Persistent Headaches: Causes, Treatments, and When to Seek Help

Q: Persistent Headaches: Causes, Treatments, and When to Seek Help

Hello： Your symptoms may suggest a vascular headache. <br>Consider the following criteria： (a) recurrent migraine attacks that significantly affect the patient's quality of life or daily activities, with triggers ruled out, and appropriate use of acute treatment medications and l

Persistent headache

Hello Doctor,
On a certain day in May, I suddenly experienced a severe headache accompanied by nausea and the urge to vomit.
At that time, I was undergoing treatment in the obstetrics and gynecology department for recurrent candidiasis, and I had taken multiple courses of antibiotics and antifungal vaginal suppositories.
Since then, it is now nearly October, and the headache has not ceased.
I wake up every day with a persistent feeling of tightness and heaviness on both sides of my temples, and I also experience pain on the top of my head and at the back of my skull.
Bending forward makes my head feel even heavier, and there has not been a moment when the pain has stopped.
Occasionally, the pain intensifies (about three times a week or less), which slightly affects my work and daily life.
The feelings of nausea and vomiting are infrequent, occurring less than twice a week or not at all.
Pressing certain areas of my scalp feels sore, and my neck and shoulders are quite tense.
There is a slight abnormality in the angle of my cervical spine, which is straighter than normal (the doctor said this is due to poor posture).
I had taken corticosteroids for a week in the neurology department, and I have been taking pain relievers (acetaminophen), ibuprofen, and the anti-anxiety medication alprazolam for over three weeks now, but my symptoms have not significantly improved.
My EEG results were normal, and my doctor believes that my symptoms are due to anxiety and tension.
Indeed, I have been experiencing some work-related stress and frequent urination with lower abdominal pain (similar to interstitial cystitis, which I am also being treated for in the obstetrics and gynecology department), which has contributed to my anxiety.
However, my headache symptoms began in May, and the anxiety at that time may have been caused by the recurrent vaginal candidiasis from April to July of this year.

I would like to ask the doctor if there are other possibilities.
I came across a type of headache online called "new daily persistent headache," characterized by daily pain that does not respond to pain medication, and patients can clearly remember the day their headache first started.
This description closely matches my symptoms.
The article mentioned that antidepressants or anticonvulsants could be effective treatments.
I would like to know if the doctor has any knowledge about this, as when I explained my situation to my doctor, he believed it was due to anxiety and tension and that I likely do not need antidepressants.
Alternatively, do you think I should try antidepressants or require further examinations, such as a CT scan? Thank you very much for your response!

Nìmíng, 20~29 year old female. Ask Date: 2020/10/26

Dr. Jiang Junyi reply Neurology

Hello: Your symptoms may suggest a vascular headache.
Consider the following criteria: (a) recurrent migraine attacks that significantly affect the patient's quality of life or daily activities, with triggers ruled out, and appropriate use of acute treatment medications and lifestyle modifications; (b) frequent migraine attacks occurring more than 4 times per month, or on more than 8 days per month, indicating a potential progression to chronic migraine; (c) failure of acute treatment medications, contraindications, or overuse; (d) the patient's personal desire to minimize the frequency of attacks as much as possible; (e) specific forms of migraine.
Preventive medications may be considered, including β-blockers, antidepressants, or antiepileptic drugs.
Neurologists who are members of headache medicine societies are more familiar with these conditions, and I recommend seeking such specialists.
Wishing you good health, peace, and happiness.
Dr.
Jiang from Taoyuan Medical Center cares about you.

Reply Date: 2020/10/26

More Info

Persistent headaches can be a significant source of discomfort and can greatly affect one's quality of life. Based on your description, it seems that you have been experiencing ongoing headaches since May, characterized by a tight, heavy sensation around the temples, top of the head, and back of the skull. You also mentioned that these headaches are accompanied by nausea and occasional vomiting, although these symptoms are infrequent. Additionally, you have noted muscle tension in your neck and shoulders, as well as some postural issues.

There are several potential causes for your persistent headaches, and it is essential to consider both primary and secondary headache disorders. Primary headaches, such as tension-type headaches and migraines, are not caused by underlying medical conditions. In contrast, secondary headaches are symptomatic of other health issues, which could include medication overuse, infections, or structural problems in the brain.

Given your history of recurrent vaginal yeast infections and the use of antibiotics, it is possible that your headaches could be related to medication overuse, particularly if you have been taking pain relievers frequently. Overuse of analgesics can lead to rebound headaches, which can perpetuate the cycle of pain. It is crucial to evaluate your medication regimen and consider tapering off any overused medications under the guidance of your healthcare provider.

Your symptoms also suggest that tension-type headaches could be a significant factor. These headaches are often triggered by stress, anxiety, and poor posture, which can lead to muscle tension in the neck and shoulders. Since you mentioned experiencing increased anxiety and tension due to work-related issues and other health concerns, it is plausible that these factors are contributing to your headache symptoms.

The condition you referenced, "new daily persistent headache," is characterized by a sudden onset of daily headaches that persist without relief. This condition can be challenging to treat and may require a multidisciplinary approach, including medications such as antidepressants or anticonvulsants, which have been shown to be effective in some cases.

In your situation, it may be beneficial to explore the following options:
1. Consult a Neurologist: Since your symptoms have persisted for several months and have not improved with current treatments, it may be worthwhile to seek a second opinion from a neurologist. They can conduct a thorough evaluation, including imaging studies like a CT scan or MRI, to rule out any structural abnormalities or secondary causes of your headaches.

2. Consider Medication Adjustments: Discuss with your healthcare provider the possibility of adjusting your current medications. If you are experiencing rebound headaches, it may be necessary to taper off pain relievers and explore preventive medications, such as antidepressants or anticonvulsants, which can help manage chronic headache conditions.

3. Lifestyle Modifications: Implementing stress management techniques, such as cognitive-behavioral therapy, mindfulness, or relaxation exercises, can be beneficial in reducing anxiety and tension. Additionally, maintaining good posture, regular physical activity, and ensuring adequate hydration can help alleviate headache symptoms.

4. Physical Therapy: Given your reported neck and shoulder tension, physical therapy may be helpful. A physical therapist can provide exercises to improve posture, strengthen neck muscles, and reduce tension.

5. Regular Follow-Up: Since your headaches have been persistent, regular follow-up with your healthcare provider is essential to monitor your symptoms and make necessary adjustments to your treatment plan.

In conclusion, while anxiety and tension may be contributing factors to your headaches, it is crucial to rule out other potential causes and consider a comprehensive treatment approach. Open communication with your healthcare provider about your symptoms and concerns will be vital in finding an effective management strategy.

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