mystery headaches and heart palpitations

[mls417]

I'm a 36 year old female.

Sometime in November I developed a cold sore in the corner of my mouth and a painful swollen gland under my chin (this might be relevant later). Around this time I was also experiencing heart palpitations, but kept putting off a doctor's appointment. On Thanksgiving day, I ended up going to the hospital because my heart was beating hard and fast and I just did not feel right. They kept me overnight and did various blood tests, EKGs, and an Echocardiogram. They couldn't find anything wrong (said it was possibly dehydration). The heart palpitations died down a little.

About two weeks later (early December-ish), I started to feel like I was getting an ear infection in my right ear and what felt sinus pressure. I saw my primary doctor who couldn't find anything wrong. I had also seen a cardiologist during this time and since they couldn't find anything wrong in the hospital, he concluded that I was having PVCs and that they were benign.

A few days after all that I developed a headache. By Christmas time I was absolutely miserable (bad headache, ear ache, extremely tired).  I was convinced I was having a serious brain issue and went to another doctor (I cried in the office because the headaches were worrying me so much). She decided it might be TMJ symptoms from clenching my teeth--even though I wasn't having the classic popping or locking jaw. She gave me naproxen, flexeril, and a small dose of xanax. Those seemed to help a little but the headaches never fully went away. Over the next few weeks I always had a mild headache and some slight dizzyness. The PVCs were bothering me again. I just didn't feel like my normal self.

Finally my doctor referred me to a neurologist about 3 weeks ago. She said from the pains I was describing (shooting pain around my right eye and into my head, as well as pressure on the sides of my head), that it sounded like trigeminal neuralgia (which is caused by a virus, such as a cold sore). I had an MRI and an MRA, which came back clear, thank god, but that also discredits the trigeminal neuralgia (apparently something would have shown up on the MRA from that).  I went for a follow up and told her that I am still feeling really tired. Some days I feel like a ton of bricks when it's time to get out of bed. The headaches are getting better but haven't fully gone away yet, and I'm still getting heart palpitations every day. She decided to set me up with a holter monitor, which I'll get later this week.  Yesterday I also noticed a tender gland on the right side of my neck near my jaw.

I am at my wit's end. I used to be perfectly healthy before all this started and now I just feel so weak and tired, with mild headaches (some days) and PVCs (almost every day). Not like myself at all. Any ideas?

[mls417]

Thank you, this is all good information.

The PVCs are the most scary symptom right now. I know I've read a lot of info on them already, and it always says they're pretty harmless, but they don't *feel* harmless. I"m hoping the Holter monitor test will put my mind at ease.

My doctor was going to do blood tests for inflammation, but then I don't think she ever did (I can't remember. I've had more blood tests over the past 2 months than I have through my whole life!) I will bring it up again at my next follow-up.

[achillea]

First, let's talk about your palpitations. PVCs can show up when people are feverish or ill, but they can also appear for no known reason at all.  Annoying and disturbing as they are, if the EKG shows them to be benign, and there are fewer than 10,000 per day, then they usually have almost no medical significance.

About the head pain: Actually, the MRI doesn't rule out trigeminal neuralgia, because its cause is not agreed on:  Some researchers  believe that it's the result of some type of biochemical malfunction within the trigeminal nerve itself, rather than a structural compression.  A physical compression might be detected by MRI, but a biochemical error would not be.

'Sidedness' in headaches is important to diagnosis, so If your headache/pain persists and is ONLY one-sided and almost always consists of brief shots of severe pain, then it sounds as though trigeminal neuralgia remains a good bet. One-sidedness is important in the diagnosis of migraine, too.

You mention pain from a tender gland on the right side of your neck, which makes me think it would be a good idea to google 'carotidynia,' which means 'carotid pain,' which can have various causes.

If your headaches are felt on both sides of your head, or if your skull is tender around your temples, then something like temporal arteritis or polymyalgia rheumatica might be involved.  People feel terribly fatigued and kind of generally ill with this condition.  There is also usually pain and stiffness in the shoulders or hips.

But if your blood tests included something called a 'sedimentation rate' or C-reactive protein (which check for inflammation) and those tests were normal, that pretty much excludes temporal arteritis.

You say that the headaches are diminishing somewhat, which is good, but  your continued exhaustion and sense of being unwell is troubling. This is not generally part of the trigeminal neuralgia problem.

It sounds to me as though you are dealing with some kind of infection or autoimmune condition.  If I were you, I'd ask my doc about these possibilities and ask him/her at least what your Sed Rate was.  

More blood work (red cells, white cells, and markers for inflammation) should help figure out what's going on, at least with the fatigue.