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 like using the bathroom or during sexual arousal, can be concerning and may indicate a few underlying issues. Based on your description, it seems that you have experienced this type of pain intermittently over the past several years, and you have undergone a magnetic resonance imaging (MRI) scan that returned normal results. This is a good first step in ruling out serious conditions such as tumors or significant structural abnormalities in the brain.

The pulsating nature of your pain could be related to several factors. One possibility is that it is a form of exertional headache, which can occur during or after physical exertion, including activities that increase intra-abdominal pressure, such as straining during a bowel movement or sexual activity. This type of headache is often benign but can be exacerbated by factors such as dehydration, lack of sleep, or even tension in the neck and shoulders.

Another consideration is that the pain may be related to your previous eye surgery and the subsequent diagnosis of fourth cranial nerve palsy, which can lead to issues with eye alignment and may contribute to headaches due to the strain on the eye muscles. The fact that you experience diplopia (double vision) could also be a factor in your overall discomfort, as the brain may be working harder to compensate for the misalignment of the eyes, leading to tension headaches.

Your blood pressure readings, which seem to be on the lower side when you wake up, could also play a role. Low blood pressure can sometimes lead to symptoms like dizziness or headaches, especially when transitioning from lying down to standing up. The increase in blood pressure you noted after walking could indicate that your body is compensating for the initial low readings, which might also contribute to the pulsating pain you experience.

Given your symptoms and history, it would be advisable to consult with a neurologist or a headache specialist. They can provide a more comprehensive evaluation of your headaches, considering both your neurological history and the recent eye surgery. They may recommend further diagnostic tests, such as a CT scan or additional imaging studies, to rule out any vascular issues or other neurological conditions that could be contributing to your symptoms.

Additionally, it may be beneficial to keep a headache diary, noting the frequency, duration, and intensity of your headaches, as well as any associated symptoms (like visual disturbances or changes in blood pressure). This information can be invaluable for your healthcare provider in determining the best course of action for diagnosis and treatment.

In the meantime, consider lifestyle modifications that may help alleviate your symptoms. Staying well-hydrated, managing stress, ensuring adequate sleep, and avoiding known headache triggers can be beneficial. If you find that certain activities consistently lead to headaches, it may be worth discussing these with your doctor to develop a tailored management plan.

In summary, while your pulsating pain in the back of the head may be benign, it is essential to follow up with a specialist to ensure that there are no underlying issues that need to be addressed. Your history of eye surgery and the current symptoms warrant a thorough evaluation to provide you with the best care possible.