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Stiff neck headache nausea: Fatigue, Headache, Nausea Or Vomiting And Stiff Neck


A Stiff Neck & A Weak Stomach: How Neck Pain Can Cause Nausea?

Pain in the neck can be anywhere from inconvenient to completely debilitating, and include a wide range of symptoms.

The structures of the neck are extremely important to the wellness and functioning of every person. Pain or injury in this area can also lead to other symptoms throughout the body, including tingling, dizziness, weakness, and nausea.

This sensitive area is susceptible to many different forms of injury and damage. Injury can occur in spine, spinal cord, muscles, tendons, cartilage, and nerves.

Read on to learn about the anatomy of the neck, what could be causing pain, how it is diagnosed and treated the connection with nausea, and alternative forms of therapy that can help alleviate symptoms.

Structures of the Neck and Spine

There are three sections of the spine: cervical (neck), thoracic (torso), and lumbar(lower back). The cervical spine is the section that exists in the neck. This section of the spine is responsible for supporting the head, lower spine, and shoulder area. The spine also protects spinal cord, which contains many of the nerve endings that send signals from the brain to the rest of the body. These nerve endings are a very important part of the entire body’s ability to perform most activities.

Despite the protection that the spine offers, nerve endings can still be susceptible to damage or injury. When nerves are damaged, signals can no longer be sent in the same way, causing a myriad of symptoms. Nerve damage can have many causes as well, due to the fact that there are many moving structures that could contribute to different forms of damage. These structures include muscle, tendons, cartilage, vertebrae, nerves, and spinal discs. Each has a list of things that can go wrong, depending on an individual’s activity level, history of injury, or degenerative illness.

What May Cause Neck Pain?

The many small parts of the neck leave it susceptible to several different injuries. The causes listed below are the most common, but it is important to get examined to ensure that the cause of neck pain is diagnosed correctly. Common causes of neck pain are:

  • Injury: traumatic injuries, especially those that involved a form of whiplash, can contribute to neck pain after the injury and later in life. Some injuries may heal, but they can sometimes heal in an incorrect way that leads to neck pain later in life.
  • Arthritis: arthritis is characterized by the gradual degeneration of  the structures in the body. Osteoarthritis in the cervical spine typically affects the articular cartilage between the bones of the vertebrae, causing them to rub against one another and cause damage. This damage can not only cause pain, but it can also change the structure of the joint to the point where it is pinching or causing damage to nearby nerves.
  • Poor Posture: a lifetime of holding the neck in a poor position can lead to neck problems and pain later in life.

The aspect of neck pain that can lead to nausea involves the condition called cervical vertigo. Cervical vertigo is caused by a nerve or blood vessel being pinched in the neck. This can lead to nerve signals not being sent where they need to go, and disrupted oxygen flow in the case of a pinched blood vessel. This condition can also impact the inner ear, causing the sensation of dizziness or nausea. Cervical vertigo and neck problems, in general, have a long list of potential symptoms.

Signs and Symptoms of Neck Pain

The predominant symptom of an underlying issue in the neck is pain. This can be a pain that begins as dull and increases in intensity over time, or can be a pain that comes on suddenly or only during certain activities. The degree of pain that an individual feels can vary greatly. It is recommended to see a doctor after injury, or when the pain impacts daily living activities. This could look like disrupted sleep, inability to perform simple tasks, or difficulty exercising. Symptoms that may be associated with neck pain are:

  • Dizziness
  • Nausea
  • Weakness
  • Tenderness
  • Tingling sensation in the neck, shoulders, or back

Nausea that is associated with neck pain is often a related to other symptoms such as dizziness or loss of balance. It is important to describe the symptoms with as much detail as possible when consulting with a doctor.

Diagnosing Neck Pain

The first step in diagnosing neck pain involves a consultation with a doctor. One of the best ways to ensure an accurate diagnosis is to be honest about all the symptoms experienced and when. Some symptoms that may seem unrelated could be important information for doctors and lead to a correct diagnosis. Doctors may perform tests during your consultation in order to help pinpoint the source of the pain. These tests may involve turning the head, moving the eyes, and searching for sensitivities by touching the neck. Initial testing may indicate certain conditions, but doctors often use the help of certain technology in order to diagnose a condition:

  • MRI: Magnetic Resonance Imaging allows doctors to see a picture of the soft tissues in the neck, which could reveal a pinched or damaged nerve and blood vessel.
  • CT Scan: this form of imaging lets doctors see if there is an issue within a specific cross-section of the neck.
  • X-Ray: this type of imaging of the bone structures that may reveal skeletal abnormalities causing pain and discomfort.
  • EMG: electromyography tests the speed at which nerve signals are conducted throughout the body. This may reveal nerve damage, as a damaged nerve sends signals more slowly than a healthy one.

Once a diagnosis has been made, doctors can begin to devise a treatment plan that is unique for each patient.

Conventional Treatments of Neck Pain and Associated Symptoms

Treating neck pain often begins with simply taking over-the-counter painkillers (NSAIDs) and temporarily eliminating painful activities. Applying heat or cold to the area can help with pain management as well. It may also be recommended that a patient take anti-nausea or anti-dizziness medication. Like NSAIDs, these over the counter nausea treatments can be found in most drug and big box stores.

If the initial steps of treatment fail to reduce pain, there are other treatment options that doctors may recommend to alleviate symptoms. These include:

  • Avoid Strenuous Activity: if there is a motion or activity that aggravates neck pain, it is generally suggested to stop the activity or consult a physical therapist about how to do it in a less painful way.
  • Sleep Positions: certain sleep positions can result in reduced pain. A doctor or physical therapist can recommend ways to adjust sleeping positions to ensure greater comfort.
  • Practice Good Posture: good posture can contribute to pain management and reduce the chance of back complications in the future.
  • Physical Therapy: the practice of physical therapy generally seeks to ease symptoms of an injury while simultaneously strengthening the muscles surrounding it.
  • Massage Therapy: manual manipulation of the musculoskeletal tissues by a massage therapist can alleviate pain and inflammation in the affected area.
  • Corticosteroid Injections: by injecting a powerful anti-inflammatory solution into the site of pain, doctors can relieve pain symptoms. These injections should be monitored closely, as they can lead to damaged tissue if overused.
  • Prescription Medication: some doctors may prescribe medication to ease the symptoms of pain, nausea, or dizziness depending on the severity of symptoms.
  • Surgery: if neck pain persists throughout the treatment process, surgery may become necessary. Many different types of surgery exist to help neck pain, so it is best to consult a doctor about the options.

Many treatment options exist and can be used in combination based on a patient’s individual needs. There is one more important treatment option that should be considered, Regenerative Medicine.

Regenerative Medicine for Neck Pain and Associated Symptoms

The up-and-coming practice of Regenerative Medicine is using a patient’s own cells to amplify their body’s healing abilities. These forms of therapy work with cells that already exist in the body to help an injury or damage heal. There are two forms of Regenerative Medicine offered at CELLAXYS:

  • Mesenchymal Stem Cell (MSC) Therapy: this form of therapy begins with a sample of a patient’s mesenchymal stem cells. These most often come from fat tissue, or bone marrow. Once the stem cells are extracted, they are processed to become more concentrated. They are then reinjected into the site of pain. These cells contain properties that make them ideal for helping to heal an injury or degeneration. A scientific journal about MSC therapy can be found here.
  • Platelet-Rich Plasma (PRP) Therapy: this form of therapy begins with a simple blood draw, which is then processed using centrifugal force. The purpose of the centrifuge is to separate platelets from other properties found in the blood. Platelets contain proteins and healing factors that occur in the body’s natural healing process. They are injected into the injury site with the premise that an increased number of healing properties could speed up the body’s natural processes. A scientific journal of PRP can be found here.

These therapies typically involve imaging techniques such as ultrasound or live X-Ray (fluoroscopy) in order to guide the needle to where it needs to go. These are outpatient procedures and typically don’t take longer than one or two hours. Some patients report feeling some pain at the injection site that usually goes away in a matter of days.

Regenerative Medicine may be a good treatment option for sufferers of neck pain. They can help with pain and the symptoms that come with it. These treatments could help heal nerves that have been damaged, as well as muscle or other tissue injuries.

When making the decision on how to manage pain, it is important to be aware of all the options on the market. Regenerative Medicine could be a solution to chronic neck pain.


Neck pain alone can be difficult to manage. Some individuals experiencing neck pain can experience symptoms that accompany pain, including nausea or dizziness. These symptoms can impact daily life negatively and should, therefore, be addressed.

Meeting with doctors will set patients on a path to a unique treatment plan. There are many options on the market for treating neck pain, many of which address the accompanying symptoms as well.

Investigating all of the treatment options available from Cellaxys, including the new practice of Regenerative Medicine, can lead to relief from symptoms during recovery. Without the symptoms of neck pain, quality of life can begin to improve and patients often see a return to daily living activities more quickly.

