Chronic Headaches and Back Pain: Seeking Solutions for Relief

Severe headache and lower back pain?

I have been experiencing chronic headaches (since kindergarten, and they have been getting worse).
I previously underwent a brain scan at Gengxin Hospital and an MRI at Taipei Heping Hospital, both of which reported no issues and diagnosed me with migraines.
I have changed hospitals twice and have been seeing a neurologist at Heping Hospital for almost two years, trying countless medications without improvement.
Recently, the situation has worsened, and I am considering whether to switch hospitals for treatment.

The headache episodes include symptoms such as (sharp pain, throbbing pain, pain radiating inward from the eye sockets, eye pain, pain in the back of the head, temple pain, unilateral pain, and pain starting from the center of the top of the head).
Sometimes the pain frequency synchronizes with my pulse: 1.
During the most severe episodes, I cannot sleep (I feel like I want to throw myself on the floor; painkillers are ineffective; I have taken 7 to 8 extra-strength acetaminophen tablets without relief).
During moderately severe episodes, painkillers do not work, and I experience nausea and vomiting (vomiting bile when there is nothing left in my stomach); during mild pain, I can manage it with painkillers.
2.
The hospital has prescribed medications such as Erenumab, Sumatriptan, Topiramate, Entacapone, and Tizanidine, but none have improved my condition.
3.
There are no warning signs before the pain, and sleeping does not help; I have experienced sudden attacks at night that caused me to wake up and vomit.
4.
There is no fixed pattern for the attacks, with the longest episode lasting up to three days of severe pain.
5.
I have been in a car accident once, slipped once, and hit my head twice, resulting in two concussions.
I also want to ask about my lower back issues.
I previously had a herniated disc, and the doctor said it has healed, but I experience severe pain in my lower back whenever I stand for long periods, walk a lot, or sit for extended periods.
Should I consider seeing an orthopedic specialist?

Chen, 20~29 year old female. Ask Date: 2020/04/26

Dr. Chen Bozhang reply Family Medicine

Dear Ms.
Ko83277,
The long-term headache symptoms you described appear to be indicative of severe chronic migraine, which significantly impacts your daily life.
If treatment at one hospital has not been effective, you might consider seeking a second opinion at another neurology clinic, as different medication regimens can yield varying results.

Additionally, I recommend monitoring potential triggers for your migraine attacks, including dietary factors, seasonal changes, stress, and menstrual cycles, and try to avoid these triggers as much as possible to reduce emotional and lifestyle stress.
Supplementing with B vitamins may also help stabilize your nervous system.
Regarding your lower back pain, prolonged standing or sitting can lead to severe discomfort.
It would be advisable to consult a neurosurgery clinic to assess for any possible compression of the lumbar or sacral nerves for further management.
Best regards.

Reply Date: 2020/04/26

More Info

Chronic headaches, especially those that have persisted since childhood, can be incredibly debilitating and frustrating. Your description of the pain—ranging from sharp, stabbing sensations to a dull ache, along with associated symptoms like nausea and vomiting—suggests a complex interplay of factors that may be contributing to your condition. Given your history of migraines, previous head injuries, and ongoing back pain, it’s essential to approach this issue holistically.

Understanding Your Headaches
1. Migraine Characteristics: Migraines can manifest in various ways, including throbbing pain, sensitivity to light and sound, and nausea. The fact that your headaches have been worsening and are accompanied by symptoms like eye pain and nausea indicates that they may still be migraine-related. The frequency and severity you describe, especially with pain that correlates with your pulse, are classic migraine symptoms.

2. Tension-Type Headaches: Given your long history of headaches, it’s also possible that you may be experiencing tension-type headaches, which are often triggered by stress, poor posture, or muscle tension. These headaches typically present as a tight band-like sensation around the head and can be exacerbated by prolonged sitting or standing.

3. Post-Traumatic Headaches: Your history of head trauma, including concussions, could also contribute to chronic headaches. Post-traumatic headaches can develop after a head injury and may resemble migraines or tension-type headaches.

Back Pain Considerations
Your mention of back pain, particularly after prolonged periods of standing or sitting, suggests that there may be underlying musculoskeletal issues. Chronic back pain can often lead to tension in the neck and shoulders, which can, in turn, exacerbate headache symptoms.
1. Disc Issues: Given your history of a herniated disc, it’s crucial to monitor your back pain closely. While you mentioned that it has healed, any recurrence of pain warrants further evaluation.
2. Posture and Ergonomics: Poor posture, especially during long hours of sitting or standing, can lead to muscle strain and tension, contributing to both back pain and headaches. Ergonomic adjustments to your workspace and regular breaks to stretch and move can be beneficial.

Recommendations for Relief
1. Comprehensive Evaluation: Since you have seen multiple specialists without significant improvement, consider seeking a multidisciplinary approach. This could include consultations with a neurologist, pain management specialist, and physical therapist. A fresh perspective may help identify underlying issues that have been overlooked.

2. Medication Review: It seems you have tried various medications without relief. It may be worth discussing with your doctor the possibility of preventive treatments specifically for migraines, such as CGRP inhibitors or other classes of medications that may not have been tried yet.

3. Lifestyle Modifications: Implementing lifestyle changes can significantly impact headache frequency and severity. This includes:
- Regular Exercise: Engaging in regular physical activity can help reduce stress and improve overall well-being.

- Stress Management: Techniques such as mindfulness, yoga, or cognitive behavioral therapy can help manage stress, which is a common trigger for headaches.

- Sleep Hygiene: Establishing a regular sleep schedule and creating a restful environment can improve sleep quality, which is crucial for headache management.

4. Physical Therapy: A physical therapist can work with you on exercises to strengthen the muscles supporting your neck and back, improve posture, and reduce tension that may be contributing to your headaches.

5. Alternative Therapies: Some individuals find relief through acupuncture, chiropractic care, or massage therapy. These modalities can help alleviate muscle tension and improve circulation.

When to Seek Further Help
If your headaches continue to worsen or if you experience new symptoms, such as changes in vision, difficulty speaking, or weakness, it’s essential to seek immediate medical attention. Additionally, if your back pain becomes debilitating or limits your daily activities, a visit to an orthopedic specialist may be warranted.

In summary, managing chronic headaches and back pain often requires a multifaceted approach. By exploring various treatment options and making lifestyle adjustments, you may find a combination that provides relief and improves your quality of life.

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