Chronic headache is a very common symptom that can be caused by many medical conditions. Many times, the underlying cause can be correctly identified and managed. In other situations, by contrast, the cause for a chronic headache can be misdiagnosed and thus inappropriately managed. Such a misdiagnosis occurs unluckily in a 25-year-old Australian barista.
Chronic headaches turned out to be neurocysticercosis
This young lady has been afflicted with chronic headaches for 7 years and would experience splitting headaches about every 3 months. She was diagnosed with migraines and managed as such. In her last headache episode, the headache lasted for more than one week, which is very uncommon for migraines. A brain MRI scan of her head raised the possibility of a brain tumor, and when the surgeons operated on her brain, they found that the “tumor” was actually a parasite called tapeworm. Finally, this young lady was diagnosed with neurocysticercosis.
What is neurocysticercosis?
Neurocysticercosis is a medical term for infection of the brain by the larvae (young parasites) of a parasite called Taenia solium (tapeworm).
Usually, the adult tapeworm lives in the intestines of the pigs and could produce many eggs that will be mixed with the pig’s feces. Once the foods or water we humans eat or drink have been contaminated by the pig’s feces, the tapeworm eggs in them will be swallowed into the human stomach and intestines. Then, the eggs will hatch into young tapeworms. These little tapeworms would burrow into the intestinal wall and enter the bloodstream to various organs, most predominantly the brain and the muscles. When these little tapeworms enter into the brain, they cause neurocysticercosis.
What are the symptoms of neurocysticercosis?
Many can be asymptomatic, while others can present with symptoms of headache or blurry vision. It may even cause symptoms similar to a brain stroke, such as leg weakness. Frequently, some patients could have epilepsy (seizure).
How do doctors diagnose neurocysticercosis?
A brain MRI scan is almost always needed to diagnose this condition. Moreover, doctors would also need to rule out conditions that cause similar symptoms. For example, for patients like the 25-year-old woman, doctors would need to rule out possibilities of migraine, tension headache, etc.
So, why did the Australian doctors misdiagnose this case?
It is very likely that the Australian doctors caring for this lady are not so experienced, since neurocysticercosis is predominantly seen in countries where domestic pig farming is common, such as in many Asian countries. Second, the lady had no apparent exposure to contaminated foods or drinks, which would further belie the doctors. In the above case, it is believed that she had accidentally ingested tapeworm eggs released from a carrier before.
How to treat neurocysticercosis?
Patients with no symptoms do not need to be treated. For symptomatic patients, there are oral medications that could eradicate the worm. Sometimes surgery is needed to remove the worm.
How to distinguish between neurocysticercosis and migraine?
It might not be a migraine if you:
· Have seizures
· Have muscle weakness or numbness
· Have changes in headaches over time
Obviously, patients and their doctors need to have a brain CT or MRI scan before attributing the headache to “migraine” to prevent further misdiagnoses.