Chronic Headache for Over a Month: Possible Causes and Solutions

Headache lasting more than one month?

Hello doctor, on August 14, I had sashimi and other raw foods.
On the morning of August 16, I started experiencing sharp pain in the left back of my head, which came in waves.
A couple of days later, I developed cold symptoms, including a sore throat and runny nose with yellow mucus.
I went to a clinic and the doctor said it might be caused by a cold virus.
The pain subsided after taking painkillers, but it would return if I stopped taking them.
Two weeks later, the cold symptoms improved, but the headache persisted, evolving into a dull, continuous pain in the left back of my head, accompanied by sudden onset of generalized weakness.
Pressing on a specific point in the left back of my head would cause pain, which would shift, but it wasn't severe enough to require painkillers (I have been taking traditional Chinese medicine).
After September 11, the pain shifted to my forehead, brow bone, and temples (the right side would also hurt), and my eyes felt strained.
The frequency of pain changed from daily to 3-4 days a week.
Starting September 15, both my forehead and the left back of my head would hurt, and I began taking painkillers twice a day.
On September 17, the pain shifted to my brow bone, and I also experienced throat pain.
Sometimes my head feels swollen and uncomfortable.
I have been continuously taking traditional Chinese medicine, and the pain has been intermittent for over a month, with symptoms fluctuating.
I am hesitant to take anti-inflammatory painkillers due to concerns about kidney function.
What could be the possible cause of these symptoms? Thank you, doctor!

lu, 40~49 year old female. Ask Date: 2017/09/18

Dr. Jiang Junyi reply Neurology

Based on your description, the most common cause is tension-type headache.
The recurrent pain may be due to significant temperature fluctuations recently, which have led to many individuals experiencing repeated viral infections.
The symptoms of tension-type headache include: (1) Typically bilateral, located in the occipital and parietal regions, sometimes with a widespread area of pain.
The nature of the pain is dull, aching, pressure-like, or tight, without pulsation.
There may be tightness and stiffness in the occipital and cervical regions, 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 hard nodules, known as myofascial trigger points, may sometimes be palpable.
(3) The headache does not interfere with daily activities; for example, walking or climbing stairs does not exacerbate the pain.
(4) Fatigue, tension, excitement, anxiety, insomnia, or depression can worsen the headache.
Bending the head forward and backward may trigger pain.
Regarding your concern about pain medications potentially burdening the kidneys, the metabolic pathways vary with different medications.
Some medications place minimal burden on the kidneys.
It is advisable to consult a neurologist or a rehabilitation specialist for further evaluation and follow-up.
Wishing you peace and joy.

Reply Date: 2017/09/18

More Info

Chronic headaches can be a complex issue, especially when they persist for over a month and are accompanied by various symptoms. Based on your description, it seems that your headaches began after consuming raw fish and cold foods, followed by cold-like symptoms such as a sore throat and nasal discharge. Initially, your headaches were intermittent and responsive to pain medication, but they have since evolved into a more chronic condition with varying locations and intensities of pain.

Possible Causes
1. Post-Viral Headaches: It is possible that your initial cold symptoms were caused by a viral infection, which can sometimes lead to post-viral headaches. These headaches can persist even after other symptoms have resolved, as the body continues to react to the viral infection.

2. Tension-Type Headaches: Given the chronic nature of your headaches and their response to stressors, tension-type headaches could be a contributing factor. These headaches are often characterized by a dull, aching pain and can be exacerbated by stress, poor posture, or prolonged periods of inactivity.

3. Sinusitis: The presence of yellow nasal discharge and facial pain, particularly around the forehead and eyebrows, raises the possibility of sinusitis. This condition can cause headaches that are often felt in the forehead, cheeks, and around the eyes, and may be accompanied by other symptoms such as nasal congestion and facial pressure.

4. Migraine: Your symptoms, including the unilateral nature of some headaches and the associated symptoms of nausea and sensitivity to light, suggest that migraines could also be a possibility. Migraines can be triggered by various factors, including dietary choices, stress, and environmental changes.

5. Medication Overuse Headaches: If you have been taking pain medications frequently, there is a risk of developing medication overuse headaches. This occurs when pain relief medications are taken too often, leading to a cycle of increased headache frequency and severity.

Recommendations for Management
1. Consult a Neurologist: Given the duration and complexity of your symptoms, it is advisable to consult a neurologist. They can perform a thorough evaluation, which may include imaging studies such as an MRI or CT scan to rule out any serious underlying conditions.

2. Keep a Headache Diary: Documenting your headaches can help identify triggers and patterns. Note the frequency, duration, intensity, and any associated symptoms. This information can be invaluable for your healthcare provider.

3. Lifestyle Modifications: Consider implementing lifestyle changes that may help reduce headache frequency. This includes maintaining a regular sleep schedule, staying hydrated, managing stress through relaxation techniques, and avoiding known dietary triggers.

4. Physical Therapy: If tension-type headaches are suspected, physical therapy may help. Techniques such as massage, stretching, and posture correction can alleviate muscle tension and reduce headache frequency.

5. Alternative Therapies: Some patients find relief through alternative therapies such as acupuncture, biofeedback, or cognitive-behavioral therapy. These approaches can help manage stress and improve coping strategies.

6. Medication Review: Discuss your current medications with your healthcare provider. They may suggest alternatives that are less likely to affect kidney function or explore preventive medications for chronic headaches.

7. Avoid Overuse of Pain Medications: While it may be tempting to rely on pain medications, overuse can lead to more frequent headaches. Work with your doctor to find a balance that minimizes pain without leading to dependency.

Conclusion
Chronic headaches can stem from a variety of causes, and understanding the underlying factors is crucial for effective management. A comprehensive approach that includes medical evaluation, lifestyle changes, and possibly alternative therapies may provide relief. It is essential to work closely with your healthcare provider to develop a tailored treatment plan that addresses your specific symptoms and concerns.

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