Headache-Adviser.com

Chronic Daily Headache

by Elizabeth
(Ontario, CA, USA)


I received a dural puncture(spinal tap) when I was 20, causing me to be hospitalized for nearly 2 weeks with a spinal headache and spinal fluid leak. After that resolved, I suffered from severe headaches from another six months.

Sped forward a few years and I again, had a lumbar puncture and was in and out of the hospital from June to November when they finally had to surgically correct the leak because I had many failed blood patches. Since that point in 2004, I have suffered chronic daily headaches, cluster headaches (once though to be migraines) that cause vomiting and are totally debilitating for at least 24 hours (I don't think they are migraines because I do not have vision change or auras)...now, as of the last 3 weeks, I have severe, sudden onset headaches at the front of my head as I climax with orgasm...very upsetting.



I have rods in my spine from t1-l2 and a bony fusion from l4-s1. I have tried Topomax (even high dose), fioricet, esgic plus, naproxen, excedrin migraine, tylenol, caffeine, ice, heat, massage and accupuncture (twice a week for 6 months)...and nothing seems to help. I see a pain specialist but he does not specialize in headaches and I have an internist along with my surgeons. I have had 10 spine surgeries since 1992. The chronic daily headaches are bad enough! I believe they have lead to high blood pressure because they are totally uncontrolled prior to the past few months when they seemed to be more controlled, even with back pain, my bp was never higher than 125/80 and usually was in the 110's/70's.... Fioricet helped but 3 tablets every 3 hours were necessary. I have started walking on a treadmill 20-30 minutes up to 5 days a week with no relief. They do not appear to be rebound headaches as even without any meds for days there is no change. We recently had a friend die of an aneurysm at the age of 37...I am 35... Now with the onset of the coital headaches, I am desperate. Any thoughts?

Answer

Hi Elizabeth,

I think some of your instincts are correct based on what you wrote. You have a couple of types of headache influencing your total profile.

The first headache after the tap was a post traumatic type of headache and should have been treated with steroids and Elavil which I don't think you ever got. Matters were obviously made worse by the second tap. Some of my patients have done very well on a combination of Topamax and Seroquel..low dose at night time.

The breakthrough headaches sound like cluster migraine variant..aspects of both headaches. Although rare, I do see a couple of cases per year.

Finally, a new onset of headache during sex is a neurological "flag" and should be worked up with an MRI and MRA to rule out aneurysm..please contact your doctor soon to set this up. If you do not have a neurologist or headache doctor on board, I think you should get one as your case is a bit complex..but not untreatable! There are several headache centers in California so try to get to one near you.

Good luck!
Mary Kay Betz MS RPA-C

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Daily headaches

by Nicky
(California)

Hi,

I'm a 17-year-old girl, and for the past week, I've been having headaches everyday. They're not horribly painful, but while they're bearable, it's still a bit bothersome. They usually seem to be on the left side or the back of my head, and they hurt more when I move around.

I've tried taking Midol a few times, but it doesn't seem to work.

Could this perhaps be related to stress or dehydration?

Thanks.
Nicky

Answer

Hi Nicky,

Without more information it is a little difficult to tell what type of headache you are having or what is causing it.

If you have never had headaches before, you need to talk to your parents about this and have them call your pediatrician. A headache that goes beyond 3 days and does not respond to medication is a bit concerning. A doctor is the best person to see right now to sort out what is going on..

Take care,
Mary Kay Betz MS RPA-C

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Daily Headaches

by Don
(Severna Park, Md)

On July 6th of this year I developed a headache along with what seemed like sinusitis symptoms, mainly increased drainage down the back of the throat, though no nasal discharge. I went to my GP and they gave me Augmentin. 5 days later it was no better so the gave me Levaquin and Prednisone.

Two weeks later, after returning from 2 weeks in England, it was still no better. I went to ENT, had a CT scan of sinuses, and he said sinuses were clear. Essentially, I have had a headache almost every day since July 6th. I wake up in the morning almost pain free, but generally pain gets worse as day progresses. Basically a left side issue, though if it gets bad enough can affect whole head. Starts as a creeping sensation along maxillary area on left side of head, and then can spread to pain behind left eyeball.

Any sort of physical activity -- simple walking, mild straining, leaning my head forward -- aggravates it. I also have a little bit of neck stiffness and cracking, grinding sensation when I move my neck.

