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What Causes Headache Along With Tremors In Hands And Feet?
Question: I have been waking up with a headache for about five weeks. For the first week and a half, it was a dull headache across my forehead. My 7-year-old son had brought a head cold home from school so I thought I was catching it. Then I suspected possible low blood sugar because I had not been eating well, had no appetite. About 10 days in the headache settled on the right side of my head with throbbing in my right temple. When it gets really bad, I have these foggy/shaky/spacey spells and I've lost some short-term memory. I am also having tremors in my hands and feet, some mild incontinence, which I'm not aware is happening and a burning sensation on the skin of my abdomen and it wraps around the sides to the back sometimes. I am not sensitive to light or sound and I have no nausea. Though it gets better and worse (no patterns that I've been able to distinguish) the headache is with me all day. I was referred to a neurologist, but the wait was about 6 weeks, so went to the ER and agreed to be admitted to the hospital for tests. I had an EKG, a CT, a chest X-ray, head and neck MRIs, and EEG and a 2-D Echo to rule out anything cardiac. They also had me on constant cardiac monitoring for two days. They took dozens of vials of blood. I came out exhausted, sore, weak and frustrated, but after three days had no diagnosis. After I got out of the hospital, while washing my hair to get the EEG adhesive out, I had a shaky spell and discovered that everything comes into total balance and peace when I close my eyes. In complete darkness with my eyes open, however, it does not go away. The imbalance becomes worse because I have no frame of reference and I see red, blue and green floaters.I forgot to give you the ingredients in the herbal tea, sorry: Chamomile, Oatstraw, Comfrey Leaf, XXXXXXX Petals, Lavender Flowers, Gotu Kola, Coriander, Fennel and Cinnamon. I've been drinking 3-4 strong cups per day for the last two days and it has helped a lot, but the headache gets bad again and the tremors start to come back about 4-5 hours after my last cup of tea. The tea does not seem to stop the shaky/spacey spells, but they don't last as long.
Brief Answer:
Persistent headache
Detailed Answer:
Good afternoon. My name is Dr. Saghafi and I am a neurologist from the XXXXXXX OH area as well as a headache sub-specialist. I would like to give you a few thoughts. I've read through your story as well as the opinion of another colleague on Healthcare magic. First off, sorry you're being overcome by what seems to be an incessant headache that nobody has been able to successfully deal with to this point.
I notice you mention that the imaging studies of the brain including a CT and MRI of the head have been negative and that a neurologist has been involved in your care. Were either of those studies (hopefully at least the MRI) done with gadolinium contrast? In order to truly rule out MS the studies should be contrasted of the head. It's always a good idea when dealing with suspected cases of MS to get cervical spine images in addition to head since some lesions can show up in the c-spine long before they show up in the brain itself even if clinically they remain silent (i.e. no symptoms of pain, numbness, or tingling in the neck or arms etc). However, we will just go ahead and run with the notion that the neurologist has covered at least the part of the case that now we can say fails to demonstrate any pathology within the head itself. So that's good news in terms of ruling out causes for this headache.
NEXT---
I read the details of what Dr. XXXXXXX wrote as related to your tremors and his thought that you may be suffering from either Lupus, Parkinson's, or Depression.
Although I can understand how the tremors may seem to be parkinsonian in some way, however, I am not getting the same flavor of any of your presentation being parkinsonian. Certainly, the persistent right sided headaches you are reporting seem more important to your case writing than the tremors.
I read that you've had headaches of a severe nature 13 years ago which to some extent share similarities with the headache you presently have and not been able to shake. You do not have nausea, vomiting, photo or phonophobia (extreme light and sound sensitivity making headaches worse) in relation to the headaches although you do state that closing your eyes brings you some relief.
I have no easy explanation to why your headache and other symptoms seem to immediately relieve themselves with eyes closed but not in darkness with eyes open. That does not have an easy explanation from a neurological perspective.
Your headache has some migrainous features though given your history and characteristics of the pain I would say that very severe tension types of headache or a type referred to as NEW DAILY PERSISTENT HEADACHE are the more likely possibilities if in fact these headaches can be ferreted out as having no relationship to anxiety, depression, or other illness/metabolic process such as what you had suggested in some other writings of Lupus and RA.
