Symptom overlap: headache?
I have been experiencing chronic headaches for about two to three years.
Previously, I had a small examination at Taipei Veterans General Hospital, which diagnosed me with migraines.
However, after my primary doctor changed and the new doctor had a very poor attitude, along with no improvement in my condition, I stopped going back.
They had performed a CT scan of my brain, but although the report was not available, the doctor with a bad attitude said, "You have nothing wrong; if it were up to me, I wouldn't even do the tests." Nevertheless, he is still a physician, so I assumed there was nothing serious.
Recently, as summer approached, my symptoms have worsened, and every year my headaches seem to become more severe.
My symptoms are as follows:
1.
During the worst episodes, I have trouble sleeping (this has only happened once so far).
When the pain is moderately severe, I experience vomiting (which has happened many times).
When the pain is mild, I don't feel much pain, just a dull sensation and some tingling, but the uncomfortable symptoms can last for four days, making it difficult to think.
2.
I have previously taken antidepressants prescribed by a doctor at Taipei Veterans General Hospital for three months.
The first time, I went a whole month without headaches, but they returned afterward.
3.
I can sense when a headache is coming, but I cannot prevent it; I can only lie down quickly to avoid worsening the pain.
4.
I experience headaches about once a week, with a minimum of one day and a maximum of four days.
5.
I have been in two car accidents and hit my head four times, three of which required sutures due to subarachnoid hemorrhage.
Suspected mental health issues include:
1.
I experience fragmented sleep, dreaming every night, and regardless of how late I go to bed (whether at 5:30 AM or 6:30 AM), I wake up at the same time.
However, I need to sleep six hours during the day to make up for it.
2.
I have dreams where I cannot wake up, desperately trying to open my eyes but unable to, or I keep waking up in the same environment as my sleeping surroundings, which happens very frequently.
3.
I experience stomach pain when under stress.
4.
I have difficulty controlling my emotions, often losing control for no apparent reason, yelling, getting angry over trivial matters, and crying.
I also feel irritated by others' words, regardless of whether they are good or bad.
5.
My judgment has deteriorated; it feels like the little person in my brain who plans my schedule has stopped working.
6.
While headache examinations have not revealed any issues in my brain, the uncomfortable symptoms are becoming increasingly severe.
Because nothing has been found, I have been suspected of having stress-related issues.
I took a test at my school's counseling center, which indicated a stress level of 97%.
I have poor health overall and have seen many doctors for my headaches, but most have had attitudes similar to that of the rude doctor, believing my pain is not significant.
However, it is genuinely distressing for me, especially since I vomit.
Doctors tend to prescribe medications just to see if they work.
I once took medication that caused breathing difficulties, and only after stopping the medication did the symptoms ease, or I experienced dizziness and lethargy, feeling groggy all day.
Yet, my headache symptoms have not improved, and it feels like I am being treated like a guinea pig.
Since I have only seen neurologists, I wonder if I might be seeing the wrong specialists, which could explain the reactions I've received, with constant suggestions that my issues are due to stress and that relaxation would help.
However, my headaches occur year-round, regardless of breaks or vacations.
I may be more prone to anxiety, but I truly do not want to take any more medication.
Classmates have told me that I smell like medication from taking so many, and I have also seen well-known traditional Chinese medicine practitioners, but their approaches seem dubious.
Therefore, I am seeking advice on which specialty I should consult: psychiatry (or psychosomatic medicine?), orthopedics (I have heard that cervical spine misalignment can cause such symptoms), or should I continue seeing a neurologist (which is the appropriate specialty for headaches)? Additionally, are there any doctors at specific hospitals that you would personally recommend? I apologize if this sounds rude, but I have seen too many doctors and taken too many medications, and I am a bit scared.
Dan, 10~19 year old female. Ask Date: 2007/07/29
Dr. Cai Jueren reply Family Medicine
Hello: Your symptoms are likely related to migraine.
The treatment for migraines is very complex and diverse, primarily due to the difficulties in diagnosis, and the effectiveness of medications can vary from person to person.
There are several types of migraines, with the two main categories being (common) and (classic).
About 90% of cases fall into the former category, which occurs without any warning and can last for several hours or even days.
The latter type is characterized by a 15-20 minute prodrome, known as an aura, which typically includes visual disturbances such as seeing stars or lightning-like flashes, as well as blurred or distorted vision.
