Medical Mysteries

Woman's crushing headache took years to diagnose

By Sandra G. Boodman
Special to The Washington Post
Monday, October 25, 2010; 3:52 PM

Right away, Lori White knew that something was very wrong.

The 44-year-old legal assistant at a Northern Virginia law firm had been working out with a personal trainer at her gym, executing a demanding and unfamiliar move. As she pulled down on a bar equipped with weights while simultaneously lunging forward, she felt an explosive pop in her head, immediately followed by a headache more crushing than any she had previously experienced.

For the next 10 minutes, White recalled, she sat on the floor, clutching her head and fearing she would throw up or pass out.

To her relief, the pain receded within a few hours. "I figured I'd just strained something," she recalled. But within weeks of the 2005 episode, an alarming new problem surfaced: stabbing pains lasting five to 30 seconds in the front of her head, similar to the "brain freeze" that people sometimes experience while eating ice cream.

It took White three years to discover what had happened that day in the gym and two more to sort out what should be done about it - a confusing and sometimes contradictory process that involved specialists in the Washington area as well as Baltimore and Charlottesville. Two weeks ago at Georgetown University Hospital, White underwent treatment that doctors hope will cure her problem.

"It's been such a frustrating and painful battle," she said, recalling the neurologists who speculated that her strange pains might be the result of caffeine, a cough or simply changing positions.

"For a long time," she said, "I don't think anyone really took me seriously."

The piercing head pains seemed to be triggered by movement: coughing, sneezing, bending over, laughing or even singing. Sometimes a change in the weather or altitude would unleash them. Although intense, they were, at first, mercifully brief, and would vanish for weeks at a time.

After several months, White consulted a neurologist who practiced in Fairfax County. The doctor performed a basic exam and took a history, but offered little in the way of advice or a diagnosis, White recalled.

A second neurologist, in Chevy Chase, seemed similarly baffled. His advice: Avoid caffeine, which can make headaches worse, to see whether the problem cleared up.

It didn't, so in 2008 White went to see a third neurologist. He ordered an MRI scan and told White she might have a "cough" headache, an unusual type triggered either by straining or, in some cases, by disorders involving the skull.

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