Migraine? Don't be too sure...

RN2B2005 · Mar 21, 2003

Had a guy in our practise recently who c/o HA's (not migraines, per se, but disabling nonetheless) and slight, transient neck pain. Not sure how long he'd had these sx but he had been seen in ER more than once, and had both a negative noncontrast CT and negative contrast MRI of the brain.

So he came to us for a cervical spine MRI, and voila! big whopping neuroma sitting at about C2. Mass effect on the cervical spine. I only saw the noncontrast images, but boy, was it startling. Cervical spine tumours (and Arnold-Chiari malformations) are relatively uncommon--not rare, but uncommon enough to startle the cripes out of myself and the tech doing the scan.

The awful thing is, this guy had seen multiple docs who told him nothing was wrong. It was only because he was an assertive patient--something that might get him labelled a drug seeker--that his PCP eventually shipped him to us for the cspine scan.

renerian, BSN, RN · Mar 21, 2003

Wow scarey stories!

renerian

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · Mar 21, 2003

Yes, people with pain need to be treated and not judged. I had a coworker that had persistant, debilitating migraines that had them in the ER constantly. Morphine was the only thing that worked. After a couple months of this, I guess someone thought that a head CT would be a good idea- very large brain anerysum requiring surgical intervention.

Hope that everything is going well for you now webbie debbie. Thanks for the reminder that all patients deserve respect and care, even when there appears no medical indication for symptoms.

colleen10 · Mar 21, 2003

Years ago my step mother suffered from horrendous debilitating migraines. They progressively got worse, to the point where she was injecting herself with pain killer and would often need to take days off of work at a time.

Docs kept saying nothing was wrong, take the pain meds and deal. After about a year one doc told her that he thought she may have the beginning stages of MS. She was sent for an MRI and what they found was a serious sinus infection deep in her sinus cavities. Treated it with heavy duty antibiotics and never had a problem since. They cured her just in time for her menopause and hot flashes to start. Will she ever win?

PennyLane, RN · Mar 21, 2003

My older sister has suffered from migraines nearly all her life. She has been to the ER more times than I can count, and once said if she had had a gun, she would have shot herself to stop the pain. Nothing works.

I think I'll ask her tonight if they've ever looked at her spine.

Thanks for sharing, webbiedebbie, glad you're back up to par!

RNonsense · Mar 21, 2003

Glad you're ok WD. Thanks for the info!

BadBird, BSN, RN · Mar 21, 2003

I had headaches every day, not migranes just headaches. I finally had a massage and guess what, she really worked my neck the next day it was sore to the touch but no more headaches!!!! The price of the massage was cheaper than all the motrin I was taking and I was amazed at how good I feel.

Tweety, BSN, RN · Mar 21, 2003

My sister had headaches daily for several years that was rooted in her neck the found eventually. Started her on neurontin and the headaches disappeared. Wonder why it isn't routine for frequent headache sufferers to have the neck checked?

RN2B2005 · Mar 21, 2003

Wonder why it isn't routine for frequent headache sufferers to have the neck checked?

Probably because it's still statistically unlikely that anything so dramatically abnormal will be found. As webdeb said, these are uncommon conditions.

In addition, the gold standards for spinal exams, myelograms and MRIs, both have drawbacks. MRI runs about $1500 for a routine (non-contrast) scan, and a myelogram is a very invasive procedure. CT and x-ray is not particularly useful for soft-tissue spinal exams. The vast majority of people with HA's are not going to benefit from these tests or from MRI as a "routine" test.

I guess I wouldn't want to have a cervical spine MRI unless I had HA's that were repeatedly refractory to medication or other therapy and I had a normal contrast-enhanced MRI of my brain.

AmyLiz · Mar 22, 2003

My husband has had headaches daily since before I met him. Some of them were full-blown "migraines" as well. He was also having some hearing loss in his left ear as well as some ringing. I finally talked him into seeing a dr, who sent him to an ear, nose & throat specialist, who had him get an MRI. They found a 2cm acoustic neuroma growing off of his nerve! :eek: He just had surgery two weeks ago. Lost all hearing in his left ear (to be expected), but they got all of the tumor.

I'm just glad the dr didn't just dismiss it as nerve damage! Husband will be fine after some PT (to get his balance back).

Anaclaire · Mar 22, 2003

I learn so much from everyone on allnurses.com!!! Thank you all for sharing your experiences--- I'm sure I'll remember them and use them as a critical thinking resource when I come across people having multiple headaches.

By the way, this thread makes me remember a dear 34 year old nurse I worked with who was having headaches for almost a year, often asking us if we had some Tylenol or Motrin, etc. during our shifts. She'd take large does but never really complain about the headaches that much... we all just noticed she had headaches quite often. She was a single Mom with 3 young children and we assumed the headaches were stress-related.

Boy we couldn't have been more wrong! She went home from work one morning, went to sleep, and 6 hours later when her sister tried to wake her up she made a groggy-grumpy nonsensical statement and rolled back over to continue sleeping. Two hours after that no one could wake her up. Ambulance called, she was comatose and never woke up again. Tests revealed a massive brain tumor. She passed away 3 days later when the doctors pronounced her brain dead leading her family to have her taken off the ventillator after surgery was done for having her organs donated. It was the saddest, saddest thing for us all! She was one of our "lead" people in our NICU and loved by everyone. She always had a rather stern and grumpy attitude but we all knew she was like that. In hindsight we felt she had been a little more quick-tempered over the final couple of months, but none of us recognized it being a possible symptom of a brain tumor. We all felt so guilty for not recognizing a serious problem. She never went to a doctor concerning the headaches that we know of... just suffering through them quietly. My heart aches just thinking about it all now. This happened in 1999.

I will forever be more thoughtful of people having headaches and aim for a deeper assessment of anyone complaining of them. That's why this thread about headaches means so much to me. Thanks again for all who posted to this thread. (By the way, the nurse's ex-husband took in the children, ages 10, 5 and 1 year and they are doing fine as far as I know... I moved away a year later.)

Thanks again to everyone for sharing their experiences!