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Severe headaches in 23 year old male



23 yr old white male had a football caused subdural hematoma senior yr in HS. Seems okay now, but told to avoid all contact sports. Just had five days of very severe headaches lasting several hours at sharp pain and then less severe for hours) while exercising, tried to see neurologist, but closest appointment was 1 month. Went to ER, they saw a 2.5 aneurysm and sent him to neurosurgeon who said there was no aneurysm and headaches were from exercise. Young man is not one to pay attention to illnes and the fact that he went to the ER with these headaches tells me they were bad. Should we just let this go? He says he can feel them start as he does pullups and if he breaths correctly they usually stop, if not then he stops the exercise.


I cannot provide a diagnosis based on the information you have provided, and would recommend that you follow up with a neurologist as planned.  That neurologist will take a detailed history and do a full physical exam, as well as review all previous imaging studies (which you should bring with you) and thus be in good position to counsel you definitively.

I can only provide general advice.  Migraines are commonly induced by exercise, and this may be nothing more than routine migraines.  Keeping a headache log would be helpful--he should write down all possible information about each headache (when did it start, what was he doing when it came on, what had he been doing and what had he eaten before it came on, what did it feel like, how long it lasted, were there any symptoms that preceded the head pain, what treatments were tried and did they work, etc.).  Migraine is a diagnosis made by history, after ruling out other causes for headache.

As to other causes, aneurysm is a diagnosis made by imaging the blood vessels around the brain.  It is important that all films be brought to the neurologist for review--small aneurysms (<3 mm) are hard to diagnose by MRI or CT based techniques of imaging blood vessels.  Thus, it is possible that radiologists were concerned about something that appeared abnormal, but the neurosurgeon disagreed that this was anything to worry about. 

I hope you find these comments helpful.  Good luck!

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Response by:

Brett   Kissela, MD Brett Kissela, MD
Assistant Professor of Neurology
Director, Neurology Residency Program
College of Medicine
University of Cincinnati