Chronic Headaches: Symptoms and Seeking Effective Treatment

The headache just won't go away?

Hello Doctor: I have been experiencing headaches since early May, and now it's June 29.
At first, I felt a bit tired after work and wanted to take a nap, but when I woke up, I had a severe headache that lasted for about two hours.
Later, after napping, I found it so painful to get up that I couldn't move, and eventually, I went to sleep without even washing up.
In the morning, I would still have some pain.
I don't know why I constantly feel tired and want to sleep! I thought maybe it was because I was napping outside of my usual sleep hours, so I tried to stay awake until my normal bedtime, but I ended up waking up with a headache every morning.
Eventually, I had some nasal congestion and visited an ENT specialist, who said there was nothing abnormal, just some phlegm.
They prescribed me pain relievers and expectorants, but after taking them, my condition worsened, and I felt dizzy and groggy while awake, or I had persistent headaches.
I stopped taking the medication, but for a week, I still felt the same.
Later, I noticed that I wasn't having headaches every day.
People suggested taking acetaminophen when I felt pain, so I took it for two or three days when the pain was worse, but it made me feel even more dizzy and uncomfortable, so I gave up on the medication.
I went to the hospital to see a doctor, and they arranged for an EEG (which I completed), but the doctor has no appointments until mid-July.
During my last visit, they prescribed Lysteda and another medication.
Although I am not feeling uncomfortable 24/7 now, there was one day last week when I had a severe headache during normal sleeping hours, and I took medication, but it didn't help much.
I ended up sleeping for 13 hours straight before I could get up, waking up in pain throughout the night! This week, my sleep schedule has been irregular; one night I went to bed at 10 PM, woke up at 2 AM, and then went back to sleep until 4 AM.
Although it wasn't very painful, my sleep has been insufficient.
There were days when I went to bed at midnight, woke up at 4 AM, then fell back asleep, woke up again at 5 AM, fell asleep, and woke up again at 6 AM.
I don't know why I keep waking up, and I feel uncomfortable with slight pain but not severe.
Then yesterday, I went to bed at midnight, and less than an hour later, I started to feel pain.
When I have pain, I toss and turn, trying to get up but unable to, and when I try to sleep again, it hurts.
I tossed and turned until around 2 AM, and my husband saw me like this and quickly got me to take the medication prescribed by the doctor.
After a while of pain, I fell asleep, but when I woke up in the morning, although it wasn't as painful, I still felt uncomfortable, and it was even more painful than before! My symptoms are: 1.
Feeling unwell leads to fatigue and a desire to sleep 2.
The more I lie down, the more pain or discomfort I feel, which makes me want to sleep 3.
Waking up from pain 4.
Headaches upon waking in the morning 5.
I can't explain the type of pain (dull, intermittent, throbbing, pressure...?) 6.
My vision is blurrier than before (I can still see, but the words appear a bit fuzzy) 7.
My memory has worsened (thinking about things makes the pain worse) 8.
Waking up in the middle of the night due to pain and still experiencing pain for a while in the morning 9.
Feeling nauseous but not vomiting 10.
The location of the headache varies (1.
the upper back of the head, 2.
the top of the head, 3.
the forehead, 4.
both sides → 1 and 2 hurt more when asleep, 3 hurts more when awake, 4 hurts all over when it occurs) 11.
Sometimes feeling dizzy 12.
Waking up in pain leads to dry mouth and a desire to drink (sometimes).
Is an EEG effective in this case? Should I just find a doctor or go to the emergency room when I have pain? Or do I need to undergo other tests? What could these symptoms indicate? They have severely affected my life; sometimes I feel dizzy while riding to work, and I can't sleep well! My life is generally happy, with no worries at home and an easy job...
so it's unlikely to be stress-related.
It doesn't seem like a migraine either, as my pain isn't predominantly on one side.
I used to only get headaches from lack of sleep, but now I feel fine after sleeping well! Can you help me?

