Intermittent Vertigo, Neck And Headache. Labs Show High Protein And Globulin Level. Advised SPEP And UPEP. Cancer?

Posted on Mon, 10 Jun 2013

Question: I had a sudden onset of vertigo over two months ago and I did seek treatment for it and was sent for an MRI of my cervical spine and had pt which did help me some. It is much better but comes and goes. I also had neck pain and headaches. I still have headaches at time and neck pain as well but its better than it was.I had labs done at the beginning of April that were normal except and elevated platelet count. Recently I saw my XXXXXXX med doc for another check up and he re-did my labs and my protein level in my blood tests was elevated and my globulin was only slightly above normal range. My albumin is normal and my A/G ratio was normal. My sed rate was high and I have slightly elevated platelets but they have come down from last test I think they are now 412. All other tests were normal. Doctor has ordered me to have SPEP and UPEP tests Im so scared because I know these are for multiple myeloma. I am terrified. What are the chances this is that type of cancer and not an auto immune disease or infection from my mouth or sinuses or something? Im going Monday to get the labs done but in the mean time I cant help but think now that I have blood cancer.

Answered by Dr. Mayank Bhargava (2 hours later)

Hi XXXXXXX,
Welcome to XXXXXXX forum.

Let me know the associated feature along with mentioned.
Do you have nasal blockage/ running nose/ frequent sneezing/ recurrent vomiting/ blurred vision?
What is the type of headache?
Do you have any aggravating or relieving factor for this headache?
What is your complete blood count report?

With the available described symptoms, there appears to be possibility of migraine; but the possibility of multiple myeloma, collagen vascular disorders, polymyalgia rheumatica (as you have elevated ESR and platelet count with headache) should also be kept in mind.

As such there is no correlation between headache & vertigo with neck pain.
Neck pain couldn't cause vertigo and headache.

There are at least 15-20 types of headache have been defined and diagnosis is made generally on the basis of history defined by patient.
Migraine is the most common type of headache and is a syndrome made up of multiple symptoms.
Migraine is associated with pulsatile type of headache, gets aggravated by lack of sleep, exposure to noise and sun light, excessive tea and coffee.
Migraine could also be associated with vertigo (as you have).
Tears from eyes and running nose is a feature of tension headache and at times, two sub types of headache may be present in a single patient.

In my personal opinion, there appears to be least possibility of multiple myeloma as globulin level is slightly raised with normal AG ratio.

You should consult with XXXXXXX medicine specialist/ neurologist and should go for thorough neurological check up.
You should also go for CT/ MRI brain to rule out brain pathology.
You should go for SPEP and UPEP, complete blood count, peripheral blood smear, urine bence XXXXXXX protein, x XXXXXXX pelvis and skull and thyroid profile.

You should also consult with ENT Surgeon and should go for thorough check up.

Treatment depends on exact diagnosis.
Meanwhile, you should take sumantriptan along with naprosyn, divalproex and propranolol on written prescription from your local doctor.
If naprosyn alone is not able to control headache, then you can also take ergotamine and tolfenemic acid.

Hope that helps.
Let me know your other query.
Take care,
Dr. Mayank Bhargava

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

Follow up: Dr. Mayank Bhargava (1 hour later)

I saw a neurologist who thought I had migraines. I do not vomit or get vision issues I do get a headache in the back of my head and neck and do get sensitive to light. I am currently just taking tylenol. The headaches are better. I am chronically stuffy and do not have runny nose. I get a lot of post nasal drip. I am having a brain mri, it has been ordered but not done yet. I will have it in the next week or so as it was just approved.

My cbc was normal with just a slight raise in platelets but everything else was all in normal range. Thyroid test was normal as well.

I just find it hard to believe that I could possibly have multiple myeloma when I have never had any issues at all and no one has these issues in my family and I am young. I am having my testing this week but Im just in shock it could be a possibility at my age.
Oh and the headaches get better with massage, ice on the neck, and exercise of the neck.

Answered by Dr. Mayank Bhargava (8 hours later)

Hi,
In my personal opinion, there is high chances of migraine and not suspecting the diagnosis of multiple myeloma.
All features suggestive of migraine are not present in single patient.
There could also be possibility of sinusitis and associated headache. You should consult with ENT surgeon.
You shouldn't perform neck exercise as you have mild spondylitis and may cause nerve damage.
Best regards,
Dr. Mayank Bhargava

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