Brief Answer:
Trigeminal Autonomic Cephalgias (TAC's)

Detailed Answer:
Thank you for your question although I'm not sure what your first statement of "Yes, I am concern because my son heard a pop in his brain....." It seems as if you are in a conversation with another physician. Generally, speaking the only time a patient can communicate DIRECTLY with one of the physicians who has answered a previous question is by writing a DIRECT QUERY to that particular doctor.

If you simply ask your question on the PREMIUM forum and post it the first physician available will answer the query.

In this case, it seems that your son has had 2 headaches of significance. The first was last week where he heard a pop then, a very painful headache with a reddened eye. The 2nd was a severe headache he got while having sexual relations.

Your son's headaches describe a family of headaches known as TRIGEMINAL AUTONOMIC CEPHALGIAS (TAC). These are not migraine headaches but are of another nature but they can be very painful, very debilitating, and as you've described occur in settings where they spontaneously occur with very specific features. In the first instance the sudden terribly painful headache with the inflamed looking eye which we may refer to an CONJUNCTIVAL INJECTION was probably of the CLUSTER type of TAC.

The 2nd during sex likely occurred at or just before the moment of climax and is termed COITAL HEADACHE and again is a subtype of TAC.

In all patients who suffer from coital headaches there should be a full and complete workup done (preferably by either a neurologist or headache specialist- who typically is a neurologist anyways) looking for things such as aneurysms, areteriovenous malformations (AVM's), and/or other pathologies which may be present but undetected.

Of course, in the cluster headache patient full workups are always advisable and preferred but they do not carry the same risk for intracranial pathology as coital headaches and therefore, may not necessitate all of the testing done for coital headaches. That is because the patient can fill out what is known as a headache diary and document the specific characteristics of the headache and usually on the basisi of a NORMAL NEUROLOGICAL examination and the specific parameters documented an accurate diagnosis can be made.

In both cases the use of a drug known as indomethacin is usually one very good initial option in order to avert next episodes.

In the case of cluster headache an effective ACUTE therapy is high flow Oxygen through a NONrebreather mask at high rates of 7-15L/min. Ibuprofen is usually not terribly effective for attacks and does nothing for avoiding future attacks.

Again, my advice is to obtain a neurologist/headache specialist, start filling out headache diaries to document things as they happen and then, to have a full and complete workup to include MRI and MRA of the brain and the neck. Treatment is based upon diagnosis of headache type and whatever else may be found on the initial history and examination.

If I've satisfactorily addressed your question could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback as to our transaction? Again, many thanks for posing your question.

Do not forget to recontact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 18 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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Brief Answer:
I cannot tell you to go or not to go...that's your son decision.

Detailed Answer:
I cannot make that sort of decision for a patient who I've never seen and in fact, am only responding to questions from a relative. The decision to go or not go to the ER for what happened must be his (if he is above the age of what is considered legal age in the state/country in which he lives) or yours if you are his legal guardian.

The only thing I will repeat is that in certain types of headache syndromes (eg- coital headaches) my practice is to have a very low threshold to work people up more vigorously (meaning additional tests or studies) DEPENDING upon my findings from detailed history AND a physical examination. In this case I cannot obtain either of those elements satisfactorily so I don't even really know if he deserves the type of workup I've described.

I've never sent anybody to the ER who I've diagnosed with any form of TAC no matter how painful. All workups have been as an outpatient. However, if the person has neurological signs that are asymmetric (meaning one side of the body reacts differently than the other) and there are symptoms or signs of something that is progressing then, an ER visit is very appropriate. Otherwise, I would say that outpatient assessment and management is quite adequate and occurs in the vast majority of such cases.

If I've satisfactorily addressed your question could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback as to our transaction? Again, many thanks for posing your question.

Do not forget to recontact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 43 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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