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Date of last update: 10/04/2017.

Forum Name: Headaches

Question: Persistent Vertex Headache & Fatigue

 Lunabelle - Mon Jan 12, 2009 6:43 pm

Hello! I have been experiencing bizarre symptoms since November 2008 and I'm wondering if anyone could offer some guidance as to what tests I should have done or what kind of specialist to see at this point.
I am a 33 year old female who is normally in excellent health. I'm usually very energetic, I exercise regularly, and run marathons. About mid-November I began to experience a persistent headache on the top of my head. I'm told that this is a vertex headache. The headache is accompanied by tenderness when the area is lightly touched. Several days after the headache began, I came down with a bad cold. My doctor told me that I had a bacterial upper respiratory infection and he prescribed antibiotics for 7 days. On the 8th day my cold symptoms were gone, but the headache remained. My doc told me to "wait it out and see if it gets better." I waited until mid-December when the pain became unbearable. I was sent to a Dermatologist who ruled out and skin disorders. Subsequently, I was placed on a 20 day course of antibiotics to treat what my doc thought was a type of sinusitis.
It's now 2009 and the headache is getting worse. OTC meds do not alleviate the pain. The pain is minimal in the morning and increases throughout the day. Nighttime is the absolute worst. Sometimes the pain is a burning sensation and the area is always painful to light touch. I now have new symptoms of nausea and fatigue. The fatigue hits me so hard that walking is a chore. My limbs just feel so tired. I had a CAT scan which was negative. I'm told that the CAT would have shown sinus issues if there are any? I'm following up with my MD this week to receive the results of a thyroid test and receive a referral to a neurologist.
I'm wondering if this could be a thyroid disorder or perhaps Lyme disease? Are there specific tests I should ask to have done?
 John Kenyon, CNA - Tue Feb 10, 2009 2:28 am

User avatar Hi there -

This doesn't sound, to me, like typical vertex headache. While it is in the right location, there are certain features that make it sound more like something else. Specifically, it would seem there might be some irritation of the xiii cranial nerve, possibly a herpes simplex infection or something pressing on the nerve near its outlet. I say this because of the tenderness to touch, which seems to persist much longer than usual. This is often seen with herpes (shingles), but your episode has lasted long enough to make me wonder if there might not be some structural interference with the nerve.

A neurological workup for this problem could be fairly simple. It's relatively easy for a neurologist to trace the nerve pathway and an MRI of the brain might not be a bad idea, to rule out some sort of compression of the XIII cranial nerve, but a cursory exam might well expose a long-lasting herpetic or post-herpetic syndrome. This is often easily treated wtih drugs like gabapentin or pregabalin, which block the pain until the inflammation (if present) finally resolves. If this isn't the problem then there may be some mechanical pressure on the nerve causing a similar symptom, and this would need to be identified (thus the brain MRI). The increasing fatigue also suggests something viral, but this also could be a herald symptom of something more like MS (again, the brain MRI would be invaluable in ruling this out). A neurological consult is a very good next step. I'm very sorry you've had to put up with this for so long, but now maybe you can finally get to the bottom of it and get it managed or even resolved.

I hope this is helpful. Please follow up with us as needed. Keep us updated, also.

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