Headache Worries

Laura has been having bad headaches the last few weeks. This always worries me. Nearly six years ago, a bad bout of headaches caused her to be diagnosed with pseudotumor cerebri, also known as Benign Intracranial Hypertension. Here's a succinct description from the National Institute of Neurological Disorders and Stroke (NINDS):

Pseudotumor cerebri literally means "false brain tumor." It is likely due to high pressure caused by the buildup or poor absorption of cerebrospinal fluid in the subarachnoid space surrounding the brain. The disorder is most common in women between the ages of 20 and 50. Symptoms of pseudotumor cerebri, which include headache, nausea, vomiting, and pulsating intracranial noises, closely mimic symptoms of brain tumors.

Read a little further down the page about the prognosis: "may cause progressive, permanent visual loss in some patients. In some cases, pseudotumor cerebri recurs." [emphasis mine]

The first time she had pseudotumor was quite eventful, with two emergency room visits and one 3-day hospital stay, an MRI, two spinal taps, and several months on a drug (Diamox) that made her hands, feet, and lips tingle and made carbonated beverages taste "metallic." It was late summer in 1999. My memory of the whole thing is pretty hazy. The word "tumor" is pretty scary, even with that odd "pseudo" positioned in front of it. There were other words tossed about, like papilloedema, which I think refers to the swelling of the optic nerve. Apparently she had a pretty good case of it the first day she went to the Rush-Presbreytarian St. Luke's Eye Center. I recall Laura being somewhat exacerbated by a parade of ophthalmology interns coming into her examining room to look at her eyes.

The spinal taps (technically lumbar punctures) were very painful. The purpose is to drain out the excess fluid, but in Laura's case, both taps caused "low pressure headaches" -- the opposite of the original problem. The first time was the worst, because they did the tap in the emergency room right away. That brought us back to the emergency room the next day -- the headache was so bad it caused nausea and she couldn't keep down even water, so she became dehydrated.

Mostly I remember sitting around the emergency room on an uncomfortable molded plastic chair. Then, later, sitting in her hospital room in a somewhat more comfortable chair. Then, frequent visits back to see the neural-ophthalmologist for checkups. They checked for vision loss and papilloedema. Eventually the condition pretty much went away. She cut back on the drugs. Her visits to the Eye Center became less and less frequent, until they dropped to just once a year.

But she's having these headaches again, so she's starting to worry. Pseudotumor can come back. The Eye Center didn't have any regular appointments until July, but they agreed to squeeze her in the week after next so that they can check for papilloedema and ease our minds. Of course, if it isn't a recurrence of pseudotumor, then what in the heck has caused three weeks worth of headaches?