Stiff Neck and Nausea | Causes

A stiff neck is an occasional annoyance for some, but for others, it’s a daily problem. Matters are even more difficult when the neck stiffness is accompanied by nausea.

In some cases, a stiff neck with nausea can be a symptom of meningitis. This is an inflammation of the meninges, which is a covering that runs along the spinal cord and the brain. This kind of infection also causes fever, vomiting, light sensitivity and confusion. If you have a stiff neck and nausea, it’s best to be safe and have an examination for meningitis so you can get treatment immediately if necessary.

If you don’t have meningitis, it’s likely your stiff neck and nausea are related to one of the following three conditions.

Three common causes of a stiff neck and nausea

  1. Sprains and strains — Your neck has a large amount of tissue and many muscles in it that help support and move the head and cervical spine (the part of your spine in the neck). When one of these are stretched or torn, you can experience a stiff neck. This tension can increase pressure on the spinal column, which could even lead to nausea.
  2. Whiplash — Whiplash is sort of a package deal of neck injuries. It occurs when your head is violently jerked frontward and backward like a whip cracking. This usually occurs in motor vehicle accidents. With whiplash, you may have strains, sprains and spine injuries that all contribute to stiffness and nausea.
  3. Arthritis — Arthritis is the breaking down of cartilage in your joints that causes pain when using the joints. This can occur in the vertebrae of your spine, which causes pressure to increase on the nerves running through the spinal cord. This can lead to pain and stiffness in the neck accompanied by nausea. 


Visit Advent Physical Therapy for stiff neck treatment

Is your constant stiff neck making it difficult to get through each day? It’s time to talk to a physical therapist to discover how therapeutic exercises and other natural treatments can help. Contact our team today for more information about the causes of a stiff neck and nausea or to schedule an initial appointment.

Diagnostic Dilemma of a Young Man With Fever and Headaches

Neurohospitalist. 2012 Oct; 2(4): 156–162.

Arielle P. Davis

1University of Washington, Harborview Medical Center, Seattle, WA, USA

Christina M.


1University of Washington, Harborview Medical Center, Seattle, WA, USA

Sandeep P. Khot

1University of Washington, Harborview Medical Center, Seattle, WA, USA

1University of Washington, Harborview Medical Center, Seattle, WA, USA

Keywords: blastomyces, coccidioides, histoplasma, meningitis, meningitis, fungal, Mycobacterium tuberculosis.

A 23-year-old man was admitted to the hospital in the fall because of fever and headache. He had been well until 5 days earlier when he developed headaches associated with photophobia, neck pain, nausea, and vomiting. He had no significant medical history and took no medications. He lived with his parents in Seattle, Washington, and took classes at a local college. He had immigrated from China in 2007.

The patient was alert and interactive. The temperature was 40.0°C, blood pressure was 161/92 mm Hg, pulse was 91 beats/min, and oxygen saturation was 100% on room air. His general examination revealed anicteric sclerae and no skin rash. Pain was noted with passive neck flexion. On neurologic examination, the patient was oriented with fluent speech and no dysarthria. Visual fields and extraocular movements were full. The remaining cranial nerve functions were intact. Muscle bulk and strength were normal. Sensation was preserved with no extinction detected. The tendon reflexes were equal at 2+, and plantar responses were flexor. There was no dysmetria on finger-to-nose testing. The gait was normal.

Laboratory studies including a basic metabolic panel, liver function tests, coagulation studies, and urinalysis were notable only for a low sodium of 135 mEq/L (ref 136-145 mEq/L) and an elevated white blood cell count of 13 000/μL (ref 4.30-10.00 thousand/μL). Blood cultures were obtained. Chest radiograph revealed clear lungs and pleural spaces. Computed tomography (CT) of the head showed no abnormalities. The results of cerebrospinal fluid (CSF) analysis are shown in .

Table 1.

Cerebrospinal Fluid Analysis

Variable Reference Range, Adults Initial Admission Readmission, 5 Days Later
Opening Pressure 60-250 mm H2O 345 mm H2O Not recorded
Color Colorless Colorless Slightly orange
Red cells (per μL) None 18 485
White cells (per μL) 0-5 1,050 1,748
Differential count 17% Neutrophils, 52% lymphocytes, 23% monocytes, 4% eosinophils, 4% basophils 40% Neutrophils, 41% lymphocytes, 7% reactive lymphocytes, 10% monocytes, 2% eosinophils
Protein (mg/dL) 15-45 163 210
Glucose (mg/dL) 40-80 38; 41% of serum glucose of 93 7; 5% of serum glucose of 135
Gram stain Negative 2+ Polymorphonuclear lymphocytes, 2+ monocytes, no organisms 2+ Polymorphonuclear lymphocytes, no organisms
Herpes simplex virus (HSV) 1 and 2 polymerase chain reaction (PCR) Negative Negative Negative
Varicella zoster virus (VZV) PCR Negative Negative Negative
Enterovirus PCR Negative Negative
Parechovirus PCR Negative Negative
West Nile PCR Negative Negative
Broad range mycobacterium primer Negative No acid fast bacilli (AFB) DNA, no Mycobacterium avium complex DNA, no Mycobacterium tuberculosis complex DNA
Venereal disease research laboratory (VDRL) Nonreactive Nonreactive
Flow cytometry Negative No abnormal B or T cell population
Cryptococcal antigen Negative Negative

Dexamethasone, vancomycin, ceftriaxone, and acyclovir were started for possible bacterial or viral meningitis but discontinued once the blood cultures, CSF Gram stain and bacterial cultures, and viral polymerase chain reaction (PCR) tests were negative. Contrast-enhanced magnetic resonance imaging (MRI) of the brain was normal. The patient was discharged home after 3 days with a diagnosis of viral meningitis.

Five days after initial discharge, the patient returned to the hospital with lethargy and confusion. His mother reported that he was less responsive, intermittently mumbling in response to questions, and requiring assistance with basic daily functions.

The patient was drowsy and disoriented. The temperature was 38.2°C, blood pressure 119/90 mm Hg, and pulse 116 beats/minute. On examination, he exhibited neck stiffness, incoherent speech, and impaired comprehension.

Serum sodium was 121 mEq/L and white blood cell count was 15 500/μL. Head CT showed mild dilatation of the third and lateral ventricles compared to the study 5 days before. Contrast-enhanced brain MRI demonstrated abnormal enhancement of the prepontine and interpeduncular cisterns (see ). Human immunodeficiency virus (HIV) test was negative. Repeat CSF analysis is shown in .

Magnetic resonance scans of the brain. A, T1 fat-saturation postcontrast axial magnetic resonance image on initial presentation shows normal contrast enhancement. B, T1 postcontrast axial image 5 days later shows mild enhancement of the interpeduncular cistern. C, T1 postcontrast axial image on hospital day 26 shows marked basilar enhancement.

Antibiotics and antiviral medications were restarted. On hospital day 2, the patient had a witnessed convulsive seizure. Repeat head CT showed worsening hydrocephalus. An external ventricular drain was placed, and the patient was given a loading dose of phenytoin. The patient’s mother reported that the patient may have been exposed to an uncle with active pulmonary tuberculosis, leading to the initiation of antituberculous medications, including rifampin, isoniazid, pyrazinamide, and ethambutol.

Three days after readmission, a presumptive mold grew in the CSF bacterial cultures. A rash was also noted on the patient’s right flank, consisting of plaques and papules with a central pearly pink color. A skin punch biopsy and additional laboratory studies were obtained, including antinuclear antibody (negative), rheumatoid factor (<13 IU/mL; negative), aspergillus galactomannan assay (0.114; negative), and Quantiferon-TB Gold (indeterminate). Upon further questioning, the patient’s mother reported the patient had spent 8 months in California 1½ years before. Liposomal amphotericin B was started. Six days after readmission, the results of 2 diagnostic tests were received.

Differential Diagnosis

Discussant: Dr Sandeep Khot

Neurohospitalists are often called upon to evaluate patients with possible meningitis. Clinical, imaging, and laboratory testing may suggest an alternative diagnosis, such as delirium or a toxic-metabolic encephalopathy; but in the febrile patient who is confused and complaining of headache, a diagnostic lumbar puncture is needed early in the clinical course to evaluate for a central nervous system infection. The patient’s laboratory studies were consistent with a diagnosis of meningitis or inflammation of the meninges, evidenced by an elevated number of white blood cells in the CSF, and the foremost concern was for acute bacterial meningitis. Patients with acute bacterial meningitis may not develop the classic triad of fever, neck stiffness, and altered mental status—seen in only 44% of patients in 1 nationwide prospective study1—but often present with impairment in consciousness. In this study, a Glasgow Coma scale of less than 14 was seen in 69% of cases of adults with acute community-acquired bacterial meningitis and 95% of patients had at least 2 of headache, fever, neck stiffness, and altered mental status.

