Chronic Headaches: Causes, Symptoms, and Treatments

Head pressure/pain/nausea?

I have been experiencing headaches for over a year.
Initially, I thought it was just a migraine, and taking painkillers and resting would help.
However, the more I slept, the more intense the pain became, accompanied by nausea and a feeling of wanting to vomit, along with weakness and a desire to lie down.
After several hours of discomfort, I would rush to the bathroom to vomit.
Eventually, I went to the emergency room, where the doctor diagnosed me with "benign paroxysmal positional vertigo" (BPPV).
After that, the episodes became less frequent, but my headaches gradually became more frequent.
I consulted a neurologist 3 to 4 times, and the doctor said this is classified as "migraine," noting that some people experience nausea while others do not, and symptoms can vary from person to person.
I was prescribed medication to prevent headaches, which helped improve my condition.
Later on, I often felt fatigued at work, had difficulty concentrating, and would zone out (not sure if it's due to lack of sleep).
During vacations, I would sleep for extended periods, but upon waking, I would have headaches and a feeling of heaviness in my head.
In more severe cases, I would start to feel nauseous and want to vomit.
Typically, I would take painkillers, use peppermint essential oil for neck and shoulder massage, or try gua sha to feel better.
Sometimes, I would have episodes every 2 to 3 days, and other times, twice a week.
Changes in weather also seemed to trigger headaches.
The pain is usually unilateral, but it can vary; sometimes it’s in the middle of my forehead or related to high eye pressure.
Whenever I have a headache, if I feel nauseous or watch TV, it becomes very uncomfortable (though not every time).
I have seen a neurologist, and all tests came back normal.
Should I consider undergoing further examinations?

Fei, 20~29 year old female. Ask Date: 2021/10/29

Dr. Jiang Junyi reply Neurology

Dear Miss Fei,
You mentioned that "the pain location can vary, usually it is unilateral, occasionally in the middle of the forehead or associated with high eye pressure, and whenever a headache occurs, there is a feeling of nausea." First, we should consider typical migraine headaches.
Common prodromal symptoms of migraines include visual disturbances, such as seeing stars or lightning-like flashes, as well as blurred or distorted vision.
A few minutes after these prodromal symptoms appear, the face, hands, or legs may experience tingling, weakness, or numbness.
During the attack, symptoms such as nausea, vomiting, photophobia, phonophobia, and pallor may accompany the headache.
Once the prodrome subsides, the patient may experience severe, unilateral throbbing pain in the head.
These migraine symptoms typically last for several hours, and can even extend up to 2-3 days.
As for migraine prevention medications, it is recommended to take them for 3-6 months.
They are commonly used in the following situations: 1.
Recurrent migraine attacks that significantly affect the patient's quality of life or daily activities, after excluding triggering factors, and with proper use of acute treatment medications and lifestyle modifications.
2.
Frequent migraine attacks occurring more than 4 times a month, or more than 8 days a month, which may progress to chronic migraines.
3.
Failure of acute treatment medications, contraindications, or overuse.
4.
The patient's personal desire to reduce the frequency of attacks as much as possible.
If there are concerns about structural issues in the brain, a CT scan can be performed for diagnosis.
If there are concerns about radiation exposure, it is recommended to consider an MRI (Magnetic Resonance Imaging) at the patient's own expense.
Neurologists who are members of headache medicine societies are more familiar with these types of conditions, and I suggest you consult with such specialists.
Thank you for your inquiry.
If you have further questions, feel free to discuss them! Wishing you good health, peace, and joy.
Dr.
Jiang, Taoyuan Medical Center, cares about you.

Reply Date: 2021/10/29

More Info

Chronic headaches can be a debilitating condition that significantly impacts daily life. Based on your description, it appears that you have been experiencing a variety of symptoms associated with headaches for over a year, including nausea, vomiting, and sensitivity to light and sound. These symptoms can be indicative of several types of headaches, with migraines being a primary suspect given your history and the nature of your symptoms.

Understanding Chronic Headaches
Chronic headaches can be categorized into primary and secondary types. Primary headaches, such as migraines and tension-type headaches, are not caused by underlying medical conditions. Secondary headaches, on the other hand, are symptoms of another health issue, such as sinus infections, high blood pressure, or even more serious conditions like tumors or aneurysms.

#
Symptoms of Migraines
Migraines are characterized by:
- Unilateral pain: Often on one side of the head.

- Pulsating or throbbing pain: This can be moderate to severe and may worsen with physical activity.

- Nausea and vomiting: Many individuals with migraines experience gastrointestinal symptoms.

- Sensitivity to light and sound: This can make it difficult to engage in normal activities during an attack.

- Aura: Some people experience visual disturbances before the headache begins.

Given that you have experienced nausea and vomiting, along with sensitivity to light and sound, it aligns with migraine symptoms. The fact that your headaches have become more frequent and intense over time is also a common pattern seen in chronic migraine sufferers.

Potential Triggers
You mentioned that changes in weather and fatigue can trigger your headaches. Other common triggers include:
- Stress: Emotional stress can lead to tension headaches or exacerbate migraines.

- Sleep disturbances: Both lack of sleep and oversleeping can trigger headaches.

- Dietary factors: Certain foods, caffeine, and alcohol can also be culprits.

- Hormonal changes: Fluctuations in hormones, particularly in women, can lead to migraines.

Treatment Options
1. Preventive Medications: Since your neurologist has already prescribed preventive medications, it’s essential to adhere to this regimen. These medications can help reduce the frequency and severity of headaches.

2. Acute Treatments: For immediate relief during a headache, over-the-counter pain relievers like ibuprofen or acetaminophen can be effective. However, if you find yourself relying on these medications frequently, it may lead to medication-overuse headaches.

3. Lifestyle Modifications:
- Sleep Hygiene: Establish a regular sleep schedule and create a restful environment.

- Stress Management: Techniques such as mindfulness, yoga, or meditation can help reduce stress levels.

- Hydration and Nutrition: Ensure you are drinking enough water and maintaining a balanced diet.

4. Alternative Therapies: Some individuals find relief through acupuncture, chiropractic care, or physical therapy. Additionally, practices like massage therapy or using essential oils (like peppermint) can provide symptomatic relief.

5. Regular Follow-ups: Since you have seen a neurologist multiple times and tests have returned normal, it may be beneficial to continue regular follow-ups. If your symptoms persist or worsen, further imaging studies (like an MRI) may be warranted to rule out any underlying conditions.

Conclusion
Chronic headaches, particularly migraines, can be complex and multifaceted. It’s crucial to work closely with your healthcare provider to develop a comprehensive management plan tailored to your specific symptoms and triggers. Keeping a headache diary can also be beneficial in identifying patterns and triggers, which can aid in treatment adjustments. If your current treatment plan does not yield satisfactory results, do not hesitate to seek a second opinion or explore additional treatment options. Your well-being is paramount, and finding the right approach can significantly improve your quality of life.

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