jmj11 Posted September 28, 2010 Share Posted September 28, 2010 Here is one I'm posting only because I think it was missed by, 1) one FP doc, 2) two neurologists, 3) one headache specialist/pain doc. 47 yo male, no history of headaches, was in a boating accident on Puget Sound two years ago. They did a hard 90 degree turn in a speed boat. The boat jumped a wave and came down, causing a hard hit to his right temple with the windshield. Then, before they could get the boat under control, it happened exactly the same. No LOC. Immediate headache that actually worsened over the next week. In summary, the headache has been unchanged since (now two years). I will describe it in more detail Location: Rt temple, rt periorbital, sometimes rt occipital area. Quality: Baseline pain dull. Secondary, sharp stabs occasionally. Severity: Baseline pain wavers between a 4 and an 8. The sharp stabs about a 9. Associated Symptoms: Sensitivity to light, mostly in the rt eye. Slight tearing of the rt eye. Slight nausea when the pain is an 8. Modifying factors: Triggers: injury Aggravtors: none Alevers: cold compresses on the side of his head. Work Up: CT and MRI. Treatment: None because nothing has helped. Past Headache Hx: Treated prophylactically with gabapentin, toparimate, valproate, amitriptyline, verapamil (had to stop due to constipation) none helped at all. Also tried sumatriptan sq with no help. Tried a variety of pain meds with no benefit. Any thoughts? Can you out-wit the neurologists and headache specialists? Feel free to use an "open-book." Link to comment Share on other sites More sharing options...
kismet Posted September 28, 2010 Share Posted September 28, 2010 SUNCT Syndrome came to mind (as previous treatments were not helping). Also unilateral stabbing pain similar to cluster HA. Link to comment Share on other sites More sharing options...
jmj11 Posted September 28, 2010 Author Share Posted September 28, 2010 SUNCT Syndrome came to mind (as previous treatments were not helping). Also unilateral stabbing pain similar to cluster HA. Good guess, but SUNCT is even more rare and, as far as I know, we don't know of any cases brought on by trauma. Also, by definition, SUNCT is "Short lasting" not continuous. Link to comment Share on other sites More sharing options...
kismet Posted September 28, 2010 Share Posted September 28, 2010 Have you tried treating with Indo? Link to comment Share on other sites More sharing options...
jmj11 Posted September 28, 2010 Author Share Posted September 28, 2010 Have you tried treating with Indo? shhhhhhhhh . . . . now don't give away yet. I want someone to give me the dx:>) Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted September 28, 2010 Administrator Share Posted September 28, 2010 Hemicrania Continua? Link to comment Share on other sites More sharing options...
jmj11 Posted September 28, 2010 Author Share Posted September 28, 2010 Hemicrania Continua? Yes! Post Traumatic see: http://www.rwevansmd.com/EvansPublictations/posttraumatic%20hemicrania%20continua.pdf This was missed by several people over two years. Indomethacin 50MG tid, renders him headache free. Link to comment Share on other sites More sharing options...
kismet Posted September 28, 2010 Share Posted September 28, 2010 Ahh, I was soo getting there with the indomethacin. Hey jmj, have you tried the patient on amytriptiline? Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted September 28, 2010 Administrator Share Posted September 28, 2010 Ahh, I was soo getting there with the indomethacin. Ah, I assumed you already had it. I worked backwards from the indo clue with UpToDate to come up with the answer. My class doesn't get to Neuro until spring. :-) Link to comment Share on other sites More sharing options...
kismet Posted September 28, 2010 Share Posted September 28, 2010 Heck, I'm not even in PA school. I like reading about neurology. It's fun. Link to comment Share on other sites More sharing options...
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