The laboratory evaluation of patients with suspected acute bacterial meningitis should include CSF cell count, Gram stain, and bacterial cultures, as well as blood cultures; blood cultures should always be drawn before the antibiotics are administered. In untreated bacterial meningitis, the CSF WBC count typically is between 1000 and 5000 cells/μL with a neutrophilic predominance on the order of 80% to 95%, although about 10% of the patients may present with a lymphocytic predominance.2 Other typical CSF findings in bacterial meningitis include low glucose concentration of less than 40 mg/dL in 50% to 60% of patients and an elevated protein concentration in virtually all patients (usually 100-500mg/dL). In patients who do not receive prior antimicrobial therapy, the CSF Gram stain is positive in 60% to 90% of patients and the CSF culture is positive in 70% to 85% of patients. Broad-spectrum PCR on CSF may be useful in some instances where Gram stain and culture are negative. A study using bacterial PCR primers demonstrated a sensitivity of 100% and a specificity of 98.2% for the diagnosis of bacterial meningitis.3

The initial CSF findings in this patient were consistent with bacterial meningitis. Antimicrobials and dexamethasone were appropriately discontinued when CSF and blood cultures did not show any growth. The presumptive diagnosis of acute aseptic meningitis was given. Viruses are the major cause of acute aseptic meningitis and most cases are caused by enteroviruses.4 Bacterial causes of aseptic meningitis include Mycobacterium tuberculosis (TB), spirochetes such as Treponema pallidum subspecies pallidum (the bacterium that causes syphilis) or Borrelia burgdorferi (the bacterium that causes Lyme disease). Fungal causes of aseptic meningitis include Cryptococcus neoformans, Cryptococcus gatii, Coccidioides immitis, Histoplasma capsulatum, and Blastomyces dermatitidis. Tuberculous and fungal meningitis are typically associated with a CSF lymphocytic pleocytosis, an elevated CSF protein level and decreased CSF glucose level. In HIV-infected patients with aseptic meningitis, tuberculosis, syphilis, and cryptococcal should be given particular attention. Many noninfectious etiologies should also be considered in the differential of aseptic meningitis. These include inflammatory diseases (systemic lupus erythematosus, sarcoidosis, Behçets disease, Sjögren’s syndrome), drug-induced aseptic meningitis (due to nonsteroidal anti-inflammatory agents and certain antimicrobial agents), and carcinomatous or lymphomatous meningitis.

The patient’s exposure history was initially self-reported to include only his immigration from China; no history of travel within the United States was obtained. When he was readmitted, the patient’s family reported possible exposure to a family member with tuberculosis leading to the initiation of antituberculous medications. The persistent CSF lymphocytic pleocytosis with low glucose and elevated protein helped to narrow the differential to tuberculous or fungal meningitis. Patients with tuberculous meningitis compared to patients with bacterial meningitis typically have a longer duration of illness (≥6 days) and a lymphocytic CSF pleocytosis with a low glucose.5 Fungal meningitis is more likely to present as either subacute or chronic meningitis. The additional travel exposure of a remote trip to California was obtained only after the discovery of mold in the CSF bacterial culture.

Diagnostic Challenges

One of the difficulties in this case was confirming the diagnosis of either tuberculous or fungal meningitis. Diagnostic certainty remains difficult with these infections due to the poor sensitivity of available diagnostic tests. As seen in this case, treatment decisions can be particularly challenging in patients with clinical worsening or complications related to basilar meningitis.

Diagnosis of Tuberculous Meningitis

Delay in treatment of tuberculous meningitis is strongly associated with death.6 When the diagnosis is suspected, treatment should be instituted immediately, even without a confirmed diagnosis. A history of TB exposure or known extrameningeal TB is helpful in suggesting the diagnosis, although confirmation of the diagnosis requires demonstration of M
tuberculosis in culture.

In patients with a history of TB exposure, evaluation often starts with tuberculin skin testing or interferon-γ release assays, such as the Quantiferon-TB gold. Both of these tests are based on the patient’s cellular immune response to M tuberculosis. However, these tests are not able to distinguish between latent and active tuberculosis, and so while they might establish that a patient is at risk for tuberculous infection, they cannot confirm a diagnosis of TB meningitis.7

Cerebrospinal fluid smear is a rapid presumptive diagnostic method for TB meningitis, but it is variably positive, ranging between 12.5% and 87%6,8 and does not distinguish between TB and other acid fast bacilli (AFB). Cerebrospinal fluid culture is also relatively insensitive and can delay the diagnosis, as results are typically not available for weeks and are often negative. In one study, a diagnosis was made by CSF smear or culture in 81% of adults with TB meningitis, with AFB seen on smear in 77 (58%) of 132 and on culture in 94 (71%) of 132 patients.9 Successful smear diagnosis was associated with the duration of microscopy (at least 30 minutes) and culture diagnosis was associated with the larger volumes of CSF (at least 6 mL).

Other diagnostic techniques in TB meningitis also have limited utility. Molecular diagnosis with nucleic acid amplification (NAA), including PCR testing, is performed by the amplification of target nucleic acid regions unique to M tuberculosis. The NAA tests provide rapid results and can better detect mycobacterial DNA after treatment initiation compared to CSF microscopy and culture. However, the sensitivity of NAA is poor and a negative result cannot exclude the diagnosis of TB meningitis. A meta-analysis evaluating commercially available NAA tests on CSF found a sensitivity of only 56% compared to a specificity of 98%.10

Diagnosis of Coccidioidomycosis Meningitis

Both C immitis and C posadasii are soil-dwelling fungi endemic in the desert of the southwestern United States, including the southern and central valley of California. Primary infection, usually due to inhalation, may be asymptomatic or present with a nonspecific pulmonary infection. Extrapulmonary dissemination is rare, typically occurring within the first 6 months of infection, although it can occur years later.11 Sites of disseminated coccidioides most commonly include the skin or subcutaneous soft tissue, bones, and the meninges.12

Isolating coccidioides from the CSF provides a definitive diagnosis, but the culture is positive in only 20% to 38% of cases.13,14 Serologic testing or histopathological identification of coccidioides spherules in tissues can offer additional means of diagnosing coccidioides infection. Coccidioides serologic testing is more reliable than such testing in other mycoses, but the sensitivity is dependent on a number of variables, including the time duration since infection, host immune status, extent of infection, and the method of serologic testing. One study compared 3 commonly used serum serologic tests: immunodiffusion (ID), enzyme immunoassay (EIA), and complement fixation (CF).15 Among the immunocompetent patients within 1-year of symptom onset and with confirmed or probable pulmonary, thoracic cavity, or extrathoracic disseminated coccidioides, EIA was positive in 87%, CF in 75%, and ID in 73%; at least 1 test was positive in 95% of patients. Reactive serological tests can indicate recent or remote infection. The serology of CSF tends to be less sensitive than serum serology. One recent study of 30 patients with coccidioides meningitis identified antibody in CSF by CF in 59% compared to the detection of immunoglobulin G (IgG) antibody by EIA in 71%.14 The CF, which measures the later IgG antibody response, may not be detectable early in infection. Nonetheless, CF is considered a mainstay of CSF diagnosis in coccidioidal meningitis; results can be expressed as quantitative titers and a decrease in titer can be used as a marker of response to antifungal treatment.16

Diagnosis of Histoplasmosis Meningitis

Histoplasma capsulatum is endemic in the soil of southeastern states and the upper Midwestern states bordering the Ohio and Mississippi river valley (Arkansas, Kentucky, Mississippi, North Carolina, Tennessee, Louisiana, Illinois, and Wisconsin).17 The most common site of primary infection is the lung through inhalation with a wide spectrum of disease depending on the intensity of exposure and the host’s immunity. Acute exposure can result in asymptomatic infection or acute pulmonary histoplasmosis with severe pneumonitis and respiratory compromise.18 Disseminated histoplasmosis is rare, occurring mostly in immunocompromised patients. Isolated chronic meningitis occurs in approximately a quarter of these patients.19 Diagnosis can be made from blood culture or, in patients with disseminated histoplasmosis, antigens can be detected in the urine in >90% of patients and in serum in 80% of patients.18 Antibodies to H. capsulatum can be detected using CF or ID in the CSF of patients with CNS disease.17,20

Diagnosis of Blastomyces Meningitis

The geographic distribution of Blastomyces dermatitidis also includes the states that border the Ohio and Mississippi river valleys, especially the northern Wisconsin. Lungs are most commonly involved, typically presenting with a pulmonary infiltrate and dissemination of infection is rare. Neurologic involvement, characterized by CNS mass lesions or meningitis, in individuals with disseminated blastomycosis is rare. However, in 1 small series of 15 patients with acquired immune deficiency syndrome (AIDS), 40% of patients had CNS disease.21 Similar to histoplasmosis, blastomycosis is relatively easy to detect in blood culture in patients with disseminated disease but antibody testing through ID or CF techniques can be unreliable for diagnosis.17 There are few cases of isolated blastomyces meningitis.22 Isolation of B dermatitidis from CSF culture obtained via lumbar puncture is uncommon, though the culture of ventricular fluid may have a higher sensitivity.23

Diagnostic Results

Six days after readmission, fungal CSF cultures grew C immitis. The skin punch biopsy also showed budding yeast, consistent with coccidioides (see ) and AFB stains were negative.

