Case report
On November 25th, 2021, a 32-year-old man with a 20-year history of
chronic headaches was referred to the National Institute of
Neurosciences & Hospital. Apart from that, the physical checkup was
normal. Since 2002, he has had constant and recurring headaches,
occurring 2-3 times each week. The headaches were reported as forehead
pain that did not extend to his eye or any other body part. The attacks
lasted 30 to 45 minutes on average. These headaches frequently occurred
in the afternoon and were not characterized by eye redness or weeping.
The headaches were so bad that he could not stand it any longer. Except
for NSAIDs, which only eased the pain to a minor degree, no therapies
were helpful before consulting with a physician. He was previously
diagnosed with tension headaches and also treated as migraine for dull
on-off headaches. He had previously been prescribed paracetamol, NSAIDs,
Propranolol, methysergide, antihistamines anti-anxiety and sedative
medication and naproxen sodium were among the earlier ineffectual
treatments. A clinical interview, the Minnesota Multiphasic Personality
Inventory-2 (MMPI-2), the State-Trait Anxiety Inventory (STAI), and the
Beck Depression Inventory (BDI) were all used in a comprehensive
psychiatric assessment. The psychological perception was the situational
anxiety resulting from her disease, with no underlying psycho-emotional
dysfunction. On numerous occasions, physicians have recommended that he
undergo contrast-enhanced computed tomography (CT scan) and magnetic
resonance imaging (MRI), but he has always planned to do it later. He
experienced acute watery diarrhoea recently on 10 November 2021, and lab
tests revealed Hb-15.90 g/dL, WBC-28.93 x 109/L, Platelets-342 x 109/L,
ESR-16 mm in the first hour. Sodium 133 mmol/L, potassium 5.4 mmol/L,
creatinine 2.3 mg/dl. The electrocardiogram, liver/renal function,
clotting profile, chest X-ray, and liver/renal function were normal. But
this acute diarrhea period he had associated severe headache so he
underwent contrast-enhanced computed tomography (CT scan) (Figure:01)
and Magnetic Resonance Venography (MRV) (Figure:02); which revealed the
jugular venous system of the left side is not visualized and the right
side jugular venous system is prominent and deep veins and dural venous
sinuses appear normal which suggestive of congenital agenesis of jugular
venous system of left side. Due to financial difficulties, he has not
yet undergone an intervention or any other procedure. He still had a
persistent headache, but the patient remained constant during the
follow-up visit the following week.