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Headache for 6 Days...not responding to any Rx!
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Headache for 6 Days...not responding to any Rx!

Hi, I will try to explain as briefly as possible.  I have now had a mild-moderate headache (in the bilat temple areas) for 6 days now.  I have tried every analgesic, and nothing even decreases the pain.  The ONLY time the pain is slightly better is first thing in the am upon awakening, but within 30 min, it returns. NO other symptoms except a FEW twitches under my left eye (today only, maybe 3 times).

I was seen in the ER last night, CT scan normal, BP slightly elevated at 164/95, no history of HTN, BP usually runs about 11/70.  Doc unsure if pain causing increase in BP, or BP causing headaches.

Saw my PCP today and had a complete lab work-up, which I do not yet have the results.  I am 35, female, overweight (by about 50 lb), and smoke a little less than 1 pack per day.  My glucose was checked in the PCP office via fingerstick (fasting), result was 124.  I have NO history of high or low blood sugar. BP in the office today was 142/78.  Doc started me on 80 mg Corgard to see if there is any improvement, in case it is BP related.  Took one dose today thus far.

My only medical history is MVP, depression/anxiety.  I do not know my familial history due to being adopted.  I also have recently had some dental work done, and having some ongoing dental issues (need some more work done that is scheduled)....and I realize that that also may be a cause

I am just at a loss here and VERY frustrated.  I literally have had NO relief at all in 6 days, other than when sleeping.  The headache is CONSTANT.  The severity ranges, but I would say it hovers around a "5-7" on a pain scale.  Dull aching pain right in the temple area, SOMETIMES the left side being slightly worse.  NO other symptoms, no neuro symptoms, my neuro exam in ER and today was normal.

HELP????  Any suggestions?  Any ideas?  I have tried everything to get relief, and have had none thus far.  Thanks a million in advance for your time, please feel free to ask any pertinent questions...I will check back often.  I am really leaning towards thinking it may be the glucose?  I'm aware that hyperglycemia can cause headaches.  Thanks again.

Frustrated in PA
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Avatar_dr_f_tn
Hi.

Your glucose was taken randomly and  the sample was taken from capillary( small vessels ) blood so this is not really the gold standard in establishing a hyperglycemic or diabetic state. A fasting blood sugar taken at two different occasions with elevated levels will help establish the diagnosis of diabetes.

With regards to your post, there are several factors that may contribute to the headaches. Your dental problems may cause referred pain and the elevated BP may also cause the headaches although I would agree with your physician that it may also be the other way around. However, repeated determination of your blood pressure still showed  elevated levels. You may need futher evaluation with regards to this.

At this point, a referral to an eye or an ENT specialist may help. This will help rule out any underlying involvement of these structures. Also, a complete assessment of your cardiac and thyroid hormone functions may be necessary. A 2D Echo and evaluation of your neck vessels may be necessary. Also, kidney function tests like serum BUN and creatinine  may help. It is best to be evaluated thoroughly given your elevated BP.



Is there any family history of stroke or heart disease in the family?

Any previous history of a recent viral or flulike infection?
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480448_tn?1403547723
Thank you so very much for your comments and suggestions.  I'll be anxious to find out tomorrow what my glucose level was via venipuncture.  I'm at the point where I'm so anxious for a definitive diagnosis so that I may just handle the problem and get some relief.  I hardly ever get headaches, and when I do, they usually respond wonderfully to Excedrin.

As per your questions, I am adopted, therefore I am unaware of my family history.  Makes it a little more difficult for sure.

I haven't had any recent illnesses whatsoever.....HOWEVER, a bit of pertinent info that also may lean towards the possibility of a new Type II DM diagnosis....is....I was on a diet for approx a month, I lost about 7-8 lbs, and then for some reason, stopped losing (I was just eating more healthy, nothing drastic)...I became quite frustrated and actually went OFF the diet completely to the extreme (about a week after Easter).  I was actually quite shocked to see that I gained 10 pouinds when weighed this am at the MD office.

Certainly, if I was teetering with tendencies towards diabetes, I would think that could have just thrown me over the edge, and caused the glucose to elevate.  Just a guess of course....either way, I DO realize the importance of ruling out, or treating a BP/cardiac issue or diabetes.

Oh, if only there was a quick and magical answer.  The dental issue...the thing that would baffle me there...is the fact that the h/a responds to nothing, and very seldom even IMPROVES even slightly with any type of medication.  I was given 2 doses of IV Morphine and one dose of IV Toradol in the ER....with ZERO effect.  I would think a h/a caused by a dental issue wouldn't be QUITE so unrelenting.

My history of anxiety initially concerned me, as I considered (and discussed with my MD) the possibility of it being depression/anxiety related, although honestly, my emotional health has been fairly sound and consistent.  