Skin biopsy (images and interpretation courtesy of Dr Funda Vakar-Lopez). A, Grocott’s methenamine silver (GMS) stain, ×200 magnification, demonstrates a budding yeast (arrow). B, hematoxylin and eosin (H&E) stain, ×100 magnification, shows granulomatous inflammation surrounding the tip of a presumed hair follicle with multinucleated giant cells (long arrows) and a coccidioides spherule (short arrow).

Coccidioidomycosis Meningitis

Discussant: Dr Arielle Davis

Coccidioidomycosis meningitis is a rare but dreaded form of disseminated coccidioides infection that is nearly uniformly fatal within 2 years if left untreated.11 The Centers for Disease Control and Prevention reported that the number of annually reported coccidioidomycoses cases in California more than tripled in the time periods between 1995–2000 and 2000–2006 (incidence of 2.5 per 100 000 to 8.0 per 100 000).24 Risk factors for extrapulmonary dissemination include male gender, certain racial or ethnic groups (especially African American, Hispanic, and Asian), pregnancy, and immunosuppression due to HIV, malignancy, or medications.

The differentiation of coccidioidal meningitis from meningitis due to other endemic mycoses or tuberculous meningitis remains challenging, due to similar clinical presentations and CSF profiles. The diagnosis often rests on a detailed travel history. In this case, the travel history to California was initially missed as the patient was not explicitly asked about travel within the United States. Only after clinical worsening was the additional information obtained from the patient’s family.

Complications of Disseminated Meningeal Disease

Encephalitis can ensue from extension of coccidioidal meningitis into brain parenchyma from the perivascular spaces.25 Meningeal infection typically affects the basilar meninges. Severe meningeal inflammation may cause extensive arachnoidal fibrosis that can result in communicating or noncommunicating hydrocephalus.26 Hydrocephalus occurs in approximately 40% of patients with coccidioidal meningitis27 and is associated with a 12-fold increased risk of mortality.28 Early neurosurgical intervention for ventricular decompression is often necessary, as occurred in our patient. Complications of coccidioidal meningitis can result in depressed consciousness, confusion, seizures, and focal neurologic deficits.

Coccidioidomycosis-induced vasculitis may develop in up to 40% of cases and is the most common cause of death among patients with coccidioidal meningitis.25,26 Similar to hydrocephalus, the risk of vasculitis is related to the degree of meningeal inflammation.26 A localized vasculitis from basilar meningitis can cause cerebral infarction by direct invasion of the artery, leading to occlusion or distal embolization. Resulting strokes can occur in apparently stable patients.29 Other rare complications of coccidioidal meningitis include lumbosacral arachnoiditis or myelitis and cerebral venous or dural sinus thrombosis.26,30

Treatment of Coccidioidal Meningitis

Over the past 20 years, azoles have largely replaced intrathecal amphotericin B as the first-line treatment for coccidioidal meningitis. Intravenous (IV) amphotericin has poor CSF penetration and has a limited role as monotherapy in the treatment of coccidioidal meningitis.26 High doses of fluconazole, typically with an initial dose of between 800 and 1000 mg/d orally or IV, are effective and better tolerated than intrathecal amphotericin B.26,31 Lower doses of fluconazole (400 mg/d orally) can also be effective, but some clinicians prefer early high-dose therapy.31 Itraconazole and posaconazole are oral azoles that are as effective as fluconazole.31,32 Azoles are fungistatic and are therefore not curative for coccidioidal meningitis; lifelong treatment is necessary to prevent relapse. In one study, 78% of patients treated with azoles for coccidioidal meningitis had a relapse because they stopped their therapy.33 The azoles are also not always effective in maintaining remission in the long term, even when maintained at high doses.25 A recent study found that the newer agents, voriconazole and posaconazole, were reasonable options for salvage treatment of refractory pulmonary, skin or soft tissue, bone or joint, or meningeal coccidioidomycosis, although few patients treated in the study had coccidioidal meningitis.34 Intrathecal amphotericin B therapy with or without continuation of azole treatment should be considered in patients with severe disease or clinical relapse.31 Although it has the potential advantage of being curative or offering long-term control, intrathecal amphotericin B may cause meningeal irritation, arachnoiditis, and transverse myelitis and is limited by significant side effects (nausea, vomiting, headaches, fever, and abdominal pain).26

Hydrocephalus is a serious complication of coccidioidal meningitis that can develop during treatment and does not necessitate switching to an alternative therapy.31 The optimal management of other complications, such as lumbar arachnoiditis or vasculitis with stroke, remains unclear.26 Some authorities recommend a trial of corticosteroids in patients with acute stroke and severe meningeal inflammation35,36 though this approach remains unproven.

Case Follow-Up

Once a mold was found growing in the CSF culture, TB therapy was discontinued and intravenous liposomal amphotericin B was initiated. Amphotericin was discontinued and oral fluconazole 800 mg orally daily was started after confirmation of coccidioides meningitis. On hospital day 65, the patient began intensive inpatient rehabilitation and subsequently returned home with his parents. After a year from the initial admission, he reported considerable improvement in function and had returned to his college classes although with persistent memory deficits. He remains on chronic suppression with oral fluconazole at a dose of 400 mg orally daily.


We wish to recognize Dr W. T. Longstreth Jr, for his assistance in the preparation of this manuscript and Dr Funda Vakar-Lopez who provided skin biopsy images and assistance with pathology interpretation.


Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.


van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M.
Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med. 2004;351(18):1849–59 [PubMed] [Google Scholar]2.
Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, et al.
Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267–84 [PubMed] [Google Scholar]3.
Saravolatz LD, Manzor O, VanderVelde N, Pawlak J, Belian B.
Broad-range bacterial polymerase chain reaction for early detection of bacterial meningitis. Clin Infect Dis. 2003;36(1):40–5 [PubMed] [Google Scholar]4.
Kupila L, Vuorinen T, Vainionpaa R, Hukkanen V, Marttila RJ, Kotilainen P.
Etiology of aseptic meningitis and encephalitis in an adult population. Neurology. 2006;66(1):75–80 [PubMed] [Google Scholar]5.
Thwaites GE, Chau TT, Stepniewska K, Phu NH, Chuong LV, Sinh DX, et al.
Diagnosis of adult tuberculous meningitis by use of clinical and laboratory features. Lancet. 2002;360(9342):1287–92 [PubMed] [Google Scholar]6.
Verdon R, Chevret S, Laissy JP, Wolff M.
Tuberculous meningitis in adults: review of 48 cases. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 1996;22(6):982–8 [PubMed] [Google Scholar]7.
Thwaites G, Fisher M, Hemingway C, Scott G, Solomon T, Innes J.
British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. The Journal of infection. 2009;59(3):167–87 [PubMed] [Google Scholar]8.
Kennedy DH, Fallon RJ.
Tuberculous meningitis. JAMA: the journal of the American Medical Association. 1979;241(3):264–8 [PubMed] [Google Scholar]9.
Thwaites GE, Chau TT, Farrar JJ.
Improving the bacteriological diagnosis of tuberculous meningitis. Journal of clinical microbiology. 2004;42(1):378–9 [PMC free article] [PubMed] [Google Scholar]10.
Pai M, Flores LL, Pai N, Hubbard A, Riley LW, Colford JM., Jr
Diagnostic accuracy of nucleic acid amplification tests for tuberculous meningitis: a systematic review and meta-analysis. The Lancet infectious diseases. 2003;3(10):633–43 [PubMed] [Google Scholar]11.
Vincent T, Galgiani JN, Huppert M, Salkin D.
The natural history of coccidioidal meningitis: VA-Armed Forces cooperative studies, 1955-1958. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 1993;16(2):247–54 [PubMed] [Google Scholar]12.
Crum NF, Lederman ER, Stafford CM, Parrish JS, Wallace MR.
Coccidioidomycosis: a descriptive survey of a reemerging disease. Clinical characteristics and current controversies. Medicine. 2004;83(3):149–75 [PubMed] [Google Scholar]13.
Drake KW, Adam RD.
Coccidioidal meningitis and brain abscesses: analysis of 71 cases at a referral center. Neurology. 2009;73(21):1780–6 [PubMed] [Google Scholar]14.
Mathisen G, Shelub A, Truong J, Wigen C.
Coccidioidal meningitis: clinical presentation and management in the fluconazole era. Medicine. 2010;89(5):251–84 [PubMed] [Google Scholar]15.
Blair JE, Coakley B, Santelli AC, Hentz JG, Wengenack NL.
Serologic testing for symptomatic coccidioidomycosis in immunocompetent and immunosuppressed hosts. Mycopathologia. 2006;162(5):317–24 [PMC free article] [PubMed] [Google Scholar]16.
Saubolle MA.
Laboratory aspects in the diagnosis of coccidioidomycosis. Annals of the New York Academy of Sciences. 2007;1111(1):301–14 [PubMed] [Google Scholar]17.
Bradsher RW.
Histoplasmosis and blastomycosis. Clin Infect Dis. 1996;22
Suppl 2:S102–11 [PubMed] [Google Scholar]18.
Wheat LJ, Freifeld AG, Kleiman MB, Baddley JW, McKinsey DS, Loyd JE, et al.
Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007;45(7):807–25 [PubMed] [Google Scholar]19.
Wheat LJ, Batteiger BE, Sathapatayavongs B.
Histoplasma capsulatum infections of the central nervous system. A clinical review. Medicine (Baltimore). 1990;69(4):244–60 [PubMed] [Google Scholar]20.
Rauchway AC, Husain S, Selhorst JB.
Neurologic presentations of fungal infections. Neurol Clin. 2010;28(1):293–309 [PubMed] [Google Scholar]21.
Pappas PG, Pottage JC, Powderly WG, Fraser VJ, Stratton CW, McKenzie S, et al.
Blastomycosis in patients with the acquired immunodeficiency syndrome. Annals of internal medicine. 1992;116(10):847–53 [PubMed] [Google Scholar]22.
Friedman JA, Wijdicks EF, Fulgham JR, Wright AJ.
Meningoencephalitis due to Blastomyces dermatitidis: case report and literature review. Mayo Clin Proc. 2000;75(4):403–8 [PubMed] [Google Scholar]23.
Bariola JR, Perry P, Pappas PG, Proia L, Shealey W, Wright PW, et al.
Blastomycosis of the central nervous system: a multicenter review of diagnosis and treatment in the modern era. Clin Infect Dis. 2010;50(6):797–804 [PubMed] [Google Scholar]24.
Increase in Coccidioidomycosis – California, 2000-2007
MMWR. Morbidity and mortality weekly report. 2009;58(5):105–9 [PubMed] [Google Scholar]25.
Williams PL.
Coccidioidal meningitis. Ann N Y Acad Sci. 2007;1111(1):377–84 [PubMed] [Google Scholar]26.
Mathisen G, Shelub A, Truong J, Wigen C.
Coccidioidal meningitis: clinical presentation and management in the fluconazole era. Medicine (Baltimore). 2010;89(5):251–84 [PubMed] [Google Scholar]27.
Romeo JH, Rice LB, McQuarrie IG.
Hydrocephalus in coccidioidal meningitis: case report and review of the literature. Neurosurgery. 2000;47(3):773–7 [PubMed] [Google Scholar]28.
Arsura EL, Johnson R, Penrose J, Stewart K, Kilgore W, Reddy CM, et al.
Neuroimaging as a guide to predict outcomes for patients with coccidioidal meningitis. Clin Infect Dis. 2005;40(4):624–7 [PubMed] [Google Scholar]29.
Williams PL, Johnson R, Pappagianis D, Einstein H, Slager U, Koster FT, et al.
Vasculitic and encephalitic complications associated with Coccidioides immitis infection of the central nervous system in humans: report of 10 cases and review. Clin Infect Dis. 1992;14(3):673–82 [PubMed] [Google Scholar]30.
Kleinschmidt-DeMasters BK, Mazowiecki M, Bonds LA, Cohn DL, Wilson ML.
Coccidioidomycosis meningitis with massive dural and cerebral venous thrombosis and tissue arthroconidia. Archives of pathology & laboratory medicine. 2000;124(2):310–4 [PubMed] [Google Scholar]31.
Galgiani JN, Ampel NM, Blair JE, Catanzaro A, Johnson RH, Stevens DA, et al.
Coccidioidomycosis. Clin Infect Dis. 2005;41(9):1217–23 [PubMed] [Google Scholar]32.
Blair JE.
Coccidioidal meningitis: update on epidemiology, clinical features, diagnosis, and management. Curr Infect Dis Rep. 2009;11(4):289–95 [PubMed] [Google Scholar]33.
Dewsnup DH, Galgiani JN, Graybill JR, Diaz M, Rendon A, Cloud GA, et al.
Is it ever safe to stop azole therapy for Coccidioides immitis meningitis?
Ann Intern Med. 1996;124(3):305–10 [PubMed] [Google Scholar]34.
Kim MM, Vikram HR, Kusne S, Seville MT, Blair JE.
Treatment of refractory coccidioidomycosis with voriconazole or posaconazole. Clin Infect Dis. 2011;53(11):1060–6 [PubMed] [Google Scholar]35.
Johnson RH, Einstein HE.
Coccidioidal meningitis. Clin Infect Dis. 2006;42(1):103–7 [PubMed] [Google Scholar]36.
Williams PL, Johnson R, Pappagianis D, Einstein H, Slager U, Koster FT, et al.
Vasculitic and encephalitic complications associated with Coccidioides immitis infection of the central nervous system in humans: report of 10 cases and review. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 1992;14(3):673–82 [PubMed] [Google Scholar]

When does a headache need to be seen at the hospital?

As a neurosurgeon, I encounter a lot of people who are concerned with ruptured brain aneurysms (blood vessel blisters). Ruptured brain aneurysms typically present with severe headache. I am incessantly asked, “When is a headache more than just a headache? When should I go to the hospital?”

A headache is considered to be pain located anywhere in the region of the upper neck or head.  It is one of the most common locations of pain in the human body and can have many difference causes.  There are three major categories of headaches which include primary headaches, secondary headaches, and cranial neuralgias which can be associated with facial pain.

  • Primary headaches include tension, migraine, and cluster headaches.
  • Secondary headaches are those due to something affecting the underlying structure of the head and neck.  Causes include bleeding in the brain, tumors, meningitis, and encephalitis.
  • The third type of headaches which involve neuralgias and facial pain are usually caused by inflammation of the nerves in the head and neck.

Tension headaches are the most common type of primary headache and are more common in women than men.  Their cause is unknown but thought to be due to the contraction of the muscles covering the skull.  Tension headaches usually occur because of physical or emotional stress placed on the body.  Symptoms of a tension headache include pain which is described as “tightness” that begins in the back of the head and upper neck.  It is usually mild in intensity, bilateral and not associated with vomiting or sensitivity to light.  Usually, these headaches do not impair function.

Migraine headaches are the second most common type of primary headache and are also more common in women than men.  They are associated with unilateral headache, nausea, vomiting, and sensitivity to light.

Cluster headaches are rare primary headaches and occur more commonly in men than women.  The cause of cluster headaches is unknown.  They tend to run in families, which suggest genetics may play a role.  They may be triggered by changes in sleep pattern and by certain medications.  Symptoms of a cluster headache include unilateral pain in the face and head that is sharp in quality and very short in duration.  The pain is usually excruciating and the eyes and nose may become watery.

Secondary headaches include causes such as head and neck trauma, blood vessel problems in the head and neck (ruptured brain aneurysms fall into this category), non-blood vessel problems in the brain, medications, infection, and changes in the body’s normal environment, problems with the structures of the head, and psychiatric disorders.

Headaches are treated differently depending on the type, cause, and nature of the headache.

Tension headaches are usually treated successfully with medications such as aspirin, ibuprofen, acetaminophen and naproxen.  If these fail, supportive treatments should be sought out such as massage, biofeedback, and stress management.  If mild, migraine headaches are usually first treated with non-steroidal anti-inflammatory agents or NSAIDs.  The drugs of choice for migraines are considered to be triptans such as Imitrex, Maxalt, Amerge, Zomig, Axert, Frova, Relpax, and Treximet.  Some other medications used include ergots, anit-nausea medications, butalbital combinations, and opiates.  Cluster headaches are usually treated with inhalation of high concentration of oxygen, injection of triptan medications, injection of lidocaine, ergotamines, and caffeine.  Preventative medications include calcium channel blockers, prednisone, lithium, and valproic acid.

When should a headache be treated?

A patient should seek medical care it for a headache when it is considered the “worst headache of his/her life,” different than a usual headache, starts suddenly or is aggravated by physical exertion.  Medical care should also be sought if the headache is associated with nausea and vomiting, fever, stiff neck, seizures, trauma, changes in vision, changes in speech, changes in behavior, weakness, is getting worse, and/or is disabling.

Why should a headache be treated?

A headache should be treated because it may be caused by something serious or be associated with a worsening condition and if left untreated may even lead to death.  Headaches should also be treated so that it does not become disabling and impair normal function.  Overtreatment should be avoided due to the fact that some medications, once stopped, may cause rebound headaches. So, to answer my simple original question, “When is a headache more than just a headache?” with a simple answer; any headache that presents with neurological deficits and is different than a usual type of headache that you suffer, requires medical attention.

Chaim Colen is a neurosurgeon. He can be reached on Twitter @MyNeurosurgeon.

Image credit: Shutterstock.com

Cervicogenic Headaches Start in the Neck

A cervicogenic headache starts in the cervical spine—your neck. Sometimes these headaches mimic migraine headache symptoms. Initially, pain may begin intermittently, spread to one side (unilateral) of the patient’s head, and become almost continuous. Furthermore, pain can be exacerbated by neck movement or a particular neck position (eg, eyes focused on a computer monitor).
Cervicogenic headache pain may be felt behind the brow and forehead, even though the problem originates from the cervical spine. Photo Source: 123RF.com.

Potential Causes of Cervicogenic Headaches

The cause of a cervicogenic headache is often related to excessive stress to the neck. The headache may result from cervical osteoarthritis (spondylosis), a damaged disc, or whiplash-type movement that irritates or compresses a cervical nerve. The neck’s bony structures (eg, facet joints) and its soft tissues (eg, muscles) can contribute to the development of a cervicogenic headache.

Role of Spinal Nerves

Certain spinal nerves structures are involved in many cervicogenic headaches. Spinal nerves are signal transmitters that enable communication between the brain and the body via the spinal cord. At each level of the cervical spine is a set of spinal nerves; one on the left side and one on the right of the spine. C1, C2 and/or C3 may be involved in development of cervicogenic headaches because these nerves enable function (movement) and sensation of the head and neck. Nerve compression can cause inflammation and pain.

Cervicogenic Headache Symptoms

A cervicogenic headache presents as a steady, non-throbbing pain at the back and base of the skull, sometimes extending downward into the neck and between the shoulder blades. Pain may be felt behind the brow and forehead, even though the problem originates from the cervical spine.

Pain usually begins after a sudden neck movement, such as a sneeze. Along with head and/or neck pain, symptoms may include:

  • Stiff neck
  • Nausea and/or vomiting
  • Dizziness
  • Blurred vision
  • Sensitivity to light or sound
  • Pain in one or both arms
  • Mobility difficulties

Risk Factors

Risk factors that may be involved in headache onset or aggravate cervicogenic headaches include:

Diagnosis of Cervicogenic Headache

The diagnosis of a cervicogenic headache begins with a thorough medical history with a physical and neurological examination. Diagnostic testing may include:

  • X-rays
  • Magnetic resonance imaging (MRI)
  • CT Scans (rarely)
  • Nerve block injections to confirm the diagnosis, cause

Treatment for Cervicogenic Headaches

Initially, your doctor may recommend an over-the counter non-steroidal anti-inflammatory drug (eg, aspirin, Aleve). If this is ineffective, then a prescription anti-inflammation and/or pain reliever may be prescribed. Other treatment options, listed in order of from non-invasive to invasive, include:

  • Spinal manipulation or other manual therapies
  • Behavioral approaches (eg, biofeedback)
  • Acupuncture
  • Trigger point injections
  • Prolotherapy
  • Facet joint blocks (a type of spinal joint injection)
  • Nerve blocks (this is usually of the medial branches of the nerves that supply the facet joints)
  • Radiofrequency pulse ganglionotomy of the nerve root (eg, C2, C3)
  • Spine surgery to relieve nerve or vascular compression (this is rarely necessary)

Brain Symptoms – Symptoms, Causes, Treatments

Brain symptoms can occur spontaneously or as the result of a traumatic injury to the brain or due to an infection, tumor, vascular abnormality, or other condition. With head trauma, brain symptoms can range from mild to severe, depending on the impact. Head trauma can cause a skull fracture or a rupture of blood vessels in the brain that can lead to hematoma (collection of blood) and contusions (bruises of the brain tissue). Injuries to the head are classified as open (when the source of trauma, such as a bullet or glass shards, penetrates the brain) or closed (when the object does not penetrate the skull).

Symptoms of milder injuries to the brain include headache, dizziness, fatigue, lethargy, memory loss, confusion, ringing in the ears, sensitivity to light, and nausea with or without vomiting. In addition to these symptoms, a more severe brain injury can also cause dilated pupils; weakness or numbness; behavioral changes; incoherent speech; muscle twitching, spasms, or seizures; and extreme sleepiness or inability to wake up.

Brain symptoms also include headache, which affects millions of Americans each year. There are different types of headaches, including vascular (such as migraine), inflammatory, and tension headaches. In addition to severe pain on one or both sides of the head, migraine is often accompanied by nausea, sensitivity to light, and auras (visual disturbances). Vascular headaches also include those caused by fever or high blood pressure. Tension in the muscles of the head, face and neck can cause painful tension headaches.

Brain symptoms can be important predictors of a serious underlying condition, such as an aneurysm. An aneurysm is a weakness in the blood vessels inside the brain. An aneurysm can rupture or press against other structures in the brain, causing cerebral bleeding and severe headaches. Other symptoms include loss of vision or double vision, neck stiffness, and eye pain. Stroke and transient ischemic attack are also serious conditions that can produce brain symptoms. They occur when the brain is temporarily deprived of oxygen, either from a blood clot that disrupts blood flow or a hemorrhage that causes bleeding in the brain. Symptoms include severe headache, confusion and memory loss, paralysis or muscle weakness on one side of the body, numbness, and personality changes.

Brain symptoms can be caused by serious or life-threatening conditions such as stroke or head trauma.
Seek immediate medical care (call 911) if you, or someone you are with, have any of the following symptoms: severe drowsiness; abnormal behavior; stiff neck, loss of coordination; severe headache; altered vision, hearing, or senses; or loss of consciousness.

Stomach pain should be seen as a warning sign — ScienceDaily

Patients with meningococcal infection generally develop symptoms including a high temperature, vomiting and a stiff neck… but they might also just have a bad stomach ache. This can be so severe that they are sometimes wrongly operated for appendicitis. Teams from the Institut Pasteur and the Department of Pediatrics at Bicêtre Hospital (AP-HP) decided to investigate the question. And the results speak for themselves: 10% of patients infected by the meningococcal strain that is on the rise in Europe suffer from abdominal pain. This atypical form of the disease is becoming increasingly common and needs to be brought to the attention of physicians. The findings are published in Clinical Infectious Diseases.

Within the first 24 hours of meningococcal infection — which can give rise to meningitis and septicemia as well as arthritis, peritonitis, etc. -, patients generally suffer from headaches, vomiting and a stiff neck. Over the past few years, however, abdominal pain has been observed as another early clinical sign — but physicians tend not to think of invasive meningococcal disease. “When doctors see patients suffering from stomach pain, invasive meningococcal disease doesn’t immediately spring to mind. They tend to think of gastroenteritis or possibly appendicitis,” explains Muhamed-Kheir Taha, lead author of the study and Head of the National Reference Center for Meningococci (CNRM) at the Institut Pasteur. “But delays in diagnosis and appropriate treatment for those affected can be deadly. Invasive meningococcal disease is fatal in virtually all cases if antibiotics are not administered rapidly.” The team led by Muhamed-Kheir Taha, in collaboration with a team from the Department of Pediatrics at Bicêtre Hospital (AP-HP), decided to take a closer look at these abdominal forms to assess their frequency and raise awareness among physicians of this new face of the disease.

Since meningococcal disease is a notifiable condition, the CNRM has received all the bacterial strains responsible for meningococcal infections in France since the 1980s. So the scientists were able to analyze some 12,000 meningococcal strains kept at the CNRM between 1991 and 2016 and examine the clinical presentations of the patients infected. They isolated 105 cases associated with abdominal pain, gastroenteritis or diarrhea. “That number represents just 1% of patients, which is not very many, even if the real figure is probably higher since it is hard to know whether babies are suffering from stomach pains,” says Muhamed-Kheir Taha. “But if we focus on the past two or three years and the group W bacterial strain, which arrived in Europe in 2013-2014 and has grown rapidly ever since, the figure rises to 10% of cases.” In other words, the emergence of these new W isolates changed clinical presentations and people with meningococcal infection today are more likely to suffer from abdominal pains. So it is urgently necessary to take this symptom into consideration in medical diagnosis. Abdominal pains, together with other signs such as leg pain, headaches and poor blood supply to the nails, should raise alarm bells for meningococcal meningitis.

To investigate their findings further, the team sequenced all the genomes of the bacteria in their collection to identify what sets them apart from other strains and what might explain the resulting abdominal pains. Here again, the scientists’ findings were relatively clear. The group W bacterial strain that is currently spreading across Europe and the world has around a hundred specific genes, some of which are involved in the inflammatory response. “We should remember that the bacteria infect the vessels which supply blood to the abdomen and the digestive system,” emphasizes Muhamed-Kheir Taha. “If these bacteria are likely to induce a stronger inflammatory response in tissues, that could explain the abdominal pains.” The scientists will continue their research by looking more closely at these genes to try to understand the mechanism of action of this strain, paving the way for more rapid diagnosis of a disease which still claims some 135,000 lives worldwide every year.

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Materials provided by Institut Pasteur. Note: Content may be edited for style and length.

90,000 Nausea and phobia. What kind of headache you need to go to the hospital urgently | HEALTH

A specialist from the Center for Medical Prevention and a fitness expert told AiF-Yug about what causes a headache. If the reason is in a “sedentary” lifestyle, then just a few exercises, which at first glance seem trivial, if performed regularly, will help tighten the skin of the neck, normalize sleep and get rid of pain in the cervical spine and head. If the reason is migraine, then you cannot do without a neurologist.

When pain is from muscle stasis

“There are several types of headache: due to diseases of the ENT organs and eyes, infection, disruption of blood vessels, but the most common is tension headache,” explains fitness instructor Svetlana Butova . – The human skull is surrounded by muscles, they often bother. It can be pressing pain for a day or several days.

It happens that painful sensations are completely unbearable, they can only be removed with pills.For a while, the pain subsides, but if a person is in one position for a long time, if he has a sedentary job, works at a computer for a long time, sleeps in an uncomfortable position, if his neck is strained, the headache occurs again. There is a remedy that will help get rid of it without medication. This is a special gymnastics. A few simple exercises to strengthen and stretch your neck muscles.

Alternating between strengthening and relaxing muscles without additional equipment, with minimal investment of time and without special clothing, you can independently engage in headache prevention. “

It is necessary to choose a comfortable position, you can even sit on a working chair without leaving the office. Put the palms into a lock, put on the back of the head and at the same time press with the palms on the back of the head, and with the back of the head on the palm. It should be a “draw”. During the exercise, you will feel the tension of the muscles in the back of the neck, and, therefore, they will become stronger. In the same way, it is necessary to press with the palms on the forehead, working to strengthen the muscles of the neck in the front. And, accordingly, alternately on the temporal parts, making the lateral muscles of the neck stronger.

“The head, skull, brain have an impressive weight, which falls on the cervical spine. Accordingly, for the neck to cope with the load, it must be strong enough, – continues Svetlana Butova. – Along with strengthening, it is necessary to remember about relaxation. This is also quite simple to do.

It is necessary to turn the head to one side, placing the chin over the shoulder joint. Then make a movement with your head down, drawing a semicircle, placing your chin over the other shoulder joints.Repeat this several times. ”

There is another way to stretch your neck muscles. Tilt your head with your ear to one shoulder. Others pull themselves down at this time. Hold for a few seconds. Then change the position of the head tilt.

The next exercise is to stretch and relax the muscles in the back of the neck. You just need to tilt your head down, lowering your chin to your chest. Thus, you will feel a pleasant sensation in the back of the neck and even in the thoracic spine.

With a migraine, there is always one or more accompanying symptoms – photophobia, vomiting, sound phobia, impaired sense of smell, vision, or attention.

How to tell a migraine

While it is possible to fight against some of the causes of headaches, people suffering from migraines cannot do absolutely anything during attacks, even sleep. Migraine is a chronic neurological disease, explained at the Center for Medical Prevention of the Krasnodar Territory . Its distinguishing feature is that most often only one half of the head hurts. Attacks occur from several times a year to one or two times a week.At the same time, there are no serious head injuries, stroke, brain tumors, and the intensity and pulsating nature of the pain is associated with vascular headache, and not with tension headache. For correct diagnosis and optimal treatment, it is necessary to seek the help of a neurologist.

Attacks occur due to irritants such as changes in weather and climatic conditions, excessive reactivity of the body to irritating foods (spices and spices, spicy foods, strong coffee and tea, pickles and canned food), alcohol.Psychoemotional stress and stress provoke migraine not at the moment of excitement, but after it. Bright, multi-colored or blinking light signals, strong odors, rooms with poor ventilation, physical fatigue, prolonged insomnia, changes and fluctuations in the hormonal background negatively affect the well-being.

Migraine is manifested by pulsating, paroxysmal pain in half of the head, lasting from four to 72 hours. The attack may be preceded by an aura – various neurological symptoms: vestibular, motor, sensory, auditory, visual.The visual aura arises more often than others when a person sees many bright flashes in the left or right field of vision, fragments fall out or objects are distorted.

Harbingers of migraine: weakness, fatigue, inability to concentrate, impaired attention. After seizures, drowsiness and pallor of the skin are sometimes observed. An important symptom that helps distinguish migraine pain from other types of pain is nausea. This symptom always accompanies attacks and is sometimes so severe that it comes to vomiting.In this case, the patient’s condition is relieved, it becomes easier for him for a few minutes. If vomiting does not bring relief, and the pain does not subside within a few days, then this may be a sign of a migraine status and requires inpatient treatment. The pain begins in the temple.

For correct diagnosis and optimal treatment, it is necessary to seek the help of a neurologist.

With a migraine, there is always one or more concomitant symptoms – photophobia, vomiting, fear of sound, impairment of smell, vision or attention.The arteries in the temple area are tense and throbbing, pain and tension increase with movement, so patients endure an attack in bed, in a quiet and dark room to minimize external stimuli.

Migraine is not associated with an increase or sharp drop in blood pressure, an attack of glaucoma, or an increase in intracranial pressure. According to official statistics from the World Health Organization, migraine is a problem for about 15-17% of the world’s population.At risk are those who have a hereditary predisposition. Most often, people aged 17 to 42 suffer from such a headache. The earliest age is five years old. Over 50 years of age, the disease practically does not occur. Women get sick more often: the hormonal background of the body affects. Attacks are associated with the phases of the menstrual cycle. The disease also depends on the lifestyle. Migraine is common among people in mental occupations. Frequent stressful situations and psycho-emotional instability can provoke an illness.90,000 Headaches in children: causes, diagnosis

Health care
19 november 2019

Children often report headaches, which is of great concern to both doctors and parents. Headaches are usually not life-threatening for children, but they should not be underestimated.

When parents bring their child to the pediatrician, they expect an answer to three questions: what causes the pain? How to relieve pain Is this the cause of a life-threatening condition? (in particular: is it a brain tumor, an infection?).

Most often, headache in children is primary (spontaneous), and the disease that causes it cannot be identified. This group of diseases includes: migraine, tension headache and chronic daily headache. Much less often, headache is a secondary symptom associated with a painful process located in the head (eyes, ears, teeth, temporomandibular joint) or with a general disease (diseases with fever, hypertension, neurological diseases).

Headache can occur at any age. Headache affects the behavior of children. The child becomes restless and sensitive to external stimuli, pale and apathetic, tearful, sometimes puts his hands on his head, is more agitated, irritable. A preschooler often has a headache that describes other ailments or simply reports dissatisfaction.

The clinical picture and the most common causes of headache in children:

Infection headaches, often with fever , can be a harbinger of an incipient viral infection: colds, flu, chickenpox, enterovirus.They can also be accompanied by a bacterial infection such as upper respiratory tract inflammation, angina pectoris, or pneumonia.

If the temperature is very high, it does not go away after taking anti-inflammatory drugs and is accompanied by symptoms such as: sudden severe headache, stiff neck and vomiting, you should definitely and quickly contact your doctor. This could be a sign of meningitis. In other cases, specific analgesics (such as ibufen) and pediatric counseling may be helpful, depending on the general condition of the child.

Migraine headaches can appear in children over 4 years of age and affect about 4-28% of the child population. The pain felt by the child is sharp, throbbing, and can last more than 2 hours. This can be accompanied by nausea, vomiting, photophobia, sensitivity to sounds, smells. Most often, complaints are localized on one side of the head, but in children, migraines are often bilateral, located in the frontal or temporal region. The child lies in a darkened room, mutes music, covers his head with his hands, may feel numbness, tingling or changes in skin temperature, abdominal pain, and may feel dizzy.

Contact your pediatrician. In the event of a painful attack, keep the child calm, turn off the sound, place him in a darkened room, and if the pain does not intensify, add pain reliever).

Tension headache

This pain is monotonous, sometimes it covers the head, it does not increase with physical exertion. This can last in different ways over a long period of time, several hours, or even an entire day. The child usually does not interrupt his activities.

If the pain recurs and does not get worse from time to time, you may be prescribed a pain reliever (such as ibuprofen).

Stress-related headaches

Are a common cause of headaches in children.

Pain is usually located around the forehead, occiput and temple. Appears at the end of the day or before a difficult situation for the child (classes, separation from parents). Stress can arise as a result of a situation at home (quarrels between parents, the appearance of siblings) or a preschool group (friends from the preschool group do not want to play with her).

It is worth paying special attention to the child’s emotional contacts, and if the pain persists, it is worth contacting a child psychologist.

Headaches associated with an unhygienic lifestyle and unhealthy diet. Fatigue, irregular sleep, too much time in front of the TV, computer, prolonged viewing of flickering images, too long exposure to the sun without adequate protection, and hypoglycemia (low blood glucose) due to lack of food and irregular food intake often causes headaches in children.

Contact your pediatrician and follow his instructions. It is important to provide your child with a varied diet and regular meals (breakfast is very important!). Make sure your baby sleeps regularly, spend time outdoors, limit time spent watching TV, and protect your head from excessive sunlight.

Pain associated with ophthalmic disorders (visual impairment or glaucoma). Headaches appear systematically in the afternoon or evening

Headaches associated with sinusitis or otitis media. Pain associated with sinusitis is worse when bending over. The pain is localized at the base of the nose or forehead with concomitant mucosal edema, nasal discharge, and nasal congestion.

Headache associated with inflammation of the ear, severe, the child is irritable and tearful, often touching the ear. If sinusitis and otitis media recur, see an ENT specialist.

Post-traumatic headaches

If discomfort occurs immediately after injury, it may be due to cerebral edema, intracranial bleeding, or skull fracture.However, if pain occurs within a day of the injury, accompanied by drowsiness, nausea, vomiting, and imbalance, they may indicate a concussion. In this case, you should go to the hospital immediately.

Headaches associated with neurological diseases.

In rare cases, headache is a symptom of a neurological disease (brain tumor, hydrocephalus, benign intracranial hypertension, subarachnoid hemorrhage, meningitis), but the possibility of its occurrence must be absolutely taken into account.If a febrile child has a stiff neck, vomiting, and impaired consciousness, we suspect meningitis.

When and where to seek medical help?

Headache in children is diagnosed and treated by pediatricians and pediatric neurologists, and depending on the indications, the child may be referred to other specialists, such as: an ENT specialist (sinusitis), an ophthalmologist (problems with visual acuity), a dentist (teeth of the temporomandibular joint), allergist, psychologist (problems at school).

Questions to help determine the origin of pain:

  • How often does the headache occur?
  • How long does one episode of pain last?
  • Does the pain occur at a specific time?
  • What soothes or aggravates a headache?
  • What other medications does the child take?
  • Does the child observe warning signs or can predict when he will have a headache?
  • Do headache symptoms accompany other symptoms, such as nausea, vomiting, dizziness, numbness, weakness?
  • What does a child do when they have a headache?
  • Do other family members have headaches?

90,000 Types of bumps on the back of the head

Bumps on any part of the head can be troublesome, but in most cases they are not serious.These bumps can be caused by skin conditions on the head, head injuries, infection, and abnormal growth of bone cells in the skull. Most of these problems are easily and spontaneously resolved. However, in some cases it is necessary to see a doctor. What are these bumps and what treatment they need to effectively remove them. This is why it is so important to know them.

Types of skull protrusions based on characteristics

Bumps on the back have certain characteristics by which they are classified.

They can have the following characteristics:

  • Large or small
  • Soft or hard
  • One or more
  • Fixed or mobile
  • Inflamed or not inflamed

Each of these masses is created for reasons that in many cases are not cause for concern. But, as a rule, if a bump or wound suddenly formed in your head that was painful or deformed in appearance, you need to see a doctor to heal it.

Types of bumps behind the head, depending on the reasons

Masses on the back of the head can occur for various reasons, sometimes accompanied by pain, and sometimes deformation of the scalp. Some of the reasons are listed below.

Mass due to head trauma

If, for any reason, the impact is struck from behind, a slightly stiff mass and bleeding (hematoma) may form at the impact site and under the skin. These bumps usually heal gradually over a period of two weeks.

Cold compresses can be used to reduce swelling in minor injuries. The use of pain relievers is also of great help in reducing pain.

But in case of severe injury, a person can get a concussion. Symptoms such as headache, nausea, vomiting, blurred vision, extreme tiredness or drowsiness, and memory loss are important and should be treated by a doctor.

Sebaceous cyst

Sebaceous cyst is a major group of cysts that are classified into two types.

Epidermal cyst

Epidermal cysts are composed of creatine and fat and affect the thin outer layer of the skin called the epidermis. These cysts can be the result of mild skin damage or acne and have certain symptoms.

  • These are round cysts that grow slowly up to five centimeters.
  • Cysts are not painful unless infected.
  • They are not cancerous
  • They usually do not need treatment and go away on their own.
  • If treatment is required, your doctor may prescribe antibiotics, steroid injections, or drainage of the cyst.

Kista Pilar

Pilar cysts are composed of creatine and are present in the outer hair follicle or hair follicle. These cysts form around the front and back of the hairline. They are half to five centimeters in diameter and usually:

  • They are not cancerous.
  • Are hereditary.
  • It is more common in women than in men.
  • In most cases, they go away without treatment.
  • Give antibiotics or drain the cyst if necessary.


Inflammation of the hair follicles or folliculitis develops as noticeable red or white lumps around the hair follicle. This lesion is more common in the head, especially in the back of the head. Folliculitis can be caused by a bacterial, fungal, viral infection or skin inflammation during hair growth.People with diabetes are very prone to inflammation of the hair follicles.

The bacteria can infect hair follicles and lead to folliculitis.

Treatment for folliculitis varies depending on what caused it. Antibiotics, antifungal drugs, and the right diet are effective in improving it. In addition, when treating this mass, the head should not sweat as much as possible and hair creams and shampoos should not be used.


Pilomatrixoma is the name for a tumor of the hair follicle that is abnormal but usually harmless.This mass is caused by the overproduction of hair matrix cells.

Pilomatrixoma manifests itself as domed foci of monochromatic or purple color and can grow up to several centimeters. This mass is one of the most common types of bumps on the back of the head and neck and is found in both children and adults.

A sample is taken to treat a hair follicle tumor, and then the mass is completely removed by outpatient surgery.


Lipoma is a soft mass of fat under the skin that moves in place.This mass slowly grows up to two centimeters. Lipoma is a harmless mass that can be found on various parts of the body. Of course, it appears less on the back of the head and neck.

Doctors do not know the exact cause of lipoma, but in many cases it occurs in people between the ages of 40 and 60. It is slightly more common in men than in women.

Lipomas do not need special treatment and go away on their own, but if they grow or harden, they should be checked by a doctor.

Seborrheic keratosis

Seborrheic keratosis is a wart-like, noncancerous bump that commonly appears on the head and neck of older adults. These bumps are often harmless and therefore rarely treated. If the doctor is concerned about the cancerous appearance of these lumps, he will remove them using cryotherapy or electrosurgery.


Swelling of the lymph nodes or lymphadenopathy occurs when a lymph node behind the ear becomes inflamed due to external factors.Skin or ear infections are the main cause of swelling in these nodules. These swellings usually go away on their own, but if the swelling lasts more than two weeks, you need to see your doctor.


The part of the skull bone behind the ear is called the mastoid bone. If bacteria infect this area of ​​the skull, it can cause mastoiditis. This infection occurs in the air spaces of the bone.

Mastoiditis is more common in children than in adults and is a serious infection that requires timely medical treatment.The disease manifests itself as soft red bumps on the back of the ear that can cause the ear to be pushed out.

Other symptoms include mastoiditis. For example, discharge from the ears, possible hearing loss, high fever, nausea and irritability, headache.

Doctors prescribe antibiotics to treat mastoiditis, and sometimes surgery is required to open the mass and drain the infection.


Craniosynostosis means premature healing of the skull joint.This is a birth defect in which one or more fibrous joints between the bones of the baby’s skull grow together prematurely. In this case, the baby’s umbilical cord is formed when the development of the brain is not yet complete. As the child’s brain is still growing, but the skull is closed, pressure is applied to the skull bone and the skull is deformed.

Surgery is required to treat craniosynostosis and correct head deformities so that the brain can grow normally. Early diagnosis and treatment creates ample room for brain development.

Masses due to bone growth

Bone growth (exostosis) is a benign bone tumor that rarely occurs in the skull. This complication is caused by prolonged irritation, arthritis, infection, or trauma and is sometimes accompanied by chronic pain. Pain relievers, physical therapy, and surgery are best for treating this type of mass.

Tumor of the bones of the skull

Sometimes bumps on the back can be caused by a bone tumor. One of the most common types of skull cancer is chordoma.This tumor grows from the bones at the base of the skull.

If the cordoma is small, it has no obvious symptoms, but if it is large, it is accompanied by symptoms such as difficulty walking and balance, headache, hearing and vision problems. In some cases, the tumor can spread to other parts of the body.

Treatment of skull bone tumors will depend on a number of factors, including whether the tumor is benign or malignant, the size of the tumor, the location of the tumor cells, and other individual variables.

Mass caused by subcutaneous hair

Sometimes hair grows into the skin as it grows. In this case, a small, hard, red bump appears on the surface of the skin. This noticeable mass is caused by pus from subcutaneous hair growth. Acne is usually harmless and will go away with hair growth. In some cases, it needs to be removed from under the skin with a special hair product.

The types of bumps behind the head are due to the importance of treatment

Nape masses may be harmless or need treatment.

1. Tumors that are not serious: A small lump on the scalp that goes away on its own is not serious.

2. Large swellings in the back of the head, accompanied by redness or pain, need to see a doctor, especially if they are accompanied by fever.

3. Masses that are very important to treat: Masses of the scalp that grow and set in place are very serious and definitely need treatment.

Not all bumps on the back of the head are abnormal

It is very common to find swelling and bulging in the back.Masses are formed on the skin, under the skin, or in the bones. There are a wide variety of reasons for these blows. From trauma to congenital diseases such as craniosynostosis.