What medications or what other interventions have been recommended for the headaches? Any successes (aside from the chamomile tea which is very transient). The reason the tea works in all likelihood is due to it s caffeine content more than anything else but no matter since it is not a plausible long term solution.
I believe that what is needed is something to really put a major obstacle in the way of your headaches which can be best classified (if primary in nature) as either:
1. Severe Tension Type Headache
2. New Daily Persistent Headache
If the headaches are as a consequence of another process such as Lupus or Rheumatoid Factor then, forget about anything I said up top...what then, needs to be done is the primary process needs to be aggressively treated either with high dose (possibly IV steroids) or other immunomodulating agents specific to the process under discussion in order to cure the headaches.
In my headache clinic I encourage all my patients to participate in their care with me by filling out a HEADACHE DIARY. I would be happy to send you the example of the one we use in the clinic if you think you may be amenable to filling it out and willing to learn how to document your headaches. This then, becomes an additional tool to use to take to your neurologist in order to track symptoms more efficiently and to be able to quantify things that otherwise one would rely upon memory to recall which is impossible to do from one appointment to the next. Simply provide me your email if interested and I will enclose one to your attention with an explanation of how to use it.
Otherwise, I would not further consider the diagnosis of Parkinson's disease because I simply don't feel that is the most parsimonious explanation to your symptoms and least of all your headaches. BTW, the short term memory problems you are having are not unusual in people with severe headaches which are prolonged since the block to recall is due to the ongoing pain and other symptoms and once the headaches subside the issue with the memory will rectify itself.
There is a device called a SOOTHEAWAY device which has given a lot of people relief in our headache clinic at the XXXXXXX VA Hospital and we distribute it to many of our vets with the vast majority reporting immediate and often sustained relief from its use. You can get more information on this device (likely not covered by insurance) at www.sootheaway.com
If anything I've presented has helped you understand your condition a bit more I'd appreciate a little written feedback and a STAR RATING of your choice in order to help the management folks take me under consideration for an increase in the number of bags of peanuts I'm allowed to have per shift! LOL.
Also, if you do not have further questions or comments on this question would you please CLOSE THE QUERY as this will indicate to the system that the question has been satisfactorily addressed by yours truly and can be processed, archived, and credited for future reference.
You may also write specifically to my attention in the future if you choose for any type of question and I'm happy to answer you at the following web address:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68474
This query required 73 minutes to review, research, and document in final draft form for envoy.
Persistent headache
Detailed Answer:
Good afternoon. My name is Dr. Saghafi and I am a neurologist from the XXXXXXX OH area as well as a headache sub-specialist. I would like to give you a few thoughts. I've read through your story as well as the opinion of another colleague on Healthcare magic. First off, sorry you're being overcome by what seems to be an incessant headache that nobody has been able to successfully deal with to this point.
I notice you mention that the imaging studies of the brain including a CT and MRI of the head have been negative and that a neurologist has been involved in your care. Were either of those studies (hopefully at least the MRI) done with gadolinium contrast? In order to truly rule out MS the studies should be contrasted of the head. It's always a good idea when dealing with suspected cases of MS to get cervical spine images in addition to head since some lesions can show up in the c-spine long before they show up in the brain itself even if clinically they remain silent (i.e. no symptoms of pain, numbness, or tingling in the neck or arms etc). However, we will just go ahead and run with the notion that the neurologist has covered at least the part of the case that now we can say fails to demonstrate any pathology within the head itself. So that's good news in terms of ruling out causes for this headache.
NEXT---
I read the details of what Dr. XXXXXXX wrote as related to your tremors and his thought that you may be suffering from either Lupus, Parkinson's, or Depression.
Although I can understand how the tremors may seem to be parkinsonian in some way, however, I am not getting the same flavor of any of your presentation being parkinsonian. Certainly, the persistent right sided headaches you are reporting seem more important to your case writing than the tremors.
I read that you've had headaches of a severe nature 13 years ago which to some extent share similarities with the headache you presently have and not been able to shake. You do not have nausea, vomiting, photo or phonophobia (extreme light and sound sensitivity making headaches worse) in relation to the headaches although you do state that closing your eyes brings you some relief.
