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Consultation with Neurologist (Read 651 times)
rampalicious
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Consultation with Neurologist
Sep 18th, 2009 at 5:46am
 
I had my consultation with neurologist just now. I told her once my family doctor diagnosed me with Cluster Headache. She said she cant confirm I suffer from cluster headache although I have symptoms of Cluster Headache. Told her I have been suffering for 7 years and always happen on the same month, which is the fasting month (Islamic Calender). She insisted me going for a brain scan to check if I have any growth in my brain and the scan will cost me a bomb. It feared me after hearing that. Any advices on this?

Thanks!
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black
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Re: Consultation with Neurologist
Reply #1 - Sep 18th, 2009 at 6:09am
 
I had to read your previous posts to understand.

You mention that other doctors in the past seven years diagnosed you with ch.
You mean that noone of them till now ever asked you for a scan before getting to final diagnose?
I mean i am not a doctor but i thought that this is a standard procedure to rule out whether it is secondary or primary headache.

I don't know really what to say except that if i were you i wouldn't be feared(seven years are these) but i would find a way to get that scan anyway.

pf wishes
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Oh come on!it's just water.It can't be that bad!
 
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rampalicious
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Re: Consultation with Neurologist
Reply #2 - Sep 18th, 2009 at 6:18am
 
Only a doctor diagnosed me with CH without going for a scan, while others told me it's just a migraine.

After my consultation with a specialist, she told me my symptoms are of CH but she can't confirm anything as I had to go for the scan first and furthermore CH is a very uncommon headache.

I am in fear because the way she insisted me for going for the scan is like telling me that "You have a growth in your brain!"

She even gave me Steroids for brain swelling or inflammation.

Yes. I had it for 7 years! She herself, was shocked to hear that and the attack only happened on the same month of the year.
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black
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Re: Consultation with Neurologist
Reply #3 - Sep 18th, 2009 at 6:44am
 
Quote:
I am in fear because the way she insisted me for going for the scan is like telling me that "You have a growth in your brain!"


well you are not the only one getting this feeling when asked for a scan for the first time.
i still remember when i was aked for this at highschool age.
the first thought(ok the only thought i had back then)
was
-F#^k!i am gonna die virgin!

But seriously now as i said have in mind that it is just a standard procedure and seven years of which you are fine.   
But find a way and do it before getting diagnosed with whatsoever as from my experience any doctor followed from back then,first thing he asked was to see what medical tests have been done till now.
So it's a necessary step to do.

and Don't fear.Things get bigger in our minds than they really. Smiley

(hmmm the last time i had sex was back at...wait a sec!this can't be right...2009..minus...oh crap!i feel like a virgin again!)
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Oh come on!it's just water.It can't be that bad!
 
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rampalicious
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Re: Consultation with Neurologist
Reply #4 - Sep 18th, 2009 at 6:51am
 
Thanks black.

You made me feel better.

i was thinking about it all along when i was on the way home just now. Like, "what if they detect a tumor?" "what if i have brain cancer?" you know, such paranoia thoughts.

I always tell my self that I've been suffering for 7 years, and HEY! Im still healthy and doing fine!

But MRI Scan is way to expensive for me. I can't afford to do that. =(
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Bob Johnson
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Re: Consultation with Neurologist
Reply #5 - Sep 18th, 2009 at 11:30am
 
While it is true that doing a scan is becoming standard practice, it's also true that the risk of avoiding having one done is quite small.

This article makes the case for not having it done but I can send you several others which say to have it done. This is one of those situations where the answer is not clear. If money is a major consideration for you, I'd encourage you to be direct/honest with your doc and try and get her to change her desire for a scan.
========

"To scan or not to scan in headache
Some patients with primary headaches may need imaging"


"Some life threatening brain disorders present with secondary headache, where the headache is caused by the disease. A brain tumour, for example, is best diagnosed by brain imaging early in the course of the disease, which is essential for optimal management of this and other secondary headache disorders. However, brain tumours, as an example, account for less than 0.1% of the lifetime prevalence of headache.1 This contrasts with the fact that most headaches in the community are either associated with mild systemic infection or due to primary headache,1 where the headache is itself the disorder. Dissecting primary from secondary headache is the problem, since, by definition, primary headache does not need brain imaging because no disease process exists that leads to macroscopic change in general terms.

