Medical Mysteries

Medical Mysteries: A Headache That Didn't Go Away

By Sandra G. Boodman
Special to The Washington Post
Tuesday, February 3, 2009

Valerie Novak fervently wished doctors would stop telling her the intense headache she'd endured for several weeks was a migraine. For one thing, neither the Georgetown University senior nor her close relatives had headaches, and migraines are frequently familial. None of the increasingly potent drugs doctors prescribed was doing much good. And the 22-year-old had lost 15 pounds in three weeks from bouts of severe vomiting.

"I was so frustrated and upset," recalled Novak of her ordeal last summer, which involved consultations with half a dozen doctors, several trips to area emergency rooms and two hospitalizations. Novak, who had always been healthy, said she feared the unrelenting pain in her left temple and associated symptoms were something "I'd have to live with for the rest of my life."

Her mother, Kathy Novak, a nurse practitioner in Bowie, was similarly skeptical of the diagnosis but grateful that doctors had ruled out more ominous possibilities, such as a brain tumor. When her middle daughter began complaining about double vision, Kathy took her to an ophthalmologist. His judgment led to an accurate diagnosis that had nothing to do with migraines but was instead a rare complication of a common item listed on Novak's medical records. Left untreated, it might have killed her.

An Arabic studies major who had been scheduled to graduate in December 2008, Novak said her headache began last summer while she was in Colorado visiting her boyfriend. When over-the-counter pain relievers failed to work, she consulted a Denver physician, who told her she probably had a migraine that would go away on its own.

Undaunted, she left for a two-week trip to visit an uncle in Egypt.

"I thought she might have a sinus infection, and I knew my brother would help her" if she got worse, her mother recalled. She said she did not know until weeks later how sick her daughter really felt. "She's strong, and she put up a good front," her mother said.

While in Cairo, Novak said, her headaches got worse, and she sometimes felt nauseated and had spells of vomiting, which worsened after a snorkeling trip. A doctor she saw in Cairo performed an MRI and concurred with the migraine diagnosis.

Back home in Howard County a few days before the start of the fall semester, Novak began feeling worse. Her primary care doctor prescribed Imitrex, a powerful anti-migraine drug, which, she said, did nothing to alleviate her pain and made her feel worse. She was prescribed Percocet and, when it failed, Dilaudid, an extremely powerful narcotic, which helped -- until it wore off.

Kathy Novak said neither she nor her nursing colleagues had heard of such an intractable migraine in someone who'd never had headaches. "I think I know migraines, and this isn't helping," she told Valerie's primary care physician. One night she took her daughter to a Maryland emergency room. After a CT scan found nothing, Valerie Novak was prescribed Decadron, an anti-inflammatory and anti-nausea drug given to chemotherapy patients. Nothing seemed to work for long.

Back at Georgetown, Novak tried to settle in to her dorm. She soon developed a new and alarming symptom: tingling in her left hand. On her first day of classes, she recalled, she was unable to concentrate because of the numbness that seemed to be moving up her arm and enveloping her tongue and one side of her face.

She called the student health center and was sent to a nearby emergency room. After a full work-up, she was told -- again -- that she had a migraine. Shortly afterward she was in the office of a neurologist with vomiting so severe that she was unable to keep Jell-O down. The neurologist admitted her to a Montgomery County hospital where she spent four days. "All I did was sleep and throw up," she recalled.

At the hospital, an infectious-disease specialist ruled out meningitis without doing a spinal tap, in part because Novak had never had a fever. Lyme disease and West Nile virus were also discarded as possibilities. A brain MRI, the Novaks were told, showed nothing. Novak's symptoms, including the facial and arm numbness, and intolerance of bright light and noise, were "strongly suggestive of migraine headache," a doctor wrote on her chart. She was given a pain patch and released.

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