I just need to be open to all possibilitites, and try to make sense out of it.  Being a nurse. self-diagnosis is in my blood, ha ha.  I try hard not to think the worst, and try to self treat...but at times, my mind tends to gravitate towards one thing or another.  The negative CT scan was at least one minimal reassurance.

Thanks again for your help, I appreciate it very much.

Hopefully, I will be able to update tomorrow with my lab results and plan of action.
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480448_tn?1403547723
Hi Doc,

Well, I got some news back from the doctor's office just now.  While it is good news, of course it has me stumped.  My lab work was all within normal limits with the only exception being a slightly elevated WBC (12.7) and cholesterol of 222 (which is surprisingly actually lower than I have been in the past).

So, the doc says the h/a may be due to a viral infection, either one I'm getting over, or one that is starting.

H/H were fine, glucose (that was a concern) was 99.  So, that's great too.

At this point, I have a few suspicions, one being the dental avenue.  I spoke with my DMD yesterday who advised me to call him after getting my work-up results back before we looked into that as a possibility.

The only other 2 things that would make any sense to me (besides the viral possibility) is.....and this may be a stretch....I drink a lot of coffee.  I know that re-bound h/a's are common after rapidly stopping caffeine.  Now, I haven't changed my coffee intake, but just wondering (again, grasping at straws here), if just MAYBE the coffee I bought (I buy the kind I grind in the store) was decaf in a regular bag.  That probably seems silly, but I am just trying to explore all the options here.  I DID purchase a new bag of coffee last week.

The other option I'm thinking could be depression/anxiety related, although, like I said, I really have been feeling quite good lately.

I have noticed that along with the h/a, since yesterday....my left eye has been twitching a bit, and I have an increased feeling of "fullness" in my head....and some very minimal tinnitus (VERY minimal, and very quick...there then gone).  The active dental issues I have are in the top left side of my mouth.  I had a root canal done a few weeks ago, and had been getting quite frequent "nerve" like pains after the procedure, which my dentist was aware of.  I have a tooth (the very last one top left) that needs extracted as well.  

Any input you have would be much appreciated.  The headache was completely gone upon awakening this morning, and came back after about an hour (which is a bit longer than it has returned in the past week).  Geez, I just wish there could be a cut and dry answer that would make sense.

I'm trying to narrow the possibilities down and try to see what is what.  Thank you so much for your time.

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Avatar_dr_f_tn
Hi,

You have interestingly mentioned about your coffee intake and the headaches. You are actually referring to caffeine withdrawal headaches. However, data do not seem to give a definite conclusion with regards to headaches secondary to caffeine withdrawal. In a study of about 1000 subjects “Neither in those with a high consumption of coffee: > or =10 cups a day (n = 134), nor in those with a considerable variation in consumption: > or =10 cups/day (n = 31) did there seem to be a definite increase in headache resembling caffeine-withdrawal headache…”

Source: (http://www.ncbi.nlm.nih.gov/pubmed/15030532?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum).

An ENT consult (was this done?) and a follow up consult with your DMD may help clarify things for you. I know this is frustrating but headaches are really complex and the thing with headaches is that it may be a manifestation of almost any disease process. This is where a complete medical history comes in. So just be patient and your normal laboratory tests should offer some relief. A viral cause is a likely differential.

Do keep us posted regarding your progress.
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480448_tn?1403547723
Hi Doctor Lacuesta,

Thank you again for the valuable info and insight. My dental appt is later this morning, and I am very anxious to see if perhaps that is the root of all of these problems (ha ha, no pun intended!!!  Needed a good laugh).

Actually, the day I started getting the headache, I had pretty severe pain in the tooth I had repaired for most of the day.  It was a pain almost identical to the initial pain I had before the root canal (which I hadn't had since the RC was done 3 weeks before that).  The headace developed shortly after the tooth pain subsided.  That may mean nothing, or it may be significant.  I AM aware of the very complex nature of the facial nerves, and certainly, logic would dictate that if I was having frequent nerve-like pains, or trouble in general with a tooth, that it could possibly cause these symptoms.  Again, just thinking out loud and trying to determine the possibilities.

The left eye twitching has increased significantly, both upper and lower eyelids.  Also, I am starting to actually feel poorly, in addition to the headache.  Starting last night, my legs began to feel very weak and in general, I've been noticing weakness and an extreme fatigue-like feeling.  Also, slightly more frequent episodes of tinnitus as well.  While sleeping last night, I was sweating a bit.  The eye twitching is very curious to me.  The other symptoms as well, but I know that this is all taking a very large physical toll on me.  I am literally almost completely non-functional.  With children and a husband out of town, that is VERY difficult.  I am TRYING so hard to just push through as best as I can.

