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Forum Name: Headaches

Question: Severe headaches at base of skull


 Binkalette - Thu Jan 03, 2008 10:26 pm

Hello, My fiance has been getting some really severe headaches at the base of his skull right where it meets his neck. It usually happens when we have sex,(which we stopped) but it now he says it feels like it's going to happen if he stretches his arms up above his head.. The first time it happened it was crippling to him. He immediately laid down and clutched his head in pain.. he said it felt like someone had slammed an ice pick into the back of his head. He was also frightened by the fact that he could feel his heart beating and pulsing in the back of his neck like it was having a hard time getting through and said that he had unimaginable pressure in his head, like it might explode. The first one happened last thursday, and on Saturday he had his worst one yet. He was in the shower trying to figure out what was triggering it and accidentally made it happen. He said he wasn't sure if he should even be standing up so he threw on his clothes and went to lay in his bed. I had been trying to get a hold of him on the phone while this was happening, but the pain was too bad for him to even be able to get up and answer the telephone. These attacks of intense pain usually last about 15 minutes and then taper off into just a bad headache. During the bad one, he said that he noticed his vision going black and white and then back to color with his heartbeat (which becomes very very fast) His blood pressure also goes up quite a bit when this is happening. He also mentioned that when he had the one on Saturday, he felt his heart beating very irregularly. He was on Prilosec for heartburn for six or seven days before these started happening and he stopped taking it after the first one.. but it doesn't seem to have helped. He had another one on Sunday, Monday he was fine, and Tuesday he had another. We went to the doctor on Wednesday, and the doctor didn't give us any idea as to what might be causing it. He ordered a head CT scan and took a blood sample. The blood sample he said was just to test his kidney function and make sure that the dye they would use during the CT scan would filter back out correctly, but when we went in for his CT scan the next morning, they didn't use any dye at all.. (is that normal?) Now he's just had a lingering headache for several days that gets worse at times and he mentioned that he will feel a suddenly sharp pain every once and a while..

This whole thing is really freaking me out... We've read up on everything we can find online... for a while we thought maybe it was a sexual headache or an exertion headache.. but now, my fiance said that he feels the symptoms of a Thunderclap headache is much closer to what he is experiencing. He has no vomiting, slight nausea, but he said that may be just because of what he's going through when it happens and not actually a symptom... Radiology said that we would get the results of his CT scan in a couple of days, but I don't know if they meant business days or just days. He also has an appointment coming up with Internal Medicine on the 15th. They couldn't get him in any sooner..

Any information or help or.. anything would be really appreciated!

Thanks for taking the time to read all that.. :-S
 John Kenyon, CNA - Mon Aug 11, 2008 8:36 pm

User avatar Hello -

While there could be any number of innocent causes for your boyfriend's headaches it is extremely crucial that the more serious possibilities be ruled out (or in -- either way is important) first. From the detailed description of the symptoms you provide here my first thought is that he may have an arteriovenous malformation (AVM) in or on his brain. This can be extremely serious and needs to be ruled out first, followed by the just-as-serious-but-usually-not-as-complex arterial aneurisms. The field is narrowed down from there.

The reason I think of AVMs first is because of not only "thunderclap" headaches but also the pressure, pulsing, and visual disturbances, all of which are often features of a maturing AVM, which is a congenital defect that usually doesn't show up right at birth and may take years to start causing symptoms, and is a tangled cluster of small arteries and veins which have not developed a connecting set of capillaries, and so develop pressure where the arterial and venous blood makes the return loop back to the heart. Since capillaries allow the exchange of oxygen from blood and change arterial to venous by exchanging oxygen for carbon dioxide, there is a slow buildup of pressure at such a site. Eventually it starts to cause damage to surrounding structures and that's when the symptoms begin to show up. Depending on the location in the head, the symptoms can vary, but what you've described here suggests an AVM first and foremost.

While a CT scan is usually the first step in imaging to try and demonstrate an abnormality, an MRI is usually more specific once the lesion (if there is one) has been located and if it is not located, the MRI, often with contrast (cerebral angiogram, and sometimes done with flouroscopy instead of MRI, depending on anatomical considerations) must be done in order to locate and define the lesion (again, if there is one).

This is a rather urgent matter, and hopefully the heavy work has already been done. AVMs (or aneurisms and other malformations of cerebral blood vessels) are often repaird by surgery with very good results. Aneurisms now can sometimes be repaired or at least managed by less invasive procedures such as placing a coil via a catheter. AVMs usually do require surgical repair,however.

Please follow up with us here and let us know how things have gone so far. Hopefully this was something less serious, but if it was what it sounds like, it needed to be diagnosed and treated fairly quickly to avoid a more dangerous situation.

Best of luck to you both.

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