Various types of migraines can also lead to emotional changes, such as depression, irritability, or loss of appetite.
Following these symptoms, patients often experience head pain, nausea, and vomiting.
There are many triggers for migraines: in addition to foods that cause allergic reactions, other foods (especially those containing tyramine) can also provoke migraine attacks.
Therefore, patients should avoid foods high in tyramine, such as aged cheeses, chocolate, hot dogs, bacon, and lunch meats containing nitrites.
When dining at Chinese restaurants, it is advisable to request that no monosodium glutamate (MSG) be added to dishes.
Additionally, avoid fermented foods such as beer, yogurt, pickles, and yeast used for baking and brewing, as they all contain tyramine.
If you have already tried various medications and consulted many doctors, it may be difficult for you to trust Western medicine's recommendation to see a neurologist.
If you are still concerned, you can visit a family medicine clinic.
If you are still apprehensive, feel free to email me the names of the medications you are taking, and I can provide further clarification.
Thank you for your correspondence, and I hope the above information helps address your concerns.
Dr.
Tsai Jue-Ren, Hualien Hospital
Reply Date: 2007/07/29
More Info
Chronic headaches can be a debilitating condition that significantly impacts your quality of life. Based on your description, it seems you have been experiencing these headaches for a considerable amount of time, and they have progressively worsened. You have already undergone some diagnostic tests, such as a CT scan, which did not reveal any significant issues. However, the persistent nature of your headaches, along with associated symptoms like vomiting and sleep disturbances, suggests that a comprehensive approach to diagnosis and treatment is necessary.
Firstly, it is essential to understand that headaches can arise from various causes, including tension-type headaches, migraines, and even secondary headaches due to underlying medical conditions. Given your history of head trauma from car accidents, it is crucial to consider the possibility of post-traumatic headaches or other neurological issues. While your previous doctors may have dismissed your symptoms, it is vital to advocate for yourself and seek a specialist who will take your concerns seriously.
You mentioned that you have seen neurologists but have not found the care you need. It might be beneficial to seek out a headache specialist or a neurologist with a focus on headache disorders. These specialists are more likely to understand the complexities of chronic headaches and can offer tailored treatment options. They may also consider conducting further tests, such as an MRI, to rule out any structural issues that a CT scan might not have detected.
In addition to neurological evaluation, it may be worthwhile to explore the psychological aspects of your condition. Chronic pain can often lead to or exacerbate mental health issues, such as anxiety and depression. Given your symptoms of emotional instability and high stress levels, consulting with a psychiatrist or a psychologist could provide valuable insights and coping strategies. Cognitive-behavioral therapy (CBT) has been shown to be effective for managing chronic pain and associated anxiety.
You also mentioned the possibility of seeing an orthopedic specialist for neck issues. Cervicogenic headaches, which originate from the cervical spine, can mimic tension-type headaches and may respond to physical therapy or chiropractic care. If you suspect that your headaches could be related to neck problems, consulting with a physical therapist or an orthopedic specialist could be beneficial.
As for medication, it is understandable that you are hesitant to continue taking various drugs, especially if they have not provided relief or have caused side effects. It is essential to have an open discussion with your healthcare provider about your concerns regarding medication. They may suggest alternative treatments, such as nerve blocks, physical therapy, acupuncture, or lifestyle modifications, including stress management techniques and dietary changes.
In summary, navigating chronic headaches requires a multifaceted approach. Here are some steps you can take:
1. Seek a headache specialist: Look for a neurologist with expertise in headache disorders who can provide a thorough evaluation and personalized treatment plan.
2. Consider psychological support: A mental health professional can help address any underlying anxiety or stress that may be contributing to your headaches.
3. Explore physical therapy: If neck issues are suspected, a physical therapist can assess your condition and provide appropriate treatment.
4. Discuss medication options: Have an honest conversation with your doctor about your medication concerns and explore alternative treatments.
5. Lifestyle modifications: Implement stress management techniques, maintain a regular sleep schedule, and consider dietary changes that may help alleviate symptoms.
Remember, you are your best advocate. If you feel that your concerns are not being addressed, do not hesitate to seek a second opinion or explore different healthcare providers until you find one that meets your needs. Chronic headaches can be challenging, but with the right support and treatment, you can find relief and improve your quality of life.
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