Chronic Daily Headache

by Elizabeth
(Ontario, CA, USA)

I received a dural puncture 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