I woke up this am at 6:30, it is now 8:30, and the headache is just beginning.  I suppose that is at least some improvement, that each morning I have a longer period without the pain.  After it develops, however, it stays with me in varying degrees until I fall asleep.

My PCP did end up calling Imitrex in for me to try to give me some relief while I continue to try to figure it out.  I know Imitrex is prescribed for primarily migraines, and I am a little leary of taking it, just being a new medication.  If you could offer some insight into that, I would be especially grateful.  If the pain continues through this evening like yesterday (it got quite severe last night), I will probably try the Imitrex.  The only other med I am currently taking is the newly prescribed Corgard, 80 mg once daily (for the slight increase in BP I was having).  I usually tolerate medications without any problems, and have no allergies or sensitivities.

At this point, I am PRAYING the cause of this is related to that tooth.  It would make complete sense, and I just want to be able to address the issue, as I strongly feel it is a secondary h/a, I cannot imagine developing a primary h/a lasting 8 days straight out of the complete blue.

Oh, you had asked about an ENT consult, the PCP after examining me for sinus issues said she didn't feel that was necessary JUST yet.  She DID, however refer me to a Neurologist.  She basically explained that, of course, it will take a while to get an appt with Neurology, to make one, and follow up with the PCP in the meantime, hoping we discover an answer, in which case the consult wouldn't have been needed.

Again, thank you SO very much for your input and your time.  It has been so reassuring and helpful for you to work with me during this assessment process.  I look forward to your next post.  Take care, and have a nice day.
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480448_tn?1403547723
Hello Doctor,

I figured I would type an update.

I went to my dentist yesterday, and while there is nothing HORRIBLY obvious on my dental x-rays, there is definitely enough evidence there to warrant looking into it further.  He basically told me, that...looking at this situation simplistically and logically, with my history of never having headaches, let alone chronic ones, and the recent dental work, plus active dental issues I have yet to address (ALL on the left side, most upper jaw, some lower jaw).....that he would bet the bank the teeth are casuing all of this.

He doesn't want to think it is the recently root-canaled tooth, but the more I think about it, the more suspicous I am.

So, he started me back on ATB's and referred me to an oral surgeon, to extract a tooth in the back (not the tooth I suspect is the cause of my woes), and for him to evaluate the situation, to make sure there isn't something my DMD is missing, which I admire him for.0

I took 2 double doses of the Amoxicillin yesterday as per his instructions, and within hours, I noticed some changes.  The headache itself hasn't improved significantly, but what I DO notice is that it is most definitely worse on the left side (still temple area).

In addition, I now have VERY clear sinus type symptoms, my throat is sore (more on the left), my right nostril is running a bit (clear), and I have that "itchy" feeling that travels from my LEFT ear into my nose and throat area.  The eye twitching has diminished almost completely.  I ALSO can actually FEEL that the tooth we did the root canal on is aching a bit.  Now, the sore throat MAY indeed be totally unrelated, as my daughter has complained of a sore throat most of the week.

That all leads me to believe basically, that once the atb's got a jump start, it helped enough to prehaps release some of the pressure that would have been there (if indeed this is dental related)...and in turn, that minimized pressure has made me be able to pinpoint symptoms MUCH better...and actually I am having symptoms I didn't have before (or were completely overshadowed by the h/a).

I have an appt with the oral sugeon tomorrow morning and am hopeful I will have even more answers.  

I also had a low grade fever last night (99.7), that I hadn't had before, not to mention just "feeling" absolutely awful...weak, exhausted, etc.  The phsyical toll this headache has taken is incredible.  Truly gives me a new perspective and a lot more compassion for those of you who live with this all the time.

I would LOVE your input on this, Doctor, and will update you as I find more out.  I am now at LEAST a bit more hopeful that there is a solid and obvious reason for this, it has been so scary.  I was really starting to become concerned about an undiagnosed serious medical concern.

Again, thank you for taking the time this week to share your ideas and wisdom with me, it has been MOST helpful.
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Avatar_m_tn
Do these breathing exercises and the headache will start to go down after a few days.Drink warm water.
Build up your timing gradually.If you feel tired or dizzy, stop and resume after 1 minute.

Anulom Vilom -  Close your right nostril with thumb and deep breath-in through left nostril  
then – close left nostril with two fingers and breath-out through right nostril  
then -keeping the left nostril closed  deep breath-in through right nostril
then - close your right nostril with thumb and breath-out through left nostril.
This is one cycle of anulom vilom.
Repeat this cycle for 20 to 30  minutes twice a day(maximum 60 minutes in one day).
You can do this before breakfast/lunch/dinner or before bedtime or in bed.Remember to take deep breaths into the lungs.

