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Hello Amy, I am Dr. Arun and will be helping you today.Was a colored doppler study done (specialized ultrasound) for the pulsatile neck mass?Have you consulted any specialist?
Hello Amy,Did your doctor consider an MRI of the brain for your symptoms of headache, unsteadiness / imbalance and feeling of falling?Just to confirm; the pleomorphic adenoma is of parotid salivary gland?
I have had 2. In the last year. They were clear.
Hello Amy,Are your present main concerns; Headache seesaw vision, more in the right eye,imbalancetachycardiashortness of breathfacial flushing.
Are you stressed and anxious?
Some and I can't sleep. I cry and am more easy to anger.
Yes low normal. Since that time my Levothyroxine was decreased to 25mg. I don't know what my thyroid levels are now. That was about 2 weeks ago. Did I mention alpecia. Seems as if my hair has been falling more in the last 2 weeks.
Diagnosed with Hashimoto's Thyroiditits last Oct. Last TSH was in low normal. Cortisol has been low 4 times over the past year. I passed the adrenal function test twice. Can't remember the name but blood was drawn at 30 and 60 minutes. I passed with a low normal response at 60 minutes.
1) Erythrocyte sedimentation rate,
2) Thyroid function tests,
3) Muscle enzymes;
4) Anti-nuclear antibodies (ANA)
5) Adrenal function test
8) Anti-SSA (Ro) or Anti-SSB (La)
9) Coombs test
Stress and anxiety can also be partly playing in your symptoms conglomerate.
The causes to consider for facial flushing are;
A. Drugs and medications; your medicines do not seem to be responsible for it and a periodic flushing is not likely due to it. The medicines responsible can be
1) nicotinic acid,
5) amyl nitrate
B. Anxiety; this is most important in your case.
C. Various cancers; I would not consider them here; though I am enumerating just for the completion of the list.
1) carcinoid syndrome
2) kidney cancer
5) systemic mastocytosis
6) thyroid cancer (medullary)
D. Physiological reasons.
1) ingestion of hot drinks
2) ingestion of monosodium glutamate
So anxiety need to be considered as cause. For initial screening testing for plasma peptides such as gastrin, calcitonin, vasoactive intestinal polypeptide, and somatostatin, as well as urine excretion of 5-hydroxyindole acetic acid, metanephrine, or histamine and other tests of endocrine function, such as adrenocorticotropin-stimulation test for adrenal insufficiency, should be considered by your physician. Than the medical imaging like CT scan of the abdomen and MRI may be done. It is extensive, I can understand but since it is periodic, a complete evaluation will give peace of mind.
Most headaches are caused by following:
Chronic daily headache
Chronic daily headache is not a type of headache but frequent headaches of various kinds. Most people with chronic daily headache have migraine or tension-type headache as the underlying type of headache. Tension headaches are the most common type of primary headache. So probably this would be the first to be considered in the differential diagnosis of your headache also. A tension headache is a headache caused by tense muscles in the face, neck, or scalp. These headaches give a feeling of tightness around the head. The neck muscles can also become sore and tight. Tension headaches can be caused by staying in one position for a long time, such as reading, playing video games or using a computer.
Migraine headaches are the second most common type of primary headache. Cluster headaches are a rare type primary headache.
Instability and imbalance can occur in migraine headache but it is difficult to differentiate between migraine and tension type headache without an examination. There are other causes of headache also;
1) sinus headache.
2) Medication overuse headache
3) Post trauma headache; occur after injury or accident.
4) Secondary headache; brain tumor.
Usually a doctor's examination is sufficient to ascertain the cause of headache. But occasionally x-ray of the sinus and CT scan or MRI (done for you as you mentioned) and magnetic resonance arteriography (MRA) of the brain may be needed, especially if the headache is persisting for long is worsening and is accompanied by symptoms like vomiting, vision disturbances and imbalance. After the tension headaches commonest headache are migraine. Aura and vision disturbances are absent, many times in migraine. Please read the symptoms of the migraine in this resource;
There are two types of medications used for the treatment of migraine;
1) To abort the attack
2) To prevent the headache
Valproic acid, gabapentin
Calcium channel blockers
Beta-blockers, tricyclic antidepressants
There are dietary triggers known which should be avoided. Common triggers are
b) aged cheeses and meats,
c) wine and beer
d) citrus fruits.
I would be happy to assist you further, if you need any more information.
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