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Had Headache. Prescribed Rocephin. CT Scan Normal. What To Do?
Question: Hello, I have had a headache for two weeks. I was given a dose of Rocephin(spelling?) because my primary care thought it was sinuses. I went to the ER three days later, and they did a CT without contrast, and a spinal tap to rule out meningitis, as the headache is one sided, right side, and also has severe right sided neck pain.The CT showed no sinus infection, and the spinal tap was clear. I do not have a history of migraines, and my headache has not gotten better. It also makes my neck and ear feel hot. A few years ago I did have a MRI with contrast, and I am pretty sure one of those CT scans that show the 3d model of the brain, I am unsure what its called. I am just worried it could be an anerusym or something horrible. Do you think I have reason to worry.
Hi,
Thank you for posting your query.
First of all, I would like to reassure you that it is unlikely that you have a serious underlying brain disease, which is causing your headaches.
You have had a fairly good work up, including CT scan, MRI brain with contrast and spinal tap, and they are all normal.
At present, the most likely cause for headaches would be migraine.
Another remote possibility is cerebral venous sinus thrombosis, which can be excluded by MR venogram. In this condition, blood clotting occurs in brain veins.
Benign intracranial hypertension (BIH) can also cause headaches and MRI would be normal. In this condition, there is increased CSF pressure. During spinal tap, this pressure can be measured. So, I presume that the CSF pressure was normal during the spinal tap, so, BIH was excluded. An eye examination, including fundus examination to exclude papilledema can rule out BIH too.
The likelihood of aneurysm is unlikely based on your presentation. Headaches usually occur, when the aneurysm ruptures causing bleed in the brain, and this can be easily seen on CT or MRI of brain.
So, there is no need to worry at present.
I hope it helps. Please get back if you have any more queries.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Thank you for posting your query.
First of all, I would like to reassure you that it is unlikely that you have a serious underlying brain disease, which is causing your headaches.
You have had a fairly good work up, including CT scan, MRI brain with contrast and spinal tap, and they are all normal.
At present, the most likely cause for headaches would be migraine.
Another remote possibility is cerebral venous sinus thrombosis, which can be excluded by MR venogram. In this condition, blood clotting occurs in brain veins.
Benign intracranial hypertension (BIH) can also cause headaches and MRI would be normal. In this condition, there is increased CSF pressure. During spinal tap, this pressure can be measured. So, I presume that the CSF pressure was normal during the spinal tap, so, BIH was excluded. An eye examination, including fundus examination to exclude papilledema can rule out BIH too.
The likelihood of aneurysm is unlikely based on your presentation. Headaches usually occur, when the aneurysm ruptures causing bleed in the brain, and this can be easily seen on CT or MRI of brain.
So, there is no need to worry at present.
I hope it helps. Please get back if you have any more queries.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello, Thank you for your quick answer,
Would cerebral venous sinus thrombosis even be something I should worry about? I usually am not a panicky person, but I have been having some supine hypertension issues due to my autonomic system, and everytime I read up on it, it mentions subarachnoid hemmorage or aneursym due to the high blood pressure. However my blood pressure is never sustained high longer than two hours at a time, and I think worrying got the best of me.
Also one more question, should I be concerned my headache is now mostly with a weird pressure feeling in my right temple, and minor ache in the back of head? Or do you think that it is the headache finally going away?
I did feel sick all last week, and thought I had a sinus infection, my primary care also told me my ears were bulging but not infected.
Would cerebral venous sinus thrombosis even be something I should worry about? I usually am not a panicky person, but I have been having some supine hypertension issues due to my autonomic system, and everytime I read up on it, it mentions subarachnoid hemmorage or aneursym due to the high blood pressure. However my blood pressure is never sustained high longer than two hours at a time, and I think worrying got the best of me.
Also one more question, should I be concerned my headache is now mostly with a weird pressure feeling in my right temple, and minor ache in the back of head? Or do you think that it is the headache finally going away?
I did feel sick all last week, and thought I had a sinus infection, my primary care also told me my ears were bulging but not infected.
Thank you for getting back with more details.
I do not think you should worry about cerebral venous thrombosis now, as you are getting better and MRI was normal.
As I mentioned earlier, aneurysm and subarachnoid hemorrhage could cause headaches and neck pain, but they have been excluded by CT and MRI scans of brain.
As of now, there is no need to worry, as I feel your headaches are getting better and you would be fine soon.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
I do not think you should worry about cerebral venous thrombosis now, as you are getting better and MRI was normal.
As I mentioned earlier, aneurysm and subarachnoid hemorrhage could cause headaches and neck pain, but they have been excluded by CT and MRI scans of brain.
As of now, there is no need to worry, as I feel your headaches are getting better and you would be fine soon.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The Ct without contrast was done last week. But the MRI with contrast was done in the winter of 2011. Would that still be applicable for today?
Contrast injection is required for diagnosing meningitis or other infections. Since you had a spinal tap (lumbar puncture), which ruled out a meningitis, there is no need to do contrast MRI now. Spinal tap is more sensitive than MRI for diagnosing meningitis.
I hope it clarifies.
Dr Sudhir Kumar MD DM (Neurology)
I hope it clarifies.
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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