Dull, throbbing one-sided headache
August 4, 2010 | 15,00 EUR | answered by Dr. med. Ralf Berg
I am male, 29 years old.
No chronic underlying medical condition.
Brief history of the medications I am currently taking/have taken:
5 weeks ago, I had a tick bite and there was suspicion of a Borrelia infection (erythema migrans around the bite), so my primary care physician prescribed me an antibiotic:
Doxy-M-ratiopharm 200 mg (20 tablets, 1 x daily)
I was instructed to follow up for a blood test for antibodies 1 week after finishing the tablets. I found out that my primary care physician is on vacation. The substitute doctor said over the phone that the test can wait until the end of the month, they do not want to conduct the blood test.
For completeness:
I take 1 mg of Finasteride daily and use 1 ml of Minoxidil topically for alopecia, for about 6 months.
Regarding my symptoms:
I have had a dull, pressing headache on the left side for about a week. The pain is constant, varying in intensity but always noticeable. It is located in the back of the head, behind the left ear. My overall condition is good. My forehead feels very hot, but I do not have a fever. I took Ibuprofen tablets for 3 days (1 x in the morning and 1 x in the evening), but it did not provide relief.
Question: What is your assessment? Is there a possible connection to the Borrelia infection, or should I really wait until the end of the month for a blood test? I have never had problems with migraines - if the headaches are related to that, when should I see a doctor?
Dear patient,
I can understand your concern well. You may suspect a connection with your Lyme disease. This can affect not only the skin (as in your case) but also joints and, as neuroborreliosis, the brain. However, the infection usually needs to persist for a long time (weeks to months for joints, months to years for neuroborreliosis). Since the disease was promptly and guideline-compliantly treated by your general practitioner, the risk is very low. With the planned blood test, it can be determined whether there are still Borrelia in your body. The aim is to detect so-called IgM antibodies. However, since these antibodies sometimes take 4-6 weeks to develop, postponing the blood test is surely not a problem. If the results were unexpectedly positive, the antibiotic therapy would be resumed for a longer period. Resistant Borrelia strains against Doxycycline are very rare. If I were in your shoes, I would first have an examination of the left ear canal and the oral cavity and frontal/sinus cavities done. If no signs of sinusitis or otitis are found there, which is very likely based on your symptoms, the next step would be to look for other causes in the head. This would then require a neurological examination.
In summary: You can definitely wait until the end of the month for a blood test regarding Borrelia, but you should see a substitute for your general practitioner or possibly an ENT doctor due to the suspicion of an ear or sinus infection. I hope this information is helpful to you.
