Why Lying Down Worsens Your Headache: Neurological Pain

Headache worsens when lying down?

Hello: I have a condition where there is a mild herniation at the C4-C5 cervical vertebrae, and I am undergoing rehabilitation.
Previously, I experienced pain in multiple areas (only once), and a neurologist diagnosed it as fibromyalgia.
However, I have been experiencing persistent headaches, especially when lying down, which are quite painful.
I have received nerve block injections, but they have not been effective.
The neurologist continues to suggest it is neuropathic pain, but I feel it may not be the case.
I have been having daily headaches for the past two months.
An MRI of my brain was performed over a year ago.
Additionally, I have shoulder pain, but my request for a muscle ultrasound from a rehabilitation doctor was denied.
I am unsure where the problem lies.
I would appreciate your advice, doctor.

Cai Xiaoling, 40~49 year old female. Ask Date: 2022/05/14

Dr. Jiang Junyi reply Neurology

Dear Ms.
Tsai,
You mentioned that "I have been experiencing headaches every day for the past two months." Your symptoms may suggest chronic migraine.
If you have migraine on more than 15 days in a month, with varying severity, it can easily be confused with tension-type headaches or sinus headaches (related to the nasal cavity and sinuses).
If a patient takes pain relief medication for more than 10 to 15 days a month, it may lead to more frequent headaches.
Currently, there are four main categories of oral medications for migraine prevention: anticonvulsants, beta-blockers, calcium channel blockers, and antidepressants.
In addition to pharmacological treatment, lifestyle adjustments are also very important.
Research shows that aerobic exercises (such as jogging and swimming), relaxation training, acupuncture, and transcutaneous electrical nerve stimulation can help prevent the occurrence of migraines.
Moreover, the foods consumed in daily life are the second most discussed triggers for migraines, following stress.
If your symptoms persist, it is advisable to follow up with outpatient treatment.
Thank you for your inquiry.
If you have any related questions, feel free to discuss further.
Wishing you good health, peace, and happiness.
Dr.
Jiang Junyi, Department of Neurology, Taoyuan Hospital, cares about you.

Reply Date: 2022/05/14

More Info

Headaches can be a complex and multifaceted issue, often influenced by various underlying conditions, lifestyle factors, and neurological mechanisms. Your description of experiencing headaches that worsen when lying down, along with a history of cervical spine issues and fibromyalgia, suggests that there may be several interconnected factors at play.

Firstly, it's important to understand that headaches can be categorized into primary and secondary types. Primary headaches include migraines and tension-type headaches, while secondary headaches are symptomatic of other conditions, such as cervical spine issues, infections, or neurological disorders. Given your history of cervical spine protrusion and fibromyalgia, it is plausible that your headaches may be secondary to these conditions.

When you lie down, the position of your head and neck can significantly affect the alignment of your cervical spine. If there is an existing issue, such as a herniated disc or nerve compression in the cervical region, lying down may exacerbate the pressure on certain nerves, leading to increased pain. This is particularly relevant in cases of cervical radiculopathy, where nerve roots exiting the cervical spine become compressed, causing pain that can radiate to the head and shoulders.

Additionally, the phenomenon of increased headache pain when lying down can also be associated with increased intracranial pressure or conditions such as postural orthostatic tachycardia syndrome (POTS), where changes in body position can lead to significant discomfort. While you mentioned that you have undergone an MRI of the brain, it is crucial to ensure that there are no underlying conditions that could contribute to these symptoms, such as Chiari malformation or other structural abnormalities.

The fact that you have been diagnosed with fibromyalgia adds another layer of complexity. Fibromyalgia is characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. It can also lead to headaches, which may be tension-type or migraine-like in nature. The chronic pain and fatigue associated with fibromyalgia can exacerbate the perception of headache pain, making it feel more intense.

In terms of management, it is essential to address both the cervical spine issues and the fibromyalgia. Physical therapy focusing on neck stabilization and posture correction may help alleviate some of the pain associated with your cervical spine condition. Additionally, cognitive-behavioral therapy and stress management techniques can be beneficial in managing fibromyalgia symptoms, including headaches.

If you have not already done so, consulting with a neurologist who specializes in headache disorders may provide further insights into your condition. They may recommend additional diagnostic tests, such as nerve conduction studies or further imaging, to assess the cervical spine and rule out any other potential causes of your headaches.

In summary, the worsening of your headaches when lying down could be attributed to cervical spine issues, fibromyalgia, or a combination of both. A comprehensive approach that includes physical therapy, pain management strategies, and possibly further neurological evaluation may be necessary to effectively address your symptoms and improve your quality of life. It is crucial to communicate openly with your healthcare providers about your symptoms and concerns to ensure that you receive the most appropriate care.

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