Persistent Mild Headaches: Causes and Next Steps

Q: Persistent Mild Headaches: Causes and Next Steps

Hello： 1. The symptoms you described are likely due to muscle-related pain, and you may need to consider myofascial issues. 2. Is it possible to have slight discomfort in the neck and shoulders while experiencing continuous head pain? My understanding is that

Mild headache for 50 consecutive days?

Hello Doctor, I have been experiencing mild headaches for the past 50 days.
The pain occurs approximately every 5 minutes, lasting for about 1 second each time, and it is almost continuous throughout the day.
However, I sleep well at night.
The pain is located around my temples, eye sockets, and just above my ears (the bony areas of my skull).
When I touch the painful areas, I can feel that the muscles there are tender to the touch.
Should I conclude that this is muscle-related headache?
Additionally, I previously visited a large hospital where the doctor prescribed me a 5-day course of muscle relaxants and anti-inflammatory pain medication.
After completing the medication, my condition improved for a couple of days but then relapsed and has persisted until now.
I also consulted a rehabilitation specialist who mentioned that my neck and shoulders are not overly tense, which I also feel is the case.
Although I sometimes experience mild soreness, it does not usually bother me unless it triggers a headache.
Today, I visited another doctor at a large hospital who performed some physical examinations and stated that I do not have any significant issues.
He mentioned that experiencing some pain is normal.
I feel that if the pain were in my arms or legs, it could be easily ignored, but even a slight headache is uncomfortable and makes me feel frustrated and unmotivated.
He prescribed me medication for anxiety, but I believe I am quite happy in my life.
I am about to graduate from university, and my daily routine consists of waking up, watching TV, and playing sports.
I have no assignments or stress.
I would like to ask the doctor:
1.
Should these symptoms be considered muscle-related pain?
2.
Is it possible to have only mild soreness in the neck and shoulders while experiencing continuous headaches? My understanding is that if the headache is severe, the neck and shoulders must be significantly tense.
3.
Are there other potential causes for my head muscle issues?
4.
I have seen many doctors, and if the anxiety medication does not improve my condition, what should my next steps be?
Thank you, Doctor, for taking the time to read all of this.
I am increasingly overwhelmed and starting to question whether I should see a psychiatrist.
Waking up every day to face a whole day of headaches without knowing when it will get better is disheartening, and I feel lost.
I hope you can help me.

Mr. Zhang, 20~29 year old female. Ask Date: 2018/07/02

Dr. Jiang Junyi reply Neurology

Hello:
1.
The symptoms you described are likely due to muscle-related pain, and you may need to consider myofascial issues.

2.
Is it possible to have slight discomfort in the neck and shoulders while experiencing continuous head pain? My understanding is that for head pain to occur, the neck and shoulder discomfort must be quite severe.

3.
Are there other potential causes for my head muscle issues? The small muscles adjacent to the cervical spine connect to the head, while the larger superficial muscles in the neck and shoulders are used during significant movements.
It is possible to experience occipital headaches that are more intense than neck and shoulder discomfort.

For treating such issues, medications only alleviate symptoms; anxiolytics do not directly address pain.
The key lies in prevention.
You mentioned watching television, which can lead to overuse of the neck muscles.

1.
Change positions: Alter your posture every 15 minutes to allow the neck tissues to rest.
Any posture (including normal ones) maintained for a prolonged period can lead to fatigue and inflammation, so moving around briefly can reduce the chances of muscle inflammation.

2.
Rest: Resting allows the muscles to utilize their self-repair capabilities, and vigorous exercise should be avoided during this time.

3.
Neck heat therapy: Apply heat for 15 to 20 minutes, ensuring the temperature is safe to avoid burns.

4.
Non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants: For individuals without a history of peptic ulcers, allergies to NSAIDs, or normal kidney function, consider using NSAIDs to reduce inflammation and alleviate pain as needed.

5.
Neck muscle stretching exercises: After the acute pain phase, develop a habit of performing slow, gentle neck stretches every 15 to 20 minutes at angles that do not cause discomfort, including movements up, down, left, and right.

I recommend discussing examination and treatment options with a neurologist or a rehabilitation specialist.
Wishing you good health, peace, and happiness.

Dr.
Jiang from Taoyuan Hospital cares about you.

Reply Date: 2018/07/02

More Info

Persistent mild headaches can be quite distressing, especially when they linger for an extended period, as you have described. Based on your symptoms and the history you've provided, let's break down your concerns and explore potential causes and next steps.

1. Muscle-Related Pain: Given that you experience pain in specific areas such as the temples, around the eyes, and behind the ears, and that pressing on these areas elicits soreness, it is reasonable to suspect that your headaches may be tension-type headaches. These headaches are often associated with muscle tension in the neck and scalp, which can be exacerbated by poor posture, stress, or prolonged periods of inactivity, such as sitting for long hours while watching TV or playing sports.

2. Shoulder and Neck Tension: It is indeed possible for mild tension in the shoulders and neck to lead to headaches, even if the tension does not feel severe. The muscles in the neck and shoulders can refer pain to the head, causing discomfort. This phenomenon is known as referred pain. Therefore, even if your neck and shoulder muscles are not severely tight, they can still contribute to your headache symptoms.

3. Other Potential Causes: While muscle tension is a common cause of headaches, other factors could also be at play. These include:
- Cervicogenic Headaches: These originate from issues in the cervical spine or neck, which may not always present as significant tightness but can still lead to headaches.

- Migraine or Tension-Type Headaches: If you have a history of migraines, they can sometimes present as mild, persistent headaches. Tension-type headaches are also very common and can be triggered by stress, fatigue, or environmental factors.

- Sinus Issues: If you have any underlying sinus congestion or inflammation, this could also lead to referred pain in the head.

- Stress and Anxiety: Psychological factors can manifest physically, leading to muscle tension and headaches. Even if you feel generally happy, underlying stressors can still affect your body.

4. Next Steps: Since you have already consulted multiple healthcare providers and have undergone various examinations, it may be beneficial to consider the following:
- Neurologist Consultation: If you haven't already, seeing a neurologist could provide further insights. They can conduct more specialized tests to rule out any neurological conditions.

- Physical Therapy: Engaging in physical therapy may help alleviate muscle tension and improve posture, which could reduce headache frequency and intensity.

- Cognitive Behavioral Therapy (CBT): If anxiety is a concern, even if you feel happy, CBT can help manage stress and anxiety, which may contribute to your headaches.

- Lifestyle Modifications: Incorporating regular exercise, maintaining good hydration, ensuring adequate sleep, and practicing relaxation techniques such as yoga or meditation can be beneficial.

- Medication Review: If the anxiety medication does not yield improvement, discussing alternative treatments with your physician may be necessary.

In conclusion, while muscle tension is a likely contributor to your headaches, it is essential to consider a comprehensive approach that includes both physical and psychological aspects. Persistent headaches can be frustrating, but with the right strategies and support, you can find relief and improve your quality of life. If your symptoms persist despite these efforts, do not hesitate to seek further medical advice.

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