Question
QUESTION: Hi Dr. Leatherman!

Ok, this might get a little long and tedious, but better to be thorough.

I'm going to rewind to early February. I had a fall off my horse, and hit the
back of my head. Of course, it was the only time I've ridden without a helmet.
I don't remember hitting it very hard.. but thought I'd add it in anyway. So I
had a headache that day, but that was it. Weeks go by... I'd say about 7
weeks, and I started getting this pressure-like feeling in my head. I also
started making a habit of taking naps every day, which was unlike me. It
never got better, but never got worse. Around this time was when Natasha
Richardson died, so naturally I freaked a little. Went to the ER to get checked
out. Doctor didn't see any issues with me neurologically. Everything stayed
the same. Then about a week later, I left for Las Vegas for equestrian World
Cup Finals. I was only there for a day when I really started to feel lousy. I
ended up going out for ONE night, and then was just floored. Fever, chills,
nausea, no appetite, and my throat felt really constricted. No pain, just
constricted. Wasn't well enough to drive back home, so I stayed in the hotel
for about 3 days until I was decent enough to go home.

So I got home, and on that Monday I went in to my regular doctor's office to
be re-evaluated, since the ER doctor wrote it off as a sinus infection (I have
never had allergies or sinus issues before in my life) and she suspected
maybe mono. So I got some labwork done, and tested positive for mono.

My question is.... this "tension" in my head is constant. I still have it. My ears
also feel a little full. I know you can get headaches with mono, but is what is
going on with my head part of the mono? Or is it connected to when I fell off
my horse months ago? I am over my acute symptoms of mono... all that
remains is the fatigue (though not as bad) and the head/ear pressure.

Thank you so, so much for any help or ideas you can give me.

Sarah

ANSWER: Dear Sarah,

I think that the headache symptoms/pressure feeling is probably connected to the fall rather than the mono.  The reason why is that it was present before the mono was active.  However, with a complaint of pressure rather than specific pain, sinus congestion related to the mono could be the ultimate cause.  So, what I really need is more detailed information about the pressure symptoms.  

1.  How long before you started to get the mono symptoms did you have the pressure in the head?
2.  Where exactly in the head is the pressure:  behind eyes, forehead, over the ears, back of the head, over the top of the head?, etc... be as descriptive as you can.
3.  Is the pressure one one side of the head or bilateral?
4.  Is it constant, or does it come and go?  If it comes and goes, what time(s) of day is it most prevalent?
5.  Do you have associated pain in the face, head, or neck with this?
6.  Has it gotten any better as the MONO has improved?...mono can last 4-6 weeks.
7.  Have you had your ears checked as well?  If so, what was found?...ear infections can create this as well, but you should have had frank ear pain to go along with it...fluid behind the ears can create pressure without pain.

Get back to me with this and I will try to pinpoint things better for you.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoastehalthcare.net




---------- FOLLOW-UP ----------

QUESTION: Hi Dr. Leatherman,

About the head pressure... it's not very intense, but is just always there. Kind
of like my head is full.

I began to feel the pressure a few weeks before the bad mono symptoms
showed up. Though at the same time I developed the pressure, I also noticed
I was taking naps more.

A couple of doctors have said that it could be sinus related, though after
taking antibiotics AND getting sinus xrays which revealed nothing, we
decided it's not that.

The pressure is felt mostly on the sides and front/top of my head. Sometimes
the back too, but only if I'm really stressing about something. It is bilateral. It
is also constant, though over the two and a half months I have been feeling
it, it hasn't gotten any worse I don't think. The only time I don't notice it is
JUST after I have woken up. Once I get up, I start to feel it again. I know mono
can last a while, so I guess since the acute symptoms, I haven't given it tons
of time, but it hasn't gotten better.

I will point out that I do have an ear "problem" Several years ago, I had a
TERRIBLE ear infection, went to the doctor and she told me that my ear canals
never formed properly. Instead of dipping down, which I guess they are
supposed to do when you get older, they still go just across. It has been at
least a couple of years since I have gotten my ears cleaned out. Also, the last
few days I have noticed an increase in ear fullness. I use a neti pot, and
sometimes while using that, I can hear fluid in my ears.

It just is very frustrating and confusing, if it is connected to my fall, what
would be wrong? Especially since it has been months now.

The only reason my head hurts a little right now, is because I had a rough day
and had a couple of bouts of crying.

I hope I answered everything ok. Hope to hear from you again soon.

Answer
All right Sarah, thanks for the follow-up.

From what you have described, this definitely could be the result on the inner ear issue...especially since the Eustachian tube is in a horizontal position.  This is the main reason why children get ear infections because the tube does not drain properly.  This is easy to remedy by pulling the ear lobe down, outward, and forward...you should feel the canal actually opening up.  If you open and close your jaw while doing this, it will further help mobilization of the Eustachian tube and allow for draining.  If you do this while utilizing the Neti pot is should really help the tube drain.

Now, this could still be related to the fall...how...when you fell on the head, this can jam the top joints of the neck and head together and create fixation in this region. These joint articulations are called the occiput, atlas and axis, and clinical research has proven that this created headache issues. The fixation can create inflammation around the joint spaces, and the referral patterns of the pain goes from the back to the front and top of the head...often behind the eyes and forehead as well.  However, this is usually a true headache pain phenomenon rather than a feeling of fullness, so you don't exactly match the clinical picture.  

In my opinion, I would suggest that you try the ear stuff first, and it does not give you any relief, then have the upper joints of the neck evaluated by a chiropractic physician.  If the joints are fixated and moving abnormally, a few upper cervical spinal adjustments can be very effective in alleviating the pressure.

Hope this helps Sarah.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net