I have no easy explanation to why your headache and other symptoms seem to immediately relieve themselves with eyes closed but not in darkness with eyes open. That does not have an easy explanation from a neurological perspective.
Your headache has some migrainous features though given your history and characteristics of the pain I would say that very severe tension types of headache or a type referred to as NEW DAILY PERSISTENT HEADACHE are the more likely possibilities if in fact these headaches can be ferreted out as having no relationship to anxiety, depression, or other illness/metabolic process such as what you had suggested in some other writings of Lupus and RA.
What medications or what other interventions have been recommended for the headaches? Any successes (aside from the chamomile tea which is very transient). The reason the tea works in all likelihood is due to it s caffeine content more than anything else but no matter since it is not a plausible long term solution.
I believe that what is needed is something to really put a major obstacle in the way of your headaches which can be best classified (if primary in nature) as either:
1. Severe Tension Type Headache
2. New Daily Persistent Headache
If the headaches are as a consequence of another process such as Lupus or Rheumatoid Factor then, forget about anything I said up top...what then, needs to be done is the primary process needs to be aggressively treated either with high dose (possibly IV steroids) or other immunomodulating agents specific to the process under discussion in order to cure the headaches.
In my headache clinic I encourage all my patients to participate in their care with me by filling out a HEADACHE DIARY. I would be happy to send you the example of the one we use in the clinic if you think you may be amenable to filling it out and willing to learn how to document your headaches. This then, becomes an additional tool to use to take to your neurologist in order to track symptoms more efficiently and to be able to quantify things that otherwise one would rely upon memory to recall which is impossible to do from one appointment to the next. Simply provide me your email if interested and I will enclose one to your attention with an explanation of how to use it.
Otherwise, I would not further consider the diagnosis of Parkinson's disease because I simply don't feel that is the most parsimonious explanation to your symptoms and least of all your headaches. BTW, the short term memory problems you are having are not unusual in people with severe headaches which are prolonged since the block to recall is due to the ongoing pain and other symptoms and once the headaches subside the issue with the memory will rectify itself.
There is a device called a SOOTHEAWAY device which has given a lot of people relief in our headache clinic at the XXXXXXX VA Hospital and we distribute it to many of our vets with the vast majority reporting immediate and often sustained relief from its use. You can get more information on this device (likely not covered by insurance) at www.sootheaway.com
If anything I've presented has helped you understand your condition a bit more I'd appreciate a little written feedback and a STAR RATING of your choice in order to help the management folks take me under consideration for an increase in the number of bags of peanuts I'm allowed to have per shift! LOL.
Also, if you do not have further questions or comments on this question would you please CLOSE THE QUERY as this will indicate to the system that the question has been satisfactorily addressed by yours truly and can be processed, archived, and credited for future reference.
You may also write specifically to my attention in the future if you choose for any type of question and I'm happy to answer you at the following web address:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68474
This query required 73 minutes to review, research, and document in final draft form for envoy.
Above answer was peer-reviewed by :
Dr. Raju A.T
Dr. Saghafi,
Thank you so much for your thoughtful and detailed response and for taking so much time to review this rather complex case. I specifically posed my question to you as a headache specialist to see if your insight might be different from my neurologist or another neurologist here on the site.
My email address is YYYY@YYYY and I would be interested in your headache diary. Recording the information would help because it would be one less data set to remember as I'm shuffled around to all these medical appointments. I appreciate you suggesting that and sending me the document.
The MRI of my brain did include a portion of 5-6 minutes with the contrast. The cervical/neck MRI did not. They found some damage from chronic inflammation between the 5th and 6th cervical vertebrae. Ironically, I had absolutely no problems with my neck before the two MRIs, but I guess my neck is slightly short for the brace they put you in in the tube and it's been very sore ever since the two tests. That's what I get for allowing myself to be admitted.
I'm not sure why they did not do the spinal tap while I was in the hospital, but MS was not mentioned again after my MRI results came in.
I've had nothing prescribed for my headache, but Tylenol was recommended on my discharge papers. The pain is the only warning I have of the spacey/shaky spells coming on and, since I have no idea what is causing the pain, temporarily at least, it makes me feel safer to have a few moments' notice prior to one of these spells. As of yet I have not fallen or passed out and I'd like to keep it that way. The spells are very strange, almost like someone hits the "pause" button for a few seconds and then the picture gets shaky.
