Question: I was in a bad accident over a year ago, and have recently started having terrible headaches on the side of my head where I had a severe concussion. I get stabbing pains in my eye, blurred vision, dizziness, sensitivity to light and sound, and unclear thinking, etc. Several years ago I had migraines that went away, but this is worse and lasts much longer. The pain eases and then hits again. A CT scan was clear. Could these be cluster headaches?
Dr. Hibberd's Answer:
Your headaches require further evaluation. While your symptoms may be from migraine or perhaps cluster, other causes now need to be evaluated. Confusion during the episode also calls for further evaluation.
At the very least, this is a change in migraine pattern and may indicate arterial or venous malformation or aneurism. You should be evaluated promptly (these conditions often present with what we call "sentinel" headaches and are easily confused with migraine). Let’s also be sure you are not suffering from transient ischemia (loss of blood supply) or vasospasm (blood vessel spasm or constriction) from a correctable cause.
An injured area of the brain (irritable focus causing seizure-like activity) can also set you up for with similar symptoms, and can easily be evaluated. Once the cause is clarified, a sensible treatment plan can be formulated. This is no time for educated guessing!
Regarding your concussion — by all means use head protection and try to avoid activities that place you at risk for concussion. Repeat concussion has been associated with long term irreversible brain damage, and it is to be avoided. Athletes who sustain repeat concussions are now usually barred from participation due to the increased incidence of long term problems.
A CAT scan (CTT) used to be regarded as sufficient for brain imaging, but we now have far more sensitive methods available without the radiation exposure from a CTT imaging. CTT scans of the brain are now mainly performed to exclude acute hemorrhage (bleeding) in an emergency department setting.
MRI (magnetic resonance imaging), with its tremendous increased sensitivity and radiation free imaging, is now the preferred way to evaluate brain injury in a non-emergency setting. (It takes much longer than CTT to complete the imaging.) It may be accompanied by an MRA (magnetic resonance angiography) for screening evaluation of blood vessel integrity.
In some cases where we wish to observe cellular activity, PET scanning is an additional technique available. PET scans are especially invaluable to evaluate the spread of malignancy.
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