Persistent Headaches: Causes, Symptoms, and Treatment Options

Pain in the temples and forehead, with a tight, throbbing sensation throughout the entire head, which worsens with pressure?

Hello, doctor.
At the beginning of April, a classmate who had just recovered from the flu invited me to dinner.
After I got home that night, I noticed a slight pain when I touched below my right ear.
Prior to that, I had also felt occasional sharp pains inside my right ear.
A couple of days later, the bone above my right ear suddenly hurt a lot, and pressing on it made it worse.
That week, I developed a fever of 38 degrees Celsius, had difficulty swallowing due to a sore throat, felt nauseous, and experienced severe headaches along with palpitations.
I consulted a retired doctor from a veterans' hospital who said I had a cold and anemia, and advised me to eat more nutritious food.
A neurologist ruled out meningitis, but even after the fever subsided, I still had headaches (from the top of my head to the back, with pain sometimes shifting).
I went back to the retired doctor, who said my lymph nodes were inflamed and my immune system was weak.
I have a history of purpura syndrome, which makes me prone to bleeding; my platelet count was measured at 180,000 when I was younger.
I cannot take steroids or aspirin for pain relief due to the risk of bleeding.
After some treatment, I started to feel better, but when I was uncomfortable, I could only take apple cider vinegar, pineapple enzymes, B6, and B12.
Now that I have been resting for a while and my cold has improved, I still experience headaches, which I have never had before.
The pain in the back of my head has improved somewhat, but if I get too tired, I feel a heavy, dull pain.
Recently, the pain has shifted to my temples and forehead, feeling like a tightness in the blood vessels and nerves.
It’s not a sharp pain, but pressing on it makes me feel uncomfortable.
The entire head feels tight and uncomfortable, and my neck is also affected, making me want to stretch my temples.
Additionally, when I turn my head to the left, I hear a slight popping sound.
What could be the issue? My throat has also been uncomfortable, and the headache persists.
I went to see an ENT specialist who examined my ears and mouth and mentioned a possible issue with my jaw joint, suggesting some inflammation of the ligaments.
He prescribed muscle relaxants and recommended blood tests to check for hyperthyroidism.
Are these related to my headaches? Is it bone pain or nerve pain? The ENT doctor mentioned that if the tests come back normal, it might be due to mental stress.
I tend to get anxious and worry a lot.
Should I get a CT scan? I have wisdom teeth growing, two on the top and two on the bottom at the back, and my dentist suggested they might be related to my headaches.
However, my immune system is weak right now, and I’m afraid of complications if I have them removed, even though the tooth pain is not severe.
I’m unsure where the problem lies.
Do I need a CT scan of my head? I’ve heard that the radiation exposure is high and can be harmful to the body.
This headache is affecting my daily life and mood, and I’m hesitant to take painkillers.
I hope you can help me.
Thank you.

Jenny, 20~29 year old female. Ask Date: 2016/05/07

Dr. Jiang Junyi reply Neurology

Based on your description, the more common causes are tension-type headache or cervical myofascial inflammation.
The symptoms of tension-type headache include: (1) Typically bilateral, located in the occipital and parietal regions, sometimes with widespread pain.
The nature of the pain is dull, aching, with a sensation of pressure or tightness, without pulsation.
There is tightness and stiffness in the occipital-cervical area, which is more pronounced when turning the neck, with intensity ranging from mild to moderate.
(2) There are tender points in the muscles at the pain site, and sometimes pulling the scalp can also elicit pain.
The muscles may feel stiff, and one or more nodules, referred to as myofascial trigger points, may be palpable.
(3) The pain does not interfere with daily activities; for example, walking or climbing stairs does not exacerbate the headache.
(4) Fatigue, tension, excitement, anxiety, insomnia, or depression can worsen the headache.
Pain may be triggered by flexion and extension of the head.
Regarding the advanced imaging you mentioned, it would be advisable to discuss this with a neurologist.
If there are no obvious neurological deficits, you may need to consider out-of-pocket expenses for the tests.
It is recommended to visit a neurology outpatient clinic for examination and follow-up.
Wishing you good health and peace.

Reply Date: 2016/05/07

More Info

Persistent headaches can be a complex issue, often stemming from a variety of causes, including tension, environmental factors, and underlying medical conditions. Based on your description, it appears that your headaches may be multifactorial, influenced by both physical and psychological elements.

Understanding Your Symptoms
1. Location and Nature of Pain: You mentioned that the pain radiates from the top of your head to the back and sometimes to the temples. This pattern is often associated with tension-type headaches, which are the most common form of headache. They can be triggered by stress, poor posture, or muscle tension in the neck and shoulders.

2. Associated Symptoms: The presence of ear pain, throat discomfort, and fever suggests that there may have been an underlying infection, possibly viral, which could have contributed to your initial symptoms. The fact that you experienced lymph node swelling indicates that your body was responding to an infection, which can also lead to headaches.

3. Medical History: Your history of thrombocytopenia (low platelet count) and purple spots (purpura) adds complexity to your situation. It’s crucial to avoid medications that could exacerbate bleeding risks, such as NSAIDs (non-steroidal anti-inflammatory drugs) or aspirin, especially if you have a history of bleeding disorders.

4. Muscle Tension and Jaw Issues: The mention of jaw pain and potential issues with the temporomandibular joint (TMJ) can also contribute to headaches. TMJ disorders can lead to muscle tension in the jaw and neck, which can radiate pain to the head.

Treatment Options
1. Medication: Since you have concerns about taking traditional pain relievers due to your medical history, it’s essential to discuss alternative options with your healthcare provider. Muscle relaxants, as prescribed by your ENT doctor, may help alleviate tension-related headaches. Additionally, certain supplements like magnesium may help reduce headache frequency and intensity.

2. Physical Therapy: Engaging in physical therapy can be beneficial. A physical therapist can provide exercises to strengthen neck muscles, improve posture, and reduce tension. They may also use techniques such as manual therapy to relieve muscle tightness.

3. Stress Management: Given your mention of emotional tension and anxiety, incorporating stress management techniques such as mindfulness, yoga, or cognitive-behavioral therapy (CBT) can be beneficial. These approaches can help manage the psychological aspects contributing to your headaches.

4. Dental Evaluation: Since you have wisdom teeth that may be causing discomfort, it’s worth discussing with your dentist whether they should be removed, especially if they are contributing to your headaches. However, ensure that any dental procedures are timed appropriately considering your current health status.

5. Diagnostic Imaging: Regarding your concern about a CT scan, it’s essential to weigh the risks and benefits. If your healthcare provider believes that there is a significant concern regarding structural issues in your brain or sinuses, imaging may be warranted. However, if your symptoms are consistent with tension-type headaches and there are no alarming signs (like neurological deficits), it may not be immediately necessary.

Conclusion
In summary, your persistent headaches likely stem from a combination of tension, potential TMJ issues, and possibly residual effects from a recent viral infection. It’s crucial to work closely with your healthcare providers to develop a comprehensive treatment plan that addresses both the physical and psychological aspects of your condition. Regular follow-ups and open communication about your symptoms and treatment responses will be key in managing your headaches effectively.

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