This past Saturday, we had a severe thunderstorm and as soon as that hit, my left eye began to water, left salivary glands began to run like a faucet, and by the end of the day my left eye looked like I had pink eye, though it was cleared up next morning.

No pain killers work at all -- Ibuprofen, Excedrin Migrain, Oxycodene. In the past, Excedrin Migrain always cleared up my occasional headache immediately. ENT prescriped Relpax and that also had no effect. Only relief I get is from lying down, even very briefly.

I have been tested for temporal arteritis and it was negative. I have almost the same pattern every day: wake up in the morning feeling about 90% normal, gets worse through late in the afternoon, and then improves by the time I go to bed. I have a hard time working a full day and am doing almost nothing outside of work.

I am 55, non-smoker, generally in good health. Thank you,


Don

Answer:

Hi Don,

Since you were tested for temporal arteritis, I am going to assume you are over 50 but not retired yet if still working.

Age plays a role in headaches and head pain. You do not mention if you are a smoker or not. The reason is that a headache that has no clear defining symptoms of either tension or migraine is concerning. If it was a migraine, the Relpax would have had some effect.

What bothers me is no mention of an MRI or CT of the brain (sinus CT doesn't show brain structures). Aneurysms and tumors of the brain stem can present with the symptoms you describe. Aneurysms also present with neck stiffness as does dissection (tearing or separation of arterial walls) of neck arteries.

I would strongly urge you to call your physician first thing in the morning. If they even attempt to blow you off or say come in in a few days..get to the ER and ask for an MRI and MRA (looks at the arteries). If you are having a dissection, it may not show up on an MRI and you need the MRA.

Good luck!

Mary Kay Betz MS RPA-C


COMMENTS:

Mary Kay,
Still dealing with neck-headache. Saw a neurosurgeon on Friday who said that I was certainly an odd case. Nothing that he could see in MRI of my neck jumped out at him that would be causing the symptoms I am having. Have "mild foraminal stenosis" and bone spur at C4-5, but have no numbness or tingling in shoulders or arms. He sent me for MRI of lower and mid back to rule out CSF leak.
My ortho gave me a week's worth of prednesone two weeks ago and that definitely helped. Also, when I take larazapane for MRI claustrophobia, symptoms almost completely disappear for a day or two.
Question for you: you mentioned anti-spasmatic (Elavil) but I thought you also mentioned another one that I could take during the day???
Thanks,
Don H.

Hi Don,
Based on what you are saying now, it sounds mostly spasmotic. Lorazapam will work well for spasms but I don't recommend daily use due to possible addiction.

We use Elavil for night, 2 hours before bed about 10mg, and Skelaxin 800mg during the day..3 doses during the day. Get to PT and keep the meds on board for 3-4 weeks to get the full effect.

Isn't it lovely getting old??
Mary Kay

Mary Kay,
Went to my dentist today for TMJ. I have some muscle spasm on left side where headache is located, and my bite was misaligned. He ground my teeth to get my bite aligned, but I am skeptical.
Read about Cervicogenic Headache today. I have a lot of the symptoms. Forehead and behind-the-eye pain on one side only. Stiffness in shoulders and neck with a great deal of popping and cracking in my neck when I move it. I sit in front of a computer screen all day and have very poor head posture. Also, I almost always feel pretty good when I get out of bed in the morning and headache gets worse as the day progresses. If I lie down on my side with my head supported by a pillow, I get a fair amount of relief, frequently in just 5 or 10 minutes.
Are you familar with this type of headache?
Don

Hi Don,
Most migrainers have this and it is a form of tension type headache. You need to be on an anti-spasmotic for a few weeks and try physical therapy. The med I recommmend is low dose elavil (amitripytyline) at night as it helps relieve TMJ also.