Bhramri Pranayam -Close eyes. Close ears with thumb, index finger on forehead, and rest three fingers on base of nose touching eyes. Breathe in through nose. And now breathe out through nose while humming like a bee.
Duration : 5 to 15 times
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480448_tn?1403547723
Good Morning Dr. Lucuesta,

I'm going to post an update, as I would love to have your input on this.  It's been almost 10 days now, and the headache remains.  It feels a bit more in the front of my head (vs the temple pain I had before)...and I have some pressure around my right eye (as well as my right eye feeling "tired" if that makes any sense).  My sore throat is mostly resolved, and I have moderate amt of nasal congestion (clear drainage).  

My newest symptom is an increased feeling of "fullness" in my ears, almost like a very mild tinitus....and an occasional actual feeling of ringing.  My left ear feels "funny", almost like a very mild ache.  I have also noticed some tingling sensations in the back of my head on the left, as well as some "goosbumps" on the left arm (maybe a handful of times). I have had a low grade fever on and off.   I definitely do not "feel" well, I feel weak most of the time, especially my legs, they feel like jello.  I also am "shaky".  I also have noticed some PVC's, which I have had before in my life (hx of MVP), but I don't know if that could possibly just be stress related at this point?  

I had two teeth extracted on Friday at the oral surgeon's office.  Neither were the tooth I had the root canal in.  One was on that same row, the molar all the way in the back, and the other was just a root tip on the right upper jaw from a tooth I lost years ago.  The procedure went well, and the mouth soreness is pretty much resolved.

Last evening, the headache was the best the h/a has been (I have been taking 800 mg Motrin around the clock, along with the Corgard my PCP prescribed, and some Sudafed here and there.)  After the headache improved last night, I did have some aching in my root canaled tooth, very mild.  When the h/a DOES inprove a bit, my systemic sysmptoms worsen (shakiness, weakness, some sweating).

I called the doctor this morning to see if we could try a course of Prednisone.  I may be grasping at straws, but certainly, if there is an inflammatory process (either from a sinus infection, or tooth related).  I would imagine that may help?  I definitely have a "pressure" like feeling in my forehead.  My sinus area isn't tender to touch, except maybe a little bit on the top side of each nostril (between the eyes).  I had dental xrays on friday, wouldn't a sinus infection have showed up?  The surgeon said the sinus cavity looked okay (although he only glanced quickly at the films).

I have never had a sinus infection, allergies, or the like, so I would really not be able to narrow down the symptoms too well.  Any ideas Doctor Lucuesta?  Do you think that it would be worth a shot to try a course of steroids?  Would that be contraindicated for any reason?

Also, both the dentist and the oral surgeon say that the root canal tooth ins healing well, and does not look troublesome.  I still haven't ruled that out as the cause, but I don't want to be hasty, being that it seems to look okay?  I guess worst case scenario, I could have it extracted if it is a concern?  

Lastly, would there be ANYTHING cardiac that would cause these symptoms?  The PVC's DO have me a little concerned, but then again, I am under a tremendous amount of stress and not feeling well whatsoever.  I don't want to minimize this, in case of a serious illness, but I am also trying not to overly-worry about something like that.

I have been checking my BP at home, it has been mostly normal (110/70), with a few times my systolic being around 140 (diastolic has not been elevated at all).  The only other thing to mention, is my resting HR is usually around 100, and it has been 70-80 (which I'm sure is the Corgard).  Maybe the drop is causing the PVC's?

I truly would appreciate your input.  I apologize for this being so very long.  :0(


P.S.  Havana....thank you so very much for the breathing exercise ideas.  I haven't tried them yet, but I will.  Thanks for taking the time to post that.
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Avatar_m_tn
Just came across old post from Nursegirl, because she and I share similar symptoms. I was diagnosed with Atypical Trigeminal Neuralgia this week, but I DO NOT have the classic symptoms- triggers of shooting pain when brushing teeth, applying makeup, yawning, etc... Not me... Just constant pain and throbbing from a tooth on left side that has an old root canal in it. Endodontist said it looks fine in xrays, treated me with Augmentin for 7 days and the headaches have improved better, but I'm still in pain and my head feels "full" and have mild tinnitus in left side.

The backstory: I had new fillings put in - next to and below- that root canaled molar a few months ago, and immediately after that burning mouth syndrome started. Then, the throbbing tooth pain, finally leading to searing migraines which have subsided since last week. I've seen an Endo, a Neuro, an ENT. My primary physician doesn't think it's shingles because I have no rash, and has checked my blood for lots of other things, all came back negative.
Please, any help you can give is so appreciated. Lots of pain, only able to get through the day on pain meds and everything feels monumental. Many thanks.
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Avatar_m_tn
Do the exercises I suggested on April 18, 2008 to help the body fight the underlying problem and to also help you get through the day.
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