Sudden Severe Headaches in Long-Term Sufferer: Possible Causes and Next Steps

Chronic headache with sudden onset of severe pain?

My mother has been suffering from chronic headaches for about 20 years, experiencing pain almost every day.
On some days, she takes 4-6 tablets of acetaminophen (Tylenol).
However, from April 13 to April 17, she has been experiencing severe pain daily.
According to her, the previous headache sensation was like an explosive pain, primarily located at the top of her head or temples, which could be alleviated by taking acetaminophen.
Recently, the pain has changed to a sensation akin to tearing blood vessels, accompanied by photophobia and vomiting, with the pain now located at the back of her head, and acetaminophen is ineffective.
Additionally, on April 12, my mother visited a large hospital's endocrinology department and was diagnosed with polycystic ovary syndrome (PCOS) and started taking a medication called Metformin (brand name: Glucophage), taking two tablets daily in the morning and evening.
After taking the medication for one day, she began experiencing the aforementioned severe pain, so she stopped taking it.
We are unsure if this is related.
I would like to ask: 1.
What could be the cause of this? 2.
Should she see a neurologist? Thank you!

ruru, 40~49 year old female. Ask Date: 2016/04/17

Dr. Jiang Junyi reply Neurology

Hello, based on your description, your symptoms are likely indicative of a migraine.
This type of headache can last from 4 to 72 hours.
The characteristics of the headache include unilateral pain, which may feel like throbbing or pulsating, often accompanied by nausea and vomiting, and sensitivity to light and sound.
Additionally, activities such as walking, climbing stairs, or moving the head can exacerbate the pain.
Many patients require analgesics or preventive medications to assist with management.

In addition to pharmacological treatment, lifestyle adjustments are also crucial.
Establishing good habits, maintaining a regular schedule, ensuring adequate but not excessive sleep, avoiding overexertion, and managing stress are important.
Some individuals may have specific triggers, such as certain foods, alcohol, drastic temperature changes, or moving in and out of air-conditioned spaces during hot weather; avoiding these situations can help prevent migraines.
Metformin rarely triggers migraines clinically, so it may be necessary to consider other potential triggers.
If you find yourself using analgesics more than 10 times a month, it is advisable to consult a physician about preventive medications.
I recommend that you see a neurologist to discuss evaluation and treatment options.
Wishing you good health and peace.

Reply Date: 2016/04/17

More Info

Sudden severe headaches, especially in someone with a long history of headaches, can be concerning and warrant immediate medical attention. Given your mother's situation, where she has experienced chronic headaches for about 20 years and is now facing a significant change in the nature and intensity of her pain, it is crucial to consider several factors.

1. Change in Headache Characteristics: The recent description of her headaches as feeling like they are "tearing blood vessels" and accompanied by symptoms such as photophobia (sensitivity to light) and nausea is particularly alarming. These symptoms could indicate a more serious underlying condition, such as a migraine with aura or even a secondary headache disorder, which could be due to increased intracranial pressure or other neurological issues.

2. Medication Considerations: The timing of her new medication, Metformin, and the onset of these severe headaches is noteworthy. While Metformin is primarily used for managing blood sugar levels in patients with type 2 diabetes and polycystic ovary syndrome (PCOS), it is not typically associated with headaches. However, any new medication can have side effects or interactions that might exacerbate existing conditions. It’s essential to discuss this with her healthcare provider to determine if the medication could be contributing to her symptoms.

3. Possible Causes: There are several potential causes for her sudden severe headaches:
- Migraines: If her headaches have evolved to include nausea and sensitivity to light, they may be migraines. Migraines can change in frequency and intensity over time and can be triggered by various factors, including hormonal changes, stress, and certain medications.

- Tension-Type Headaches: Given her long history of headaches, tension-type headaches could still be a factor, but the recent severity suggests a need for further evaluation.

- Secondary Headaches: Conditions such as intracranial hypertension, subarachnoid hemorrhage, or other serious neurological conditions should be ruled out, especially given the sudden change in her headache pattern.

4. Next Steps: Given the severity and change in her headache pattern, it is advisable to seek immediate evaluation from a neurologist. A neurologist can perform a thorough assessment, which may include:
- A detailed medical history and physical examination.

- Imaging studies such as a CT scan or MRI of the brain to rule out any structural abnormalities or other serious conditions.

- Blood tests to check for any underlying metabolic or systemic issues.

5. Management and Treatment: Depending on the diagnosis, treatment may vary. If it is determined that she is experiencing migraines, preventive medications may be prescribed, along with acute treatments for when headaches occur. Lifestyle modifications, such as stress management techniques, regular sleep patterns, and dietary adjustments, can also be beneficial.

In conclusion, your mother's recent severe headaches, especially given their change in nature and accompanying symptoms, should be taken seriously. It is crucial to consult a neurologist as soon as possible for a comprehensive evaluation and appropriate management. Early intervention can significantly improve outcomes and quality of life for individuals suffering from chronic headache disorders.

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