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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 8999
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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Last couple of months I've had very strange headaches.

Customer Question

For the last couple of months I've had very strange headaches. They typicall start as a painful throbbing on the right temple. But then dull and are an annoying ache, sometime for two weeks straight. I also can feel (not hear, literally feel) my pulse in my neck and head almost 24/7, with or without a headache. I just started taking lisinopril a few months ago for high bp, so we know that isn't the cause. Any ideas?
Submitted: 7 months ago.
Category: Neurology
Expert:  Dr. Frank replied 7 months ago.

you could have a vascular phenomena causing vascular engorgement of the superficial temporal artery, called giant cell arteritis, or moya moya disease, but the most likely thing you have is migraine headache statistically. GCA, also called temporal arteritis is seen in more elderly women, starting at about age 50 and going up, so unlikely at your age unless there is a family history of autoimmune diseases, especially Rheumatoid arthritis or a muscle disorder called polymyalgia rheumatica. Moya moya is a vascular proliferation disorder at the base of the skull, that can also give you temporal artery engorgement, it is seen in younger women with a history of viral illnesses preceding the event. But very much more rare than migraine. DO you feel the headache coming on? Do you have a family history of migraine? Does light bother your eyes? or do you see flashing lights in your vision? Sounds bother you. Does taking a nap help? Nausea/vomiting? get back to me to discuss this further and I will reply. Or if satisfied with this answer, please remember to rate this service by clicking on the rating stars, as that is how I am compensated for this work. Thanks ***** oh, is it related to lisinopril ?, unlikely.

Customer: replied 7 months ago.
Hey, no history of any of that at all. I had a CT scan a few months ago that was normal and an MRI about a year ago that was also normal. I don't really feel them coming on, and I have no sensitivity to light, sound etc. I sometimes feel a little clumsy when I have them. But even when I don't have the painful throbbing on my right temple I still have this thing where I can feel my pulse in my neck and head all the time.
Expert:  Dr. Frank replied 7 months ago.

well you need some evaluations. There is a condition called carotidynia, a pain syndrome that emanates from the carotid artery in your neck, and causes engorgement up the side of your head. You will feel little bumps or tiny painful spots along the artery (in GCA, the same thing but not in the carotid in your neck). and just to exclude any kind of vasculitis or autoimmune inflammatory disorder (one is called hemicrania continua) you should get some blood work, a westergren sedimentation rate which is a cheap non specific blood test. If that is positive, then you need a neurologist to really look at you, and at the blood vessels around the sides of your head. But from a statistics viewpoint, and not being able to see you, migraine is the most common condition to explain your symptoms, and medications like triptans (sumatriptan, Imitrex or a dozen others that are available as free samples from your neurologist) should be tried to see if it works, which would also be diagnostic to confirm this is migraine. Please get back to me if I can help Dr frank

Customer: replied 7 months ago.
I don't have any raised or tender spots on my neck. I have a neurologist appt May 4th. Soonest they had. I will give you an example. I've had this headache since Monday. I woke up this morning and it was very dull, almost like a weird pressure in my head for most of the day. About an hour ago, while laying down, it started with the throbbing in the right side near temple.
Customer: replied 7 months ago.
Also, if it is that GCA, is it dangerous? Should I try to get an emergency appt before May 4th
Expert:  Dr. Frank replied 7 months ago.

as i said earlier, GCA is extremely rare in your age group. could you call your gp, and just ask him if there is any possibility you could have temporal arteritis ? (we don't really call it GCA anymore). Without that family history, it is probably a million to one shot at your age group. What you describe is typical for migraine, it doesn't have to be maximal at onset. But if you had that period in the morning, that would have been the time to take your imitrex medication. Ask your gp if he has a sample of imitrex he could give you to try??? That is the best advice I can come up with from here, you don't need a neurologist to get imitrex. Dr frank