A man’s persistent headache proves hard to diagnose and harder to treat

Michael S. Williamson/WASHINGTON POST - Michael Herndon has had a headache since November 15, 2008. Doctors have ruled out many things, but the cause of his problem is still a mystery. Herndon rubs the area where the pain is the most acute — above and around his eyes and down toward his nose.

Driving south on the Baltimore-Washington Parkway bound for his Adams Morgan home in June 2009, Michael Herndon struggled to cope with the implications of what the doctor had just told him.

For months Herndon had tried to find out why the headache he developed on Nov. 15, 2008 — he remembered the exact date — had not gone away. The 41-year-old had consulted neurologists and ear, nose and throat specialists as well as an allergist and ophthalmologist, but none of them had figured out what was causing his pain.

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“I was starting to hit a mental and physical wall,” recalled Herndon, a consumer outreach specialist at the Commodity Futures Trading Commission. “I’d been chasing this for more than six months. No one could tell me what it was. I just remember thinking, ‘How am I going to be able to function if it never goes away?’ ”

He had taken multiple courses of antibiotics and corticosteroids as well as over-the-counter pain relievers, and he had even undergone sinus surgery, all to no avail. Doctors had ruled out a brain tumor and other ailments but had no idea why his head, and increasingly his nose, still hurt.

A month later, Herndon learned the name of his disorder. It would be another year before he found effective help to cope with his chronic, and still largely inexplicable, head pain.

Now a neurologist at a major medical center in Baltimore told him his sinuses looked clear and suggested that the headache might never disappear. But he did not give Herndon a name for his condition or a remedy, suggesting only that he find a headache specialist in the Washington area.

Aftermath of a stress test

In October 2008, after experiencing chest pain, Herndon saw a cardiologist who ordered a variety of tests. During a stress test, which measures the heart’s ability to respond to exercise, “my head felt like I’d had one and a half drinks,” Herndon recalled. Testing revealed nothing amiss with his heart, and the lightheadedness gradually disappeared over the next few days, replaced almost immediately by something else: a dull ache in his upper forehead and between his eyes.

At first Herndon, who rarely got headaches, didn’t think much about it. But after several days, when the pain failed to recede or respond to nonprescription painkillers, he saw his primary-care doctor, who referred him to a neurologist, who ordered various scans.

Herndon’s brain looked normal, but a CT scan revealed a significant sinus infection — his first. Doctors prescribed antibiotics in an effort to knock it out, which would presumably eradicate the headache.

That course of antibiotics was the first of many rounds that failed to vanquish his headache; corticosteroids did nothing, either. After a few months his ENT recommended endoscopic sinus surgery to clean out and open his still-blocked sinuses, a procedure endorsed by a second specialist.

After the operation, which was performed in March 2009, Herndon was optimistic that his headache would finally disappear. But a few weeks later, he said, he had the sinking realization that “nothing felt any different.”

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