Persistent Headaches: Symptoms and Possible Causes

About headaches?

Hello Doctor: Ten days ago, at around 8 PM, I suddenly felt a strange sensation in my head, possibly similar to increased intracranial pressure, followed by a brief tingling sensation and then a persistent, severe throbbing headache.
After taking pain medication and sleeping, I felt better, but then I started feeling slightly dizzy throughout the day.
The next day, I experienced a tingling sensation all over my scalp for two full days.

On October 28th, at around 2 AM, as I was trying to sleep, I felt a tight, heavy pressure in my head, which was very uncomfortable.
However, when I sat up, the discomfort went away.
This cycle repeated several times until around 7 AM, where I experienced a sensation of my limbs twitching just as I was about to fall asleep (sometimes my fingers, sometimes my left foot, etc., in different areas).
The following night, when I went to bed at 1 AM, this phenomenon did not occur, and I was able to sleep soundly until morning.
However, I started to feel some discomfort in my head upon waking, with a slight pressure and pain.
Sitting up alleviated the discomfort, but lying down would trigger headaches again.
Over the past three days, I have experienced intermittent sharp pains in my head, and I can feel tenderness in specific areas (it feels similar to an injury, but I don't recall any trauma in recent years).
Most of the pain points are located in the back of my head on both sides, with one point on the top of my head above my right ear.
The right side of my head has also been persistently throbbing.
In the past, I would occasionally have headaches that would resolve after a good night's sleep, but now, for ten consecutive days, my head has felt strange.
I also experience episodes of facial flushing without any apparent reason, and I feel dizzy even while sitting (though it's mild and not severe enough to cause instability).
I am genuinely concerned and would greatly appreciate your insight into what symptoms I might be experiencing or what possible conditions could be at play.
Thank you!

Zhang, 20~29 year old female. Ask Date: 2022/11/01

Dr. Jiang Junyi reply Neurology

Hello Mr.
Zhang,
You mentioned that at 8 o'clock, you suddenly felt something unusual in your head, possibly similar to increased intracranial pressure, followed by a brief tingling sensation and then a persistent, severe throbbing headache.
You also noted that you experience facial flushing and dizziness, even while sitting (though it's a mild dizziness that doesn't cause instability).
Your symptoms may suggest a vascular headache, particularly cluster headache.
This type of headache is typically concentrated around one eye or the temporal region, most commonly occurring behind one eye and accompanied by symptoms such as conjunctival injection, rhinorrhea, tearing, forehead and facial swelling, facial sweating, miosis, and ptosis on the same side.
Some patients may exhibit restlessness, pacing, and may find that resting exacerbates the pain, which distinguishes it from migraine.

Cluster headaches tend to occur at the same time each day during an episode and are more prevalent in males.

I recommend the following:
- Maintain a regular sleep schedule: Irregular sleep patterns can trigger cluster headaches, so it's important to keep a consistent sleep routine during episodes.
- Avoid alcohol: Consuming alcohol during an episode may provoke cluster headaches.
I suggest you visit a neurology clinic for further evaluation and follow-up.
Thank you for your inquiry, and feel free to discuss further.
Wishing you good health and peace.
Dr.
Jiang Junyi, Taoyuan Hospital

Reply Date: 2022/11/01

More Info

Persistent headaches can be a source of significant discomfort and concern, especially when accompanied by other symptoms such as dizziness, tingling sensations, and changes in sleep patterns. Based on your description, it seems you are experiencing a complex set of symptoms that may be indicative of several underlying issues.

Possible Causes of Your Symptoms
1. Tension-Type Headaches: These are the most common type of headaches and can be triggered by stress, anxiety, or prolonged periods of poor posture, especially if you spend long hours in front of a computer. Symptoms typically include a dull, aching pain and a sensation of tightness or pressure across the forehead or on the sides and back of the head.

2. Migraine: Migraines are characterized by severe, throbbing pain, often on one side of the head, and can be accompanied by nausea, vomiting, and sensitivity to light and sound. The symptoms you described, such as the pulsating pain and the feeling of pressure, could suggest a migraine, especially if they are recurrent.

3. Cervicogenic Headaches: These headaches originate from issues in the cervical spine (neck) and can cause pain that radiates to the head. If you have been experiencing neck stiffness or discomfort, this could be a contributing factor.

4. Neurological Issues: Given the persistent nature of your symptoms, including the tingling sensations and the feeling of increased intracranial pressure, it is essential to rule out any neurological conditions. This could include conditions such as multiple sclerosis or other neurological disorders that could cause similar symptoms.

5. Sleep Disorders: The difficulty you described in falling asleep and the sensation of your limbs twitching could indicate a sleep disorder, such as restless leg syndrome or sleep apnea, which can also contribute to headaches and feelings of fatigue.

6. Anxiety and Stress: Psychological factors can significantly impact physical health. Anxiety can manifest as physical symptoms, including headaches, dizziness, and a feeling of pressure in the head. Stress management techniques, such as mindfulness, relaxation exercises, and cognitive behavioral therapy, may be beneficial.

Recommendations for Management
1. Medical Evaluation: Given the duration and complexity of your symptoms, it is crucial to consult a healthcare professional, preferably a neurologist. They may recommend imaging studies, such as an MRI or CT scan, to rule out any serious conditions.

2. Pain Management: Over-the-counter pain relievers like ibuprofen or acetaminophen can help alleviate headache symptoms. However, it’s essential to use them judiciously to avoid rebound headaches.

3. Lifestyle Modifications:
- Ergonomics: Ensure your workspace is ergonomically designed to reduce strain on your neck and back.

- Hydration and Nutrition: Stay hydrated and maintain a balanced diet, as dehydration and poor nutrition can trigger headaches.

- Sleep Hygiene: Establish a regular sleep schedule and create a restful environment to improve sleep quality.

4. Stress Management Techniques: Engage in relaxation techniques such as yoga, meditation, or deep-breathing exercises to help manage stress and anxiety.

5. Physical Therapy: If neck or posture issues are contributing to your headaches, physical therapy may help improve muscle strength and flexibility, reducing headache frequency and intensity.

6. Cognitive Behavioral Therapy (CBT): If anxiety is a significant factor, CBT can help address negative thought patterns and develop coping strategies.

Conclusion
Persistent headaches can be multifactorial, and understanding the underlying causes is crucial for effective management. It is essential to seek medical advice to ensure a thorough evaluation and appropriate treatment plan tailored to your specific needs. Remember, early intervention can often lead to better outcomes and improved quality of life.

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