Brief Answer:
Please upload your imaging study to this system for review

Detailed Answer:
Good morning. Thank you very much for your question and I'm sorry you're having such problems but hopefully I can help shed some light on your questions.

I am both a neurologist and headache specialist and so I see patients with your constellation of symptoms on a regular basis. The concept of a headache "without" pain or without the headache per se is an interesting one and actually has a name. We refer to those episodes as ACEPHALGIC MIGRAINES (or whatever type of headache is under discussion). They are most commonly believed to be migraine where pain actually never comes on and we believe is actually ABORTED in the middle of the cycle which begins with typical migraine aura which are taken to be the flashing lights, blurry vision, sensitivity to light, sound, nausea, and possibly vomiting.

However, in your case the premonitory symptoms are less clear than those of a distinct migraine headache and are more consistent with another system of the body such as either cardiovascular or cardiopulmonary. However, there is a major key that you mentioned which are the low level cerebellar tonsils and that itself could explain the slow heart rate, the headaches (when they come), dizziness, nausea, and feelings of pins and needles.

If the low level tonsils are actually going through any type of compression through a the opening in the base of the skull called the foramen magnum then, these are the symptoms you may have but if on the other hand the radiology report is simply being read as LOW LYING tonsils without evidence of herniation then, perhaps this is not the cause. In that case, there is a type of headache aside from migraine which can envelope only half the head and that can be either PAROYXSMAL HEMICRANIA, or an occipital neuralgia which can also lead to the feeling of pins and needles. I'd need a bit more explanation on the symptoms of the headaches before, during, and after to get a better fix on one of the types.

In addition, if your thyroid gland has not been checked lately for good control then, that may be another contributing factor to your headaches. I always screen my thyroid patients with the following bloodwork:

1. TSH
2. FREE T4
3. TOTAL T4

if they have thyroid disease and are complaining of strange headaches or other symptoms that are uncomfortable or odd above the neck.

If nothing comes from the analysis based on what I'm saying or if you can't find a headache specialist that can better help identify the exact type of headache you are having then, from a diagnostic point of view I might consider doing what is known as a PHASE CONTRASTED MRI as well as being sure that a baseline MRI with and without GADOLINIUM CONTRAST. I MIGHT consider a lumbar puncture to measure opening and closing pressures but that would be highly dependent upon my neurological examination as well as your clinical status.

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload more specific information regarding lab tests and diagnostic studies if done and I'll be happy to look at them in the context of your question.

Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.

Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.

This consult request has taken a total of 19 minutes of time to read, research, and respond.

---

Brief Answer:
Dysthyroid state, common cause of variable headaches

Detailed Answer:
Thank you for your return clarifications of information. Therefore, it would appear that your thyroid function is normal as of 1.5 months ago. Nevertheless, patients with dysthyroid states (hyper or hypo) can certainly suffer headaches of a variable and ill defined nature just by virtue of possessing the condition. I've had patients with headaches of a similar nature as yours with thyroid problems (both HYPER as well as HYPO states) and we have actually timed their headache episodes to coincide with when their thyroid medications were at their lowest serum levels just prior to next dosing. The fix to that problem was to be sure that the patient was not taking any other medications that could interfere with the hormone replacement and then, to change the timing of her doses so that we would not let the serum levels dip that far down before getting the next dose into her system. With 4-6 weeks the patient began noticing that her headaches started reducing dramatically in frequency and intensity.

Another thing that may be worthwhile checking if there don't seem to be any other answers to the question of etiology would be to measure MAGNESIUM levels (both total and FREE) in blood. With your dysthyroid state it is possible that the metabolism of magnesium in your system is altered and this could be a potential problem.

The surgeon that reviewed your films more likely than not was a neurosurgeon and it's quite fine if he looked at the films and decided that surgery was not an option but I will sometimes still go for the PHASE CONTRASTED MRI in order to demonstrate CSF flow dynamics more cleanly. I'm always slightly hesitant to believe a visual inspection of a film when the read is "low lying tonsils" but that's OK...the neurosurgeon is likely experienced and wouldn't miss an opportunity to spot a surgical candidate if it were present....

If you were in my clinic with this type of presentation then, I would definitely be having you fill out a headache diary in order to keep track of specific symptoms and to look for potential triggers and exacerbants including all different types of foods, beverages, medications, and activities. I would also be giving you an exercise regimen to follow since we now know that most patients with headache syndromes improve using exercise regimens of an aerobic nature.

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload more specific information regarding lab tests and diagnostic studies if done and I'll be happy to look at them in the context of your question.

Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.

Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.

This consult request has taken a total of 44 minutes of time to read, research, and respond.

---