KIKI, 20~29 year old female. Ask Date: 2012/06/29

Dr. Lan Shengxing reply Neurology

Dear KIKI,
I am truly sorry to hear about your detailed symptom description.
New and progressively worsening headaches can sometimes be a warning sign that indicates the need for a thorough examination.
Your headache description is difficult to categorize under a single condition, so a detailed evaluation is necessary.
If the EEG has already been completed and you are reviewing the results, I believe your attending physician may arrange for further tests, such as a CT scan or blood tests.
Sometimes, the treatment for this condition may not progress quickly, especially since you are more sensitive to medications, which means that adjustments in dosage or medication combinations need to be made more gradually.
For now, we can only wait for the EEG results.
I hope you find a satisfactory treatment soon.

Best wishes.

Reply Date: 2012/06/29

More Info

Chronic headaches can be a debilitating condition that significantly impacts daily life. Based on your detailed description, it appears that you are experiencing a complex set of symptoms that could be indicative of several underlying issues. Let's break down your symptoms and explore potential causes and treatment options.

Understanding Your Symptoms
1. Fatigue and Sleep Issues: You mentioned feeling fatigued and having a strong desire to sleep, which is often exacerbated by your headaches. This could suggest a possible sleep disorder, such as sleep apnea, or it could be related to chronic fatigue syndrome. Poor sleep quality can lead to headaches and a cycle of fatigue.

2. Headache Characteristics: The variability in your headache location (occipital, frontal, and temporal areas) and the nature of the pain (dull, throbbing, or pressure-like) are important. This variability can suggest different types of headaches, including tension-type headaches or migraines. The fact that you experience headaches upon waking and after napping could indicate a sleep-related headache or a rebound headache from medication overuse.

3. Associated Symptoms: Symptoms such as nausea, visual disturbances (blurriness), and memory issues can be concerning. These could indicate a more serious underlying condition, such as increased intracranial pressure or a neurological issue.
4. Response to Medication: Your experience with medications, where they seem to exacerbate your symptoms rather than relieve them, is also noteworthy. This could indicate that the medications are not appropriate for your specific type of headache or that you may be experiencing side effects.

Potential Causes
Given your symptoms, several potential causes could be considered:
- Tension-Type Headaches: Often related to stress, poor posture, or muscle tension, these headaches can cause a dull, aching pain and may be associated with fatigue and sleep disturbances.

- Migraine: Migraines can present with various symptoms, including nausea, sensitivity to light, and visual disturbances. They can also be triggered by changes in sleep patterns or stress.

- Medication Overuse Headaches: If you have been using over-the-counter pain medications frequently, this could lead to a cycle of rebound headaches.

- Sleep Disorders: Conditions like sleep apnea can lead to poor sleep quality, resulting in headaches and fatigue.

- Neurological Issues: While less common, persistent headaches with associated neurological symptoms warrant further investigation to rule out conditions such as intracranial hypertension or other neurological disorders.

Recommended Actions
1. Consult a Neurologist: Given the complexity and persistence of your symptoms, it would be wise to consult a neurologist. They can conduct a thorough evaluation, including a detailed history and possibly imaging studies (like an MRI) to rule out any serious conditions.

2. Sleep Study: If sleep disorders are suspected, a sleep study (polysomnography) may be beneficial to assess your sleep patterns and identify any abnormalities.

3. Medication Review: Discuss your current medications with your healthcare provider. They may suggest tapering off certain medications if they suspect that you are experiencing rebound headaches.

4. Lifestyle Modifications: Consider implementing lifestyle changes that promote better sleep hygiene, such as maintaining a regular sleep schedule, creating a restful sleep environment, and avoiding stimulants before bedtime.

5. Stress Management Techniques: Even if you feel that stress is not a significant factor, incorporating relaxation techniques such as mindfulness, yoga, or gentle exercise can help alleviate tension and improve overall well-being.

6. Keep a Headache Diary: Documenting your headaches, including their frequency, duration, intensity, and any associated symptoms, can provide valuable information for your healthcare provider.

Conclusion
Chronic headaches can stem from various causes, and understanding your specific symptoms is crucial for effective treatment. It’s essential to work closely with healthcare professionals to identify the underlying issues and develop a comprehensive treatment plan tailored to your needs. Remember, you don’t have to manage this alone, and seeking help is a vital step toward finding relief and improving your quality of life.

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