are not significant and can be seen in people with chronic migraine.

MRI Cervical spine shows disc prolapse at multiple levels with pressure over neck nerves. This can cause neck pain and pain in the arms. Headache is not related to this.

I sincerely hope my reply has helped you.

I would be pleased to answer, if you have any follow up queries or if you require any further information.
     
Best wishes,     
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
Dr.
Dr. Sudhir Kumar

Neurologist

Practicing since :1994

Answered : 6232 Questions

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OK. I Have A History Of Headaches For 40 Years

OK. I have a history of headaches for 40 years albiet they have not been so bad the last few years; when I was younger in my 30's I could get Migraine type headaches that would be mild in intensity but long in duration. Not much controlled them...in my 50's and 60's I used Paxel and Topimax which helped but caused kidney stones twice. The Maxalt, etc type drugs never helped. Sometimes Id get a visual aura sometimes not....more recently I get a little light headed with the headaches. I've used Toradal and prednisone...sometimes the prednisone aborts the headache but sometimes not. This time some of the headache components are a like some new....headache pain 3-4 but today 5 and I have had the headache for 7 weeks...tried toradol and 3 separate dose packs of prednisone. Now the dr has started me on a shot once a month of egallity or something thats name is simila to prevent migraines but takes 3 months to become fully effective. I also take Cymbalta 2 x daily. My headache is mostly right side which is typical and it comes around into my right cheek bone and sometimes right ear. My neck aches about equal to my head and I get light headed some. Need to abort headache. Please see MRI which my Neurologist says is ok for 70 but she has not seen MRI of cevical which my neuro surgeon friend reviews because I have some stuff going on which appears to have slightly gotten worse at C 3 AND C 4 as they had never used severe before this report....I'm wondering if my head pain is coming from the neck and thats why its not aborting? Any ideas?