Pulsating Pain in the Back of the Head After Bathroom Visits - Neurology

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Pulsating pain in the back of the head, especially after activities such as using the bathroom or engaging in sexual activity, can be concerning and warrants further investigation. The symptoms you describe, including the pulsating pain in the left posterior part of your head, may be related to several underlying conditions, and understanding these can help guide you in seeking appropriate medical care.

Firstly, the pulsating pain you experience could be related to a phenomenon known as "exertional headaches." These headaches can occur during or after physical exertion, including activities that increase intracranial pressure, such as straining during bowel movements or sexual activity. The pain is often described as throbbing or pulsating and can last for a few seconds to several minutes. In some cases, these headaches are benign, but they can also be a sign of more serious conditions, such as vascular issues or increased intracranial pressure.

Given your history of experiencing this type of pain intermittently over the past 4-5 years, it is essential to consider other factors that may contribute to your symptoms. You mentioned that you had a strabismus surgery and were diagnosed with fourth cranial nerve palsy, which can lead to double vision and difficulties with eye coordination. This condition may also contribute to headaches, particularly if there is associated muscle strain or tension in the neck and head due to compensatory mechanisms your body may be employing to manage the visual disturbances.

Your blood pressure readings, which are relatively low when you wake up but increase with activity, could also play a role in your symptoms. Low blood pressure can sometimes lead to inadequate blood flow to the brain, resulting in headaches or a sensation of pressure. However, the increase in blood pressure with activity is a normal physiological response. It is crucial to monitor your blood pressure regularly and discuss any significant fluctuations with your healthcare provider.

Considering your symptoms and medical history, I recommend that you consult with a neurologist if you have not done so recently. A neurologist can perform a thorough evaluation, including a detailed history and physical examination, to assess your headaches in the context of your previous surgeries and current symptoms. They may also consider additional imaging studies or tests to rule out any vascular issues or other neurological conditions that could be contributing to your headaches.

In addition to seeing a neurologist, it may also be beneficial to consult with an ophthalmologist or a neuro-ophthalmologist regarding your double vision and cranial nerve palsy. They can provide insights into whether your visual symptoms are related to your headaches and if any further interventions are necessary.

In summary, while your pulsating pain may be benign, it is essential to approach this symptom with caution, especially given your medical history. A multidisciplinary approach involving both neurology and ophthalmology may provide the best pathway to understanding and managing your symptoms effectively. Remember to keep a headache diary to track the frequency, duration, and triggers of your headaches, as this information can be invaluable for your healthcare providers in diagnosing and treating your condition.