My fiancée has had a headache since around the middle of November. it started as a nagging mild headache and then in one incident flared up into a headache with symptoms similar to migraine, including blurred vision, facial numbness on the left side, and photophobia. elitriptan gave her some relief the first time, but then failed to work again. barbituates and hydrocodone give her some relief, but cannot eliminate the headache. topamax made her headaches much more severe and the severity decreased markedly the first day after she stopped topamax, but was still there. NSAIDs and antihistamines do not provide relief or abate the symptoms. She has no history of migraines and neither does anyone in her family. She stopped birth control after roughly 3 weeks of the headache, and this has had no impact one way or the other. Her CT and MRIs were normal. Switching to a tyramine/nitrate free and discontinuing alcohol consumption have had no effect. The headaches seem to be worst when she wakes up, but on bad days the severe pain lasts all day. on good days her pain is a 1 or 2 but does not go away. The pain and numbness are localized to the left side of her face at or above the eye orbital. The numbness is general on the left side of the face while the pain typically has a smaller focus that varies, usually either the eye, above the eye, the ear, or in between the eye and the bridge of the nose. occasionally she is more sensitive to her hair being pulled. The blurred vision has worsened in the last few days after a few weeks of steady improvement, and keeping a headache diary hasn't revealed any obvious triggers. She isn't taking any medications other than hydrocodone when the pain is most severe. Her balance seems unaffected, though lately her sense of smell is less acute. She occasionally has mild to moderate nausea, but hasn't vomited other than one day when taking the highest dose of topamax. She had some neck stiffness early on but that has subsided. Her bloodwork was normal and she is not pregnant. She has had torn discs in her lower lumbar region last year, but is not currently experiencing back pain unless she sneezes, and then in the lower back. Any thoughts at all would be appreciated, we've stumped a few doctors already.
Brian