Massage therapy helps. Take frequent breaks from the computer and do stretches...
Mary Kay


Mary Kay,
Had MRI and MRA and both were negative, thankfully! Thank you so much for your prompt response.
As we have eliminated various possibilities: sinus, migraine, tumor, aneurysm, I have become convinced this is tension-muscle related, perhaps even TMJ for a number of reasons:
1)Though I don't have obvious soreness around the joint, the headaches follow almost a daily pattern: wakeup in the morning headache free, get worse as I progress through the work day, and then get a bit better before I go to bed. Lying down on my side with my head supported by a pillow is the only thing that will take it away. I realize this is not classic TMJ, which frequently comes from grinding teeth at night, but what am I doing during the day? Talking and eating, things that stress the jaw. Last week I had a large, 3 inch-round burrito for lunch. Head felt pretty good before I started, but once I was done I was in pain. The only 2 pain free days I have had in the past month were 2 Sundays where I did nothing but hang out around the house talking to no one all day.
2) I can only open my mouth about 1 1/2 inches comfortably (and I'm not a small person, 6 ft tall with a size 8 hat.) I have a fair amount of clicking when I move my jaw and certain jaw movements definitely creat pain in my left temple where most of the headache is. I also have tinnitus and neck and shoulder stiffnes and a great deal of cracking when I move my neck.
My GP has pooh-poohed TMJ, but I am seeing a dentist who specializes in TMJ next week and we'll go from there.
Thanks for all you help.
Don

Hi Don..well that was going to be my next guess..musculoskelatal. Either Amitriptyline 10mg 2 hrs before bed or tizanadine 2-4 mg before bed would help also. Both are anti-spasmotics that will help prevent the grinding at night.
Good luck..glad the imaging was negative and that yes..you do indeed have a brain!
Mary Kay

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DAILY HEADACHES

by P. DINGUS
(VA)

Source of Daily Headache

Source of Daily Headache

MY 15 YR OLD DAUGHTER HAS A HEADACHE EVERY DAY--MOST DAYS
THEY ARE REAL BAD. I HAVE BEEN GETTING HER CHECKEDD SINCE SEPT. BY OUR FAMILY DOCTOR--DONE A CAT SCAN AND THIS WAS GOOD--HAD HER EYES CHECKEDD--SHE DOES WEAR CONTACTS AND THERE WAS NO CHANGE IN VISION--GETTING HER CHECKED AGAIN BY DOCTOR AND HAS BEEN PUT ON NAPROXYN.

I DON'T UNDERSTAND THE HEADACHES--WE HAVE WROTE DOWN HER DAILY FOOD CONSUMPTION SINCE SEPT. --CHANGED DRINKING HABITS--WATCHED EVERYTHING I KNOW TO WATCH. YOU CAN TELL BY LOOKING AT HER SHE DOESN'T FEEL WELL--GET REAL PALE IN THE FACE, HAS TREMBLES SOMETIMES AND GETS SICK SOMETIMES--THROWING UP.

HOW CAN I STOP HER HEADACHE?

Answer:

Hi,

First of all I am sorry your daughter has been in pain this long. I am glad to hear that the CT was normal and I am assuming in addition to the eye exam, her physical exam has been normal too.

Daily headache can be complex as usually there is more than one type of headache involved. First of all she needs to stop all use of anti-inflammatories if taking them more than three times a week. This means the naproxyn, and any over the counter meds such as excedrin, tylenol, sudafed etc. These drugs lead to a condition known as anagesic rebound headache.

Make sure to have the neck evaluated too..many times I am surprised at how many teenagers have stiff muscles in the neck..worse than adults! This sends a feedback to the brain which causes pain and even triggers migraine.

Having said that, if she is throwing up, some part of this is migrainous. Unfortunately, many physicians are afraid to give migraine medications (such as Imitrex)to teens. These are very appropriate if the diagnosis is migraine and her weight is over 110 lbs.

So what can you do as a parent? Sounds like you are on the right track..keep a diary of triggers, look at her stress factors too..exams in school, peer pressure. Are any of the severe headaches tied to her menstrual cycle?

If she can tolerate vitamin therapy, we put all our patients on the migraine formula of B2, feverfew and magnesium.

Finally, I would recommend you take your daughter to a neurologist, preferably one who specializes in headache. Daily headache that is more than six months long needs to be treated with appropriate headache medications. The good news is that teens respond quickly to treatment, usually only need a few months of therapy. Ask your doctor for a recommendation or start searching around in your area. Many adult neurologtists will see a teen and you may not have to go to a pediatric neurologist unless you prefer to.

Good luck!

Mary Kay Betz MS RPA-C

COMMENTS:

Thank you for your time.

P. Dingus


No problem..hope it helped.
Mary Kay

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