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Headaches for 6 weeks

by J
(Greensburg, PA)

Migraine Activation Through Neck Pain

Migraine Activation Through Neck Pain

Hi,

I have been having headaches daily for the past 6 weeks. It started with a coital headache right at orgasm and then went away. I am a very active 33-year-old mother of 3 young children. I take spinning classes at least 2x a week, jog 1x a week and participate in strength training. The headache returned the following day again during relations and then hung on mildly. I also had this headache during a strength training routine.

I visited my PCP, who ordered tests. While waiting for auth, I had what now I believe to be an anxiety attach and was seen in the ER. They ordered a CT scan with and without contrast, chest x-ray, EKG and a panel of bloodwork, which was all normal. Two days later I had a the MRI with and without contrast and MRA performed, which were normal.

My PCP still not sure what's going on admitted me as observation so I could be seen by neurologist. (The wait time here was 5 weeks to get an appt.) While there, I had another panel of bloodwork and urinalysis, which was normal. The neurologist ordered a steroid in the IV, which was ineffective. The neurologist believes I am suffering from migraines. My PCP believes the migraines are related to tension headaches.

I have also been seen by a chiropractor but that made it worse. The headaches are daily and are not accompanied by nausea, vomiting or visual disturbance. I only suffered from light and noise sensitivity a few times.

I now have neck pain that radiates to my shoulders at times and up the back sides of my head behind my ears. During my exertion headaches, I have had throbbing behind my left ear. I was instructed to 'give my brain a break' but now have been released to mild to moderate activity.

I have been on Inderal LA 60 mg 1x a day since mid July. I must add that the week leading up to the onset my husband, healthy 34-year-old, had walking pneumonia and my 14-year-old dog was having seizures and started on phenobarb. Both doctors believe that stress brought this on and now the headaches have set in.

I tend to wake in the morning with a mild headache and have had occasional ear ringing. The pain moves from side to side and top to back. There is very little consistency of the pain location or severity. It is usually dull but has been sharp. It is usually pressure like with a burning sensation at times. It has only encompassed by entire head a few times. I have been tried on Flexeril and Melaxicam together, Lortab, Toradol and naproxen, all at different times and nothing has been effective.

I can't help but think they are missing something. How can a very healthy young woman go from being active to this? It's very depressing. Any insight or thoughts would be greatly appreciated.
Thank you for your time.

J

Answer

Hi,

Well I am glad you had such a thorough work up. The MRI and MRA were appropriately done to rule out aneurysm which can be uncovered by a headache during sex.

Like most headache patients, you sound as if stress did kick the headache off, but you do have a mixed headache syndrome. Benign coital headache can be a form of moderate to severe tension type headache. However, spasming at the back of the head can kick off a migraine (see photo at top of post).

A related type of headache is headache after exercise. Hydration before exercise, naprosyn before exercise and propranolol can all help prevent this.

The daily headache now sounds like status migrainosus and I would recommend a low dose of either Topamax or Depakote but you need to talk to the neurologist. Either can be taken with the propranolol. You also might benefit from a triptan if this is a migraine. Sometimes I will give a patient Frova twice a day for 3 days to break a headache as it is a long acting triptan.

Finally..the propranolol could go up a bit to 80mg or 120 if you are not having problems. Also, ask to have your Vitamin levels checked as Vit D deficiency causes spasms (tension headache) and 20% of migraineurs get better when Vitamin B12 deficiency is corrected.

Good luck!

Mary Kay Betz MS RPA-C

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