I do think there is some stress component and maybe anxiety and depression play a part. That's my assignment, if you will, before my Nov. 7 appointment with the neurologist: reduce my stress and work on my depression (still figuring out how to do that and return to my workload and daily responsibilities). If that's not under control by Nov. 7, she said she would probably prescribe some medication, which I understand the necessity of but am not thrilled about taking.
The results of the rheumatoid panel will be available at my primary care physician on Oct. 15, so that will provide a bit more information.
What, if anything, do you make of the Theta waves that turned up on my EEG in the left temporal lobe of my brain? Is that common?
Thanks, and I will surely give you a five-star rating and positive feedback upon closing out our discussion. Good luck with the peanut situation!!
Thanks again, XXXXXXX
Thank you so much for your thoughtful and detailed response and for taking so much time to review this rather complex case. I specifically posed my question to you as a headache specialist to see if your insight might be different from my neurologist or another neurologist here on the site.
My email address is YYYY@YYYY and I would be interested in your headache diary. Recording the information would help because it would be one less data set to remember as I'm shuffled around to all these medical appointments. I appreciate you suggesting that and sending me the document.
The MRI of my brain did include a portion of 5-6 minutes with the contrast. The cervical/neck MRI did not. They found some damage from chronic inflammation between the 5th and 6th cervical vertebrae. Ironically, I had absolutely no problems with my neck before the two MRIs, but I guess my neck is slightly short for the brace they put you in in the tube and it's been very sore ever since the two tests. That's what I get for allowing myself to be admitted.
I'm not sure why they did not do the spinal tap while I was in the hospital, but MS was not mentioned again after my MRI results came in.
I've had nothing prescribed for my headache, but Tylenol was recommended on my discharge papers. The pain is the only warning I have of the spacey/shaky spells coming on and, since I have no idea what is causing the pain, temporarily at least, it makes me feel safer to have a few moments' notice prior to one of these spells. As of yet I have not fallen or passed out and I'd like to keep it that way. The spells are very strange, almost like someone hits the "pause" button for a few seconds and then the picture gets shaky.
I do think there is some stress component and maybe anxiety and depression play a part. That's my assignment, if you will, before my Nov. 7 appointment with the neurologist: reduce my stress and work on my depression (still figuring out how to do that and return to my workload and daily responsibilities). If that's not under control by Nov. 7, she said she would probably prescribe some medication, which I understand the necessity of but am not thrilled about taking.
The results of the rheumatoid panel will be available at my primary care physician on Oct. 15, so that will provide a bit more information.
What, if anything, do you make of the Theta waves that turned up on my EEG in the left temporal lobe of my brain? Is that common?
Thanks, and I will surely give you a five-star rating and positive feedback upon closing out our discussion. Good luck with the peanut situation!!
Thanks again, XXXXXXX
Brief Answer:
Will be sending the headache diary to you.
Detailed Answer:
Here are direct responses to each part of your update.
My email address is YYYY@YYYY and I would be interested in your headache diary. Recording the information would help because it would be one less data set to remember as I'm shuffled around to all these medical appointments. I appreciate you suggesting that and sending me the document.
>>>>>I will be forwarding that log to your attention just as soon as I get to the office and pull it up from my database of patient care forms. I think you will definitely find it helpful in order to organize your thoughts with respect to your headaches so that you don't have to rely on pure memory to relay details to the docs. They will appreciate it as well (IF THEY TAKE THE TIME TO READ IT AND ANALYZE IT....we'll see about that) since they can literally scan 1 week's worth of data at a time and see a lot of information as well as the trends in response to treatments, etc.
If your headaches cam on suddenly on a particular date and have persisted literally day and night without relief. And if it's true that these should be considered primary headaches (meaning not due to stress/anxiety/psychological pressures, metabolic disease of some sort, etc.) then, the diagnosis of NEW DAILY PERSISTENT HEADACHE becomes a possibility vs. TENSION TYPE OF HEADACHE with migrainous features vs. psychologically induced stress headaches.