"How does one dissect primary from secondary headache? This question can have only a clinical response since no controlled trials have been conducted to identify causes of secondary headache. In clinical practice we generally accept that the so called red flags of headache should trigger a search for secondary headache.2 Thus change in the pattern of headache; new onset of headache in people older than 50; onset of seizures or headache associated with systemic illness, including fever; personality change; or with symptoms suggestive of raised intracranial pressure, such as new onset headache in the early morning; or headache that is worsening with coughing, sneezing, or straining should each be viewed with concern. Acute onset of the worst headache of the patient's life should trigger immediate referral for consideration as a sentinel headache of an intracranial aneurysm. An abnormal neurological finding is a clear indication to investigate, unless the finding is longstanding.2 Fortunately most worsening of headache is probably longstanding primary headache going into a more troublesome period, which mercifully is not a marker of a life threatening problem."

Source: BMJ 28 Aug 2004[Not complete article here.]
================================================================================
====================
"Imaging Strategies"
"For the vast majority of patients presenting with a headache, no imaging studies are necessary. It is estimated that only 1 in 250,000 headaches are secondary to a life-threatening condition compared with the 1 in 11 Americans who suffer from migraines.[3] The US Headache Consortium has recently offered guidelines for imaging.[4] Patients with an abnormal neurologic examination should be considered for imaging along with those presenting with an atypical headache. Magnetic resonance imaging (MRI) and computed tomography (CT) are the usual accepted methods of imaging. The Consortium has no evidence-based recommendation regarding the "relative sensitivity of MRI as compared with CT in the evaluation of migraine or other nonacute headache."[4] However, MRI is often preferred to look for suspected underlying structural abnormalities, such as tumors, while CT tends to be preferred for diagnosing subarachnoid hemorrhage.

"Dr. Unger discussed headaches at the 2003 AAFP Scientific assembly and presented the following "comfort" and "danger" signs as guides for imaging or other additional testing.[5] Comfort signs that are less likely to be associated with a secondary or life-threatening headache include positive family history of migraine, headaches that are menstrually related, those preceded by typical aura, or those that are periodic and stable over time. The clinician should consider additional testing in the presence of any "headache danger signs:" "the worst headache of my life"; sudden onset of a severe "thunderclap" headache; new onset in a patient older than 50 years of age; fever, confusion, or neck stiffness; loss of consciousness or any focal neurologic finding; or any change in headache pattern, such as progressive headaches without any symptom-free intervals. Dr. Darlow also added that the need for reassurance, either for the patient or clinician, is a possible reason to screen."[6]

Source: MEDSCAPE
==================

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« Last Edit: Sep 18th, 2009 at 11:31am by Bob Johnson »  

Bob Johnson
 
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Layla328
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Re: Consultation with Neurologist
Reply #6 - Sep 18th, 2009 at 12:07pm
 
I had had episodic CH for about 15 years before someone sent me for a scan (he told me though the scan would probably show nothing).  I had had head x-rays in the past but that's it.
My feeling is that the neuro should have been able to make a CH diagnosis (if that is in fact what you have) after taking a complete headache history.  Basically a headache history involves asking you to tell them about each episode, how many headaches, how often, when do they occur, how many per day, where are the headaches located, what does the pain feel like, how long do they last, etc.
My point is I still think a diagnosis could (and maybe should) have been made without a scan.
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rampalicious
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Re: Consultation with Neurologist
Reply #7 - Sep 24th, 2009 at 3:24pm
 
Agree with you starlight.
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Martin
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Re: Consultation with Neurologist
Reply #8 - Sep 24th, 2009 at 3:37pm
 
Actually Starlight, I think its safe for a brain scan before CH diagonosis.  IMHO better to rule out aneurysms, tumours, etc. before treating for CH's.

Easy for me to say though, here in Canada though, as MRI's and CT scans cost me nothing but the stress of waiting for results...

My CT scan was perfectly normal, and then was diagnosed with CHs.  I'd prefer knowing I have no growths in my skull before breathing 02 to treat it....

Best wishes to all you CHers out there, especially people limited in their options.  CT scans, Imitrex, and 02 should all be provided to CH sufferers.  THERE SHOULD BE SUPPORT FOR OUR PAIN!
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