Grover feared the sudden pain was a sign of what it might mean: her beloved grandfather, her guardian and caretaker, had suddenly died from a ruptured artery. Cerebral aneurysm She was 14. His death was particularly traumatic for Glover, who had a childhood scarred by chaos and violence and suffered from post-traumatic stress disorder.
For more than a year, she didn’t tell anyone about the ice pick attacks, which recurred every few months.
“I thought if I was going to die, I was going to die,” she told herself, but she wasn’t feeling that bravado. Glover said she was terrified that doctors would discover she had an aneurysm, which can be treated with surgery. Often fatal If it bursts.
After her attacks became more frequent, Glover finally sought treatment and underwent nearly a decade of treatment, including tests by multiple neurologists, who found nothing to worry about. Conventional wisdom had it that Glover, now 61, suffered from migraines, but her symptoms didn’t match that diagnosis, and migraine medications didn’t help.
It wasn’t until her seventh neurologist, a new headache specialist, asked her some important new questions that Glover learned the cause of her excruciating symptoms.
“I finally found someone who doesn’t call it a migraine,” Glover said, remembering how he felt when he told her what he suspected. “I thought, ‘Oh my god, this is it!'”
An episode at the craps table
In 2000, about a year after his first attack, Glover suffered a seizure at work and had to prop himself up over the edge of a gaming table until it subsided.
A close friend she spoke to chastised her for being “selfish” for not going to the doctor, and urged her to think about “how the people who love me would feel if I didn’t do something when I could,” she said.
In 2001, after a particularly bad attack left him with a persistent, dull headache that didn’t respond to over-the-counter painkillers, Glover went to an emergency room after hours. He told the nurse that the headache had lasted for days and that his grandfather had died of an aneurysm, so he was taken to the hospital. It can also be inherited in families.
An MRI and CT scan showed no serious brain abnormalities, but doctors found a benign cyst in her brain. Parietal lobethe part of the brain involved in sensation and perception. Glover spent the night in the hospital and was given an injection of painkillers. The headache went away.
The doctor reached into a file cabinet, pulled out a fact sheet and handed it to Glover, telling her this was the abnormality he suspected.
Doctors determined that the cyst didn’t need treatment and was probably unrelated to her increasingly frequent seizures. Over the next few years, Glover saw several neurologists and neuropsychologists who ruled out epilepsy, multiple sclerosis, and dementia. “Your headaches are a mind-body symptom,” one doctor told her.
Glover discovered much later that in a referral letter to another doctor, he had written that she may have been somatizing (experiencing symptoms that had an emotional rather than physical cause). Laziness — Exaggerating or fabricating symptoms for attention or other purposes.
“I was disappointed and disheartened,” she said. “I trusted my doctor with my personal information and experiences, and then I was accused of lying.”
But when doctors couldn’t explain her unusual headaches, Glover said, “I started to think maybe I was causing this. Then I had one attack and I thought, ‘No way, I’m doing this to myself.'” Other doctors seemed to agree.
The consensus was that Glover was suffering. migraineAlthough she had never experienced the nausea, aura, sensitivity to sound and light, and throbbing sensations that characterize migraines, she took prescribed migraine medication sporadically because it seemed to have no effect.
In 2009, Glover was referred to a “very compassionate” neurologist who seemed determined to find out what was going on and ordered blood tests for a number of diseases, including arsenic poisoning and lead poisoning. All of the results came back negative.
Confused, he asked Grover Headache Specialist“I hope he can solve the problem,” the neurologist told Glover, a neurologist highly trained in diagnosing and treating headaches and whom he respected.
She was the same.
Key Questions
After hearing Glover’s description of her attacks, her first headache specialist asked her the usual set of questions. Then he added two new ones: Did her eyes water after the pain started, and had she had a head injury? Glover answered “yes” to both. Her right eye always watered during attacks and sometimes appeared bloodshot. And she had a traumatic brain injury after being hit by a car when she was 7.
The doctor reached into a file cabinet and pulled out a fact sheet and handed it to Glover. He told her that this was what he suspected, and that it wasn’t a migraine.
Glover was showing obvious signs. Sanct: Short-lasting unilateral neuralgiform headache attacks accompanied by conjunctival injection and tearing. A rare unilateral headache characterized by sudden, stabbing pain that is often described as excruciating. SUNCT headaches last from 5 seconds to 4 minutes per attack and usually occur during the day. Five to six consecutive attacks per hour are common, with as many as 600 attacks per day reported.
Unlike migraines and many other types of headaches, SUNCT is characterized by an unusual symptom of involuntary tearing and bloodshot eyes, known as conjunctival injection. (Some patients, like Glover, also experience a runny nose.) Triggers include touching the face or head, moving the neck, and coughing. Head trauma has been associated with SUNCT, but the cause is often unknown.
The causes of SUNCT headaches are Trigeminal nerve, Seizures are neurotransmitters that send sensory signals from the face to the brain. Treatment focuses on preventing seizures. Medications to treat epilepsy and nerve pain may also be prescribed. In severe cases, injections of the local anesthetic lidocaine may be effective.
“It can be very difficult to treat,” the neurologist says. Hope O’BrienCincinnati headache specialist National Headache Foundationa resource and advocacy group. She added that it’s important to rule out cysts or tumors as a cause of unusual headaches.
After hearing the doctor’s diagnosis, Glover said, “This is me. I’m not going to die.”
Patty Glover
Although headaches are one of the most common conditions, SUNCT headaches are so rare that many neurologists have never seen them, and headaches are only a small part of neurology training, O’Brien noted.
O’Brien estimates he has treated two or three patients with SUNCT over the past 15 years. By contrast, migraines are estimated to affect 40 million Americans. Some people suffer from more than one type of headache ( over 100), further complicating the diagnosis.
O’Brien recommends keeping a detailed record of your headache symptoms, including the frequency, duration and location of the pain, to help your doctor narrow down the possibilities.
“It will pass.”
Glover remembers feeling joy and relief at her SUNCT diagnosis: “I said, ‘This is me. I’m not going to die.’
But living with the disease is difficult and effective treatments are hard to find, and Glover says that several years of taking a cocktail of powerful anti-epileptic drugs turned her into a “zombie.”
Ten years ago, Glover said she underwent treatment. Complex PTSD, It’s a type of disorder that stems from trauma over a long period of time, not a single event. With treatment, she says, she’s become better able to cope with headaches and other life stresses.
Through trial and error, Glover and her doctors NaratriptanAspirin, a migraine medication, is somewhat effective in preventing the migraine attacks that, until recently, occurred almost weekly.
In April, Glover had surgery to remove her malfunctioning gallbladder, and has been pleased to report only two bouts of cholecystitis since then. She jokes that she wished she had had her gallbladder removed years ago, and plans to ask her neurologist about the connection between SUNCT and gallbladder disease.
Glover said she is extremely grateful to the headache specialist who finally identified the cause of the ice pick attacks that had plagued her physically and mentally for years.
“I’m not having nervous breakdowns anymore,” she says. “I know what it is, and I know it will pass.”
Medical mysteries solved sandraboodeman@washpost.comNo cold cases please, you can read previous mysteries here. wapo.st/Medical Mysteries.