The symptoms of burning and incontinence are not easy to place within the framework of any of those headache types. But the fogginess and shakiness potentially could be due to the severity factor of the headache. Again, I definitely of not of the opinion that Parkinson's disease is a possibility and wouldn't even show up on my list of the first 10 possibilities of problems let alone trying to somehow make it one of the more important problems to worry about. I'm not sure about the Lupus you mentioned. We will have to wait and see if more testing comes back or not.
I generally do not treat patients for headaches until they've had time to really go home with their headache logs and bring back a solid 3-4 weeks of documented information. I simply give them the XXXXXXX to treat their headaches as they've been doing so at home to that point with whatever their doctor had given to them as well as other remedies they'd been using and then, look to see what comes back. Once we can a name to the headache then, things become more clarified and we can actually make intelligent "guesses" as to which medication to start in on.
Theta waves on an EEG mean very little to me as you've described except they can be seen in the context of a person who is drowsy or sleepy. So if you'd put a cap on me right now.....you'd probably see TONS of thetas.....doesn't really mean anything in terms of a medical diagnosis so I don't think it's significant as far as the headaches are concerned.
We'll see how the rheumatoid panel comes out.
I appreciate your thoughts on giving me a good STAR RATING and definitely will appreciate a little written feedback when you do decide to CLOSE THE QUERY as this will indicate to the system that the question has been satisfactorily addressed by yours truly and can be processed, archived, and credited for future reference.
You may also write specifically to my attention in the future if you choose for any type of question and I'm happy to answer you at the following web address:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68474
This query required 19 minutes to review, research, and document in final draft form for envoy.
Will be sending the headache diary to you.
Detailed Answer:
Here are direct responses to each part of your update.
My email address is YYYY@YYYY and I would be interested in your headache diary. Recording the information would help because it would be one less data set to remember as I'm shuffled around to all these medical appointments. I appreciate you suggesting that and sending me the document.
>>>>>I will be forwarding that log to your attention just as soon as I get to the office and pull it up from my database of patient care forms. I think you will definitely find it helpful in order to organize your thoughts with respect to your headaches so that you don't have to rely on pure memory to relay details to the docs. They will appreciate it as well (IF THEY TAKE THE TIME TO READ IT AND ANALYZE IT....we'll see about that) since they can literally scan 1 week's worth of data at a time and see a lot of information as well as the trends in response to treatments, etc.
If your headaches cam on suddenly on a particular date and have persisted literally day and night without relief. And if it's true that these should be considered primary headaches (meaning not due to stress/anxiety/psychological pressures, metabolic disease of some sort, etc.) then, the diagnosis of NEW DAILY PERSISTENT HEADACHE becomes a possibility vs. TENSION TYPE OF HEADACHE with migrainous features vs. psychologically induced stress headaches.
The symptoms of burning and incontinence are not easy to place within the framework of any of those headache types. But the fogginess and shakiness potentially could be due to the severity factor of the headache. Again, I definitely of not of the opinion that Parkinson's disease is a possibility and wouldn't even show up on my list of the first 10 possibilities of problems let alone trying to somehow make it one of the more important problems to worry about. I'm not sure about the Lupus you mentioned. We will have to wait and see if more testing comes back or not.
I generally do not treat patients for headaches until they've had time to really go home with their headache logs and bring back a solid 3-4 weeks of documented information. I simply give them the XXXXXXX to treat their headaches as they've been doing so at home to that point with whatever their doctor had given to them as well as other remedies they'd been using and then, look to see what comes back. Once we can a name to the headache then, things become more clarified and we can actually make intelligent "guesses" as to which medication to start in on.
Theta waves on an EEG mean very little to me as you've described except they can be seen in the context of a person who is drowsy or sleepy. So if you'd put a cap on me right now.....you'd probably see TONS of thetas.....doesn't really mean anything in terms of a medical diagnosis so I don't think it's significant as far as the headaches are concerned.
We'll see how the rheumatoid panel comes out.
I appreciate your thoughts on giving me a good STAR RATING and definitely will appreciate a little written feedback when you do decide to CLOSE THE QUERY as this will indicate to the system that the question has been satisfactorily addressed by yours truly and can be processed, archived, and credited for future reference.
You may also write specifically to my attention in the future if you choose for any type of question and I'm happy to answer you at the following web address:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68474
This query required 19 minutes to review, research, and document in final draft form for envoy.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Answered by
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