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Neurology (Expert Forum)
Right hemisphere headaches
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Right hemisphere headaches
by Graydove, Mar 15, 2007 12:00AM
I’m a female of 45 years, for the most part healthy.
I’ve been having HA’s for some time now. About two months ago I went in to see my PCP for what I thought was an ear infection. It felt like sharp shooting pains in my left ear and around the left ear. My PCP put me on Naproxen 325mg po TID PRN and Amitriptyline 75mg po q hs PRN. These are the only medications I’m on now. They helped for a time, but now I’m getting strange sensations in the right hemisphere, which start out as a tingling that advances to pressure and sometimes quick sharp shooting pains. This is usually always in the same area. I seem to be having an increased problem with my word formation when speaking. I was in a MVA 34 years ago in which a skull FX occurred along with a 3 day coma. The right side of the occipital was the site of injury at that time. Since then I have had 3 other concussions within the last 6 years. I do have problems with depression at times r/t PTSD. But my concern is these HA’s that are coming more frequently and not completely letting up as they use to. The mental disorders are not my concern now; they have been for the most part taken care of. The only thing that seems to help is for me to hold the side of my head when the sensation of pressure in the right hemisphere starts and put pressure on it. It feels like the HA lets up then some. My right inner ear now is beginning to ache some, but not like an infection. I would appreciate some insight as to a possible cause or solution.
Thanks Graydove
I’ve been having HA’s for some time now. About two months ago I went in to see my PCP for what I thought was an ear infection. It felt like sharp shooting pains in my left ear and around the left ear. My PCP put me on Naproxen 325mg po TID PRN and Amitriptyline 75mg po q hs PRN. These are the only medications I’m on now. They helped for a time, but now I’m getting strange sensations in the right hemisphere, which start out as a tingling that advances to pressure and sometimes quick sharp shooting pains. This is usually always in the same area. I seem to be having an increased problem with my word formation when speaking. I was in a MVA 34 years ago in which a skull FX occurred along with a 3 day coma. The right side of the occipital was the site of injury at that time. Since then I have had 3 other concussions within the last 6 years. I do have problems with depression at times r/t PTSD. But my concern is these HA’s that are coming more frequently and not completely letting up as they use to. The mental disorders are not my concern now; they have been for the most part taken care of. The only thing that seems to help is for me to hold the side of my head when the sensation of pressure in the right hemisphere starts and put pressure on it. It feels like the HA lets up then some. My right inner ear now is beginning to ache some, but not like an infection. I would appreciate some insight as to a possible cause or solution.
Thanks Graydove
Doctor's Answer
by CCF-Neuro-M.D.-SH, Apr 05, 2007 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms that you describe are non-specific, but are likely migraine headaches, although I would suggest some more testing given your history. You mentioned that you are taking naproxen 325mg PO (by mouth) TID (three time daily) PRN (as needed): this is okay as long as you do not take the medication more than 2 days out of the week. More frequent doses of the naproxen can precipitate rebound headaches, which are very hard to treat. You also mentioned Amitriptyline (generic for Elavil) 75mg (a large dose for headaches) QHS (given at bedtime) PRN (as needed) this medication should NOT be given as needed. This medication needs to be given every day and the preventative effect on headaches usually only becomes apparent after 3-4 weeks of taking the medication daily. Given your history of multiple severe head injuries I would also suggest an EEG (brain wave test) to evaluate for seizures and an MRI of the brain to evaluate for structural lesions or CSF leaks. I would also suggest that you have psychiatric treatment for your PTSD/depression as well, since you headaches are unlikely to get better without concurrent treatment of these issues.
I hope this has been helpful.
The symptoms that you describe are non-specific, but are likely migraine headaches, although I would suggest some more testing given your history. You mentioned that you are taking naproxen 325mg PO (by mouth) TID (three time daily) PRN (as needed): this is okay as long as you do not take the medication more than 2 days out of the week. More frequent doses of the naproxen can precipitate rebound headaches, which are very hard to treat. You also mentioned Amitriptyline (generic for Elavil) 75mg (a large dose for headaches) QHS (given at bedtime) PRN (as needed) this medication should NOT be given as needed. This medication needs to be given every day and the preventative effect on headaches usually only becomes apparent after 3-4 weeks of taking the medication daily. Given your history of multiple severe head injuries I would also suggest an EEG (brain wave test) to evaluate for seizures and an MRI of the brain to evaluate for structural lesions or CSF leaks. I would also suggest that you have psychiatric treatment for your PTSD/depression as well, since you headaches are unlikely to get better without concurrent treatment of these issues.
I hope this has been helpful.
some transfered wrong. Corrections for complete post are:
I’= I'm,
HA’= HA's or headaches
Thanks Graydove
Thanks Graydove
Thespeech, memory, or cognitive problems could well be side effects of the amitriptyline. Newer meds are available with far fewer side effects. Neurontin, Lyrica, Keppra, and Cymbalta, for example, are usually much better tolerated. Trileptal is also a reasonable drug to try, perhaps with clonazepam as an adjunct therapy. Keep me up to date, please. I'm a 28-year occipital neuralgia "survivor".
I stopped taking the Naproxin it did no good, I didn't like the Elavil it always made me tired and did little for the headaches anyway.
I ended up having both a CAT scan and an MRI, the Neurologist said she would call me back if she found anything abnormal, she never called back.
I have been seeing a psychiatrist for the PTSD for quite some time. I'm stable in this area.
It has been some time since this all started, I'm still having the headaches they never completely go away, my vision is not as good as it use to be, things I could read from a distance now look blurry, My right eye has always bothered me since the MVA, but I always had 20-20 vision. I need bigger font to be able to reading. I had no problem in his area until the headaches started and would not stop. My words in speaking and writing are better than they were, but I still find myself stumbling over or around words that I use to have no trouble in speaking.
I have to keep my stress level at a minimum because with any increase I find I have more problems with words in speaking and the headache gets worse.