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Chronic Migraine or Chronic Tension Type Headache?


Hello,

I wrote you earlier: "migraine medications and how long for meds to work?". I am still not sure what type of headache I have. It's constant, ~4-5 (of 10) in severity, but it's not pulsating/throbbing. Pain is felt in top and top-back of my head and very often in right eye.

My mother had similar headaches and main in her right eye, but not constant (3-4 days a week) for 3 years. No migraine-like attacks at all, but sometimes pain in my right eye gets higher. Mirtazapine 30mg, amitriptyline (starting from 25mg, stopped with 125mg), lexapro 10mg, nebivolol 5mg, magnesium glycinate/malate 1g, divalproex sodium 750mg for at least 3 months didn't help. I've tried dexamethasone for 3 weeks (8mg for 2 weeks, then 4 mg for 1 more week), during that time I felt strong pain in both of my eyes and it didn't help headache at all.

Chronic headaches are not responsive to triptans (cannot try them during attacks, because I have no migraine attacks at all). When headaches started 2 years ago, they were episodic, but not pulsating, my both eyes were very painful for ~10 days, and almost always computer/reading was a trigger for bilateral headaches (however, they do not make the headache worse now), my head was like a full of "rubbish", hard to explain. All tests (including MRI) are done, everything seems to be okay. I suffer from Raynaud's (but last time I experienced a white finger (which is always the same) is ~1 year ago), have MVP and Gilbert's syndrome, but I feel nothing from there syndromes :)

From blood tests, homocysteine is a bit higher than it should be (17.8 ╬╝mol/L), but my GP said there is nothing to worry about and it's not the cause. Do you think it's CM or CTTH(chronic migraine or chronic tension type headache)? Latest studies show that CTTH might be genetic too and I think it would be hard to believe to a doctor that a bilaterial, not pulsating, without vomting headache could be a migraine.

Thank you very much!!

Answer:

Hi,
You do present as an atypical case! Although there is a strong family history of headache, those cases also sound atypical. Have you seen a headache specialist yet? I would highly recommend that you do this. You did not list your location so I do not know if you are even in the US. None the less, talk to your doctor about a referral.

Other points to consider: we have been screening numerous patients for vitamin deficiencies and I have been surprised at some of the results. Although headache is listed as a symptom for both B12 and Vit D deficiency, some doctors seem to not believe this would impact an overall headache profile. I had two cases of CDH this month alone where the headaches disappeared after vitamin correction. (!) One patient had them for years and the other was a newer onset of 6 months of daily headache.

It is unusual that steroid would not help a headache syndrome which is why I am recommending you see a board certified headache specialist. I am hoping you do NOT have new daily persistent headache which is a difficult headache to treat. Also if it was cluster or paroxsysmal hemicrania, the steroids should have helped. Often a side effect of steroid is a little rebound edema in joints and muscles so that could explain the eye pain while on them.

Best of luck!
Mary Kay Betz MS RPA-C

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Does the scenerio above sound like you? If not, or if you think you need more information please read about different types of headaches to find out which type of headache you are experiencing.

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