Pulsating Pain in the Back of the Head After Bathroom Visits

Sometimes after using the restroom, I experience a noticeable pulsating pain in the left back of my head for a few seconds?

Hello, Doctor.
About 4-5 years ago, I started experiencing a pulsating pain in the left posterior part of my head for a few seconds after using the restroom or after masturbation.
Occasionally, I also feel a slight pressure-like pain in my head.
I previously consulted a neurologist and underwent a brain MRI, which returned normal results.
After undergoing strabismus surgery in mid-October last year, I have been experiencing double vision when looking at the center and left side, making it difficult to focus.
The doctor diagnosed me with fourth cranial nerve palsy and advised further observation.
My blood pressure upon waking is usually around 95/66, and after walking quickly, it rises to about 135/75.
I would like to ask which specialty I should consult regarding the headache to determine the cause more effectively.
Thank you.
🙏

Cai Xiansheng, 40~49 year old female. Ask Date: 2024/03/12

Dr. Jiang Junyi reply Neurology

Dear Mr.
Tsai,
You mentioned experiencing "pulsating pain in the left posterior part of the head for a few seconds, and occasionally feeling a slight pressure pain in the head." This may be related to muscle and fascia tightness in the cervical spine, as well as cervical degeneration.
Symptoms typically include localized pain, discomfort, muscle stiffness, and possibly neurological sensations.
Symptoms may worsen in the morning upon waking or with changes in weather, but can be alleviated with stretching activities, and often recur.
During acute episodes, there may be local muscle tension and spasms, leading to restricted movement.

As for the diplopia, it may require consideration of another cause.
Generally, if cervical spine compression is affecting the nerves, cervical traction can be utilized for rehabilitation.
Prior to traction, an X-ray examination should be performed to confirm the stability of the joints.
If symptoms persist, it is advisable to follow up with a neurologist for further evaluation.
Thank you for your inquiry, and I welcome further discussion.
Wishing you good health, peace, and happiness.
Dr.
Jiang Junyi
Department of Neurology, Taoyuan Hospital

Reply Date: 2024/03/12

More Info

Pulsating pain in the back of the head, especially after activities like using the bathroom or engaging in sexual activity, can be concerning and warrants further investigation. Given your history of experiencing this pain intermittently over the past four to five years, along with the recent eye surgery and the diagnosis of fourth cranial nerve palsy, it is essential to consider several potential causes and the appropriate steps for diagnosis and management.

Firstly, the pulsating pain you describe could be related to a phenomenon known as "cough headache" or "valsalva headache." These types of headaches can occur when there is a sudden increase in intracranial pressure due to activities that involve straining, such as during bowel movements or sexual activity. The pain is often described as a brief, throbbing sensation in the head, which aligns with your experience of feeling a pulsing pain in the left posterior region of your head.
Another possibility is that the pain could be related to tension-type headaches or migraines. Migraines can sometimes present with pulsating pain and may be triggered by various factors, including stress, changes in blood pressure, or even physical exertion. Given that your blood pressure readings vary significantly with activity, it is worth considering whether fluctuations in blood pressure could be contributing to your headache symptoms.

Your history of having normal MRI results is reassuring, as it suggests that there are no significant structural abnormalities in the brain. However, the presence of diplopia (double vision) following your strabismus surgery indicates that there may be ongoing neurological issues that need to be addressed. The fourth cranial nerve palsy you mentioned could potentially be related to your headaches, especially if there is any associated muscle tension or strain in the neck and head region.

In terms of next steps, it would be advisable to consult with a neurologist, as they specialize in disorders of the nervous system and can provide a comprehensive evaluation of your symptoms. They may recommend further imaging studies or tests to assess for any underlying conditions that could be contributing to your headaches. Additionally, a referral to an ophthalmologist may be beneficial to address the ongoing issues with your vision, as they can provide insights into whether your eye condition is related to your headache symptoms.

In the meantime, it may be helpful to keep a headache diary to track the frequency, duration, and intensity of your headaches, as well as any potential triggers. This information can be valuable for your healthcare provider in determining the best course of action for diagnosis and treatment.

In summary, while the pulsating pain in the back of your head could be related to various factors, including changes in intracranial pressure or tension headaches, it is essential to pursue further evaluation with a neurologist. They can help identify the underlying cause of your symptoms and recommend appropriate management strategies to improve your quality of life.

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