HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

Are MRI And CT Scans Needed To Treat Ice Pick Headache Symptoms?

Posted on Tue, 7 Feb 2017

Question: Hi Dr, My mum is 43 years old. She was complaining of pricking kinda short headache since the last couple of months; Finally today we went to a neurologist as she had a very bad headache last night. The neurologist suspected the issue to be ice picking headache based on the symptoms we shared, he suggested to go through EEG, MRI & CT scan to know the actual cause. We did the EEG today and the reports are normal and the neurologist confirmed the same. Now when the EEG is normal; is there a necessity to do the MRI & CT scan? Please share your valuable opinion

Answered by Dr. Dr. Prasad J (6 hours later)

Brief Answer:
yes, radioimaging is necessary...

Detailed Answer:
Hi,

EEG, electroencephalogram studies electrical activity of brain. While CT and MRI scans are radiological tests that help us study structures / anatomy of the brain. All of these are individual tests and cannot be used instead of other.

Her neurologist wanted to rule out abnormal electrical activity (seizure activity) and intracranial space occupying lesions plus abnormal blood vessels before confirming ice picking headache. Therefore those tests were ordered. And as I discussed above, each of these test have different uses and cannot replace each other. So yes, radiological tests need to be performed even if EEG is normal.

I hope I am clear. I will be able to answer and clarify further if needed.

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. Prasad J (3 days later)

Hi Dr XXXXXXX Thanks for your opinion. We have got the MRI reports and below are the impression.

Low lying cerebral tonsils- suggest LS spine screening to look for other abnormalities; Likely in keeping with Chari - Malformation - Type 1

S shaped DNS

Bilateral maxillary sinsues mucosal thickening

no significant abnormality.

Neurosurgeon has suggested for decompression surgery; Can this be treated with medicine. Please share your opinion

Answered by Dr. Dr. Prasad J (17 hours later)

Brief Answer:
No, medicines cannot treat chiari malformations...

Detailed Answer:
Hi,

As per MRI report there is structural abnormality noted in her lower portion of her brain. Such structural abnormality cannot be treated with medicines. Decompression surgery is needed if there are features of obstruction due to this malformations.

Perhaps you are worried about surgical treatment. I might suggest you take a second opinion from a neurologist. Neurologist will be able to give an opinion after reviewing all MRI films (not MRI report).

I hope this helps. Let me know if you need more information.

Regards

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Dr. Prasad J (54 minutes later)

Dear Dr XXXXXXX We have consulted both neurologist and a neurosurgeon, Based on the MRI films the neurologist referred us to a neurosurgeon and the neurosurgeon informed us about the decompression surgery. Since my mum doesn't have any serious symptoms (She only gets nerve pain for a couple of seconds when she laughs or coughs); Is the surgery mandatory and is this a life threatening problem? And also the neurosurgeon has suggested us to take an LS spine MRI to know if there is any problem in the lower back. She is currently on medication for the sinus problem. Would you be able to suggest any specialist in XXXXXXX whom I can consult for a second opinion? My mum is worried after hearing about the surgery and she doesn't want to undergo it, So I'm trying to find if there are any alternatives. Thanks

Answered by Dr. Dr. Prasad J (5 hours later)

Brief Answer:
Symptoms suggest obstruction...

Detailed Answer:
Headache while coughing, laughing, sneezing, yawning are due to raised intra cranial pressure. This pressure increment occurs due to obstruction. Unfortunately we can relieve obstruction only by surgical methods. None of medical drugs are as effective as decompression surgery.

I have provided my opinion based on the details provided. As per the details given, this is not an urgent requirement. You can plan further treatment/surgery after a second opinion if deemed necessary. There are multiple neuroscience centres in XXXXXXX Centres such as NIMHANS, Global hospital, Manipal hospital, apollo Fortis as well as hosmat have good neuroscience department. You can choose to visit one of these centres.

I understand this is an extremely difficult situation. But don't be worried. Decompression surgery is one of the easiest surgeries performed by neurosurgeon. I'm sure she will be well managed.

I will be happy to provide curbside consultation on this platform whenever necessary.

Thank you and regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar