Headaches and Swollen Lymph Nodes: When to Seek Help

Headache with a lump-like sensation, swollen lymph nodes on the right side?

Hello Dr.
Chen,
Last Wednesday, I was reading until around midnight, and afterwards, I felt a bit of a headache, so I went to sleep.
Usually, when I have a headache, a good night's sleep helps, but when I woke up the next day, I found that my head still hurt.
I wondered if it was related to my menstrual period, but I typically don’t feel this uncomfortable during my period, and I don’t usually get headaches.
In any case, I went to work, but during a meeting, I realized that my headache was so severe that I couldn’t concentrate.
It was a type of intermittent throbbing pain, so in the afternoon, I took leave to see a doctor at a clinic.

The doctor said that my headache was due to a fever (which was measured at 37.5°C).
I found it strange that my headache was only on the right side.
After taking medication, I noticed that the headache didn’t improve, and I felt completely exhausted, even though I had slept all day.
I also experienced pain whenever I touched the hair on the top of my head or even just the right side of my scalp; I couldn’t wash my hair without being too gentle on the right side.

Later, I went to the ENT department at the hospital because I still didn’t understand the cause of my headache.
The doctor noticed that my right lymph node was slightly enlarged (not significantly swollen, but she could feel it), and she asked if it could be related to Kawasaki disease from my childhood.
I said it probably wasn’t, as I would have noticed such an obvious swelling in my neck long ago; it should be related to the cold I’ve had these past few days.
She measured my temperature at 37.4°C and said it probably wasn’t the flu, as my temperature wasn’t high enough (but both doctors who checked me noted it was over 37°C, which I feel isn’t quite normal).

After returning home, I carefully examined my scalp and found that there were small bumps on the right side of my head, slightly larger than pimples (not clustered together), and those areas were painful.
A friend told me that those could also be swollen lymph nodes.
I also experienced headaches in the right back and top of my head, and sometimes when I swallowed food, I felt tightness on the right side (and my ear would hurt slightly).

I’m not someone who often gets colds (during my year in Germany, the worst I had was throat pain), so this prolonged cold and the unusual headache have made me quite worried (I took leave from Thursday afternoon and spent the entire weekend resting in bed).
I’m unsure if this is just a simple cold or if it could possibly be something serious like lymphoma or other symptoms.
Thank you, doctor.

Eve, 20~29 year old female. Ask Date: 2017/01/16

Dr. Chen Taicheng reply Family Medicine

Based on your description, it seems you have a history of headaches (for more information on headache issues, please refer to another article at https://goo.gl/6h7cll).
This may be migraine-related (migraines are moderate to severe headaches that can last from 4 to 72 hours, often unilateral, and may be accompanied by pulsating pain, nausea, vomiting, and can be exacerbated by light, sound, or daily activities; aura-type migraines can present with a tingling sensation).
The statement "there are painful lumps on the right side of my head" could suggest folliculitis if located on the scalp; if on the face or neck, lymphadenopathy or inflammation should be prioritized (painful lymph nodes are often reactive, typically benign, and usually resolve gradually within 1-2 months).
The description "there is pain in the back right side and the top of my head, and sometimes when I swallow food, I feel tightness on the right side (and my ear hurts a little)" sounds like it could be due to acute infection-related swelling and inflammation, which may include otitis media, temporomandibular joint issues, or trigeminal neuralgia that need to be differentiated.

Lymphoma typically presents as a painless, firm mass, sometimes accompanied by symptoms such as fever, weight loss, and night sweats.

Regarding the "painful lumps on the head" suspected to be lymph nodes and the headache issue, it is recommended to visit the ENT, neurology, or family medicine department at a hospital for further evaluation to clarify the relationship between the headache and the head lesions.
Wishing you good health, Dr.
Chen Tai-Cheng, Family Medicine, Taoyuan Hospital.

Reply Date: 2017/01/16

More Info

Understanding headaches and swollen lymph nodes can be quite complex, especially when symptoms persist or worsen over time. Based on your detailed description, it seems you are experiencing a combination of headache and lymph node swelling, which can be indicative of several underlying conditions.

Headache Types and Symptoms
From your account, it appears that your headaches are localized primarily on the right side of your head and are accompanied by a sensation of tightness or discomfort when swallowing. This could suggest a few possibilities:
1. Tension-Type Headache: These are often characterized by a dull, aching sensation all over the head, but can also present as localized pain. They are frequently triggered by stress, fatigue, or muscle tension in the neck and shoulders.

2. Migraine: Given that you experience intermittent sharp pain and sensitivity to touch, migraines could also be a consideration. Migraines typically present with unilateral pain, often accompanied by nausea and sensitivity to light and sound.

3. Sinus Headache: If you have any nasal congestion or sinus pressure, this could also lead to headaches, particularly if there is inflammation in the sinus cavities.

Swollen Lymph Nodes
The presence of swollen lymph nodes, particularly on the right side of your neck, can indicate an immune response to infection. Lymph nodes can swell due to:
- Viral Infections: Common colds, flu, or other viral infections can cause lymph nodes to enlarge as they work to filter out pathogens.

- Bacterial Infections: Conditions like strep throat or ear infections can also lead to swollen lymph nodes.

- Other Conditions: While less common, persistent swelling could indicate more serious conditions, such as lymphoma or other malignancies.

When to Seek Medical Help
Given your symptoms, it is advisable to seek medical attention if:
- Your headache persists for more than a few days without improvement.

- You experience significant changes in your headache pattern or severity.

- The swollen lymph nodes do not decrease in size after a couple of weeks or are accompanied by other concerning symptoms such as fever, night sweats, or unexplained weight loss.

- You have difficulty swallowing or experience persistent pain that affects your daily activities.

Recommended Actions
1. Consult a Specialist: Given the complexity of your symptoms, it may be beneficial to see a neurologist for your headaches and an ENT specialist for your lymph node concerns. They can perform a thorough examination and possibly recommend imaging studies, such as an MRI or CT scan, to rule out any serious conditions.

2. Monitor Symptoms: Keep a diary of your headaches, noting their frequency, duration, intensity, and any accompanying symptoms. This information can be invaluable for your healthcare provider.

3. Manage Stress and Fatigue: Since tension-type headaches can be exacerbated by stress, consider incorporating relaxation techniques such as yoga, meditation, or deep-breathing exercises into your routine.

4. Stay Hydrated and Rest: Ensure you are drinking plenty of fluids and getting adequate rest, as dehydration and fatigue can worsen headache symptoms.

5. Follow-Up: If your symptoms do not improve or worsen, follow up with your healthcare provider to reassess your condition and adjust your treatment plan as necessary.

In conclusion, while your symptoms may be related to a common viral infection or tension, it is crucial to remain vigilant and seek medical advice to rule out any serious underlying conditions. Your health is paramount, and timely intervention can lead to better outcomes.

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