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Neurology (Expert Forum)
Three month long headache on right side and blood shot eye
Answered by
CCFNeuroMD JT, MD - Neurology/Epilepsy, Neurology/General
Cleveland - OH
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Three month long headache on right side and blood shot eye
by xbrookexnicolex, Nov 25, 2007 08:36AM
I'm only 18 and in college. I have a history of migraines for years now. For the past three or so months I've had a headache on just the right side of my head. Right from the top of my head to the back, the total right side. It's as if there is a line right down my head my left side doesn't even bother me. It's so strange to explain it's not different places on the right side, but the complete even right side. Anyway....it's been almost everyday and I went to the ER one night and I get migraines but Imitrex didn't even phase it. I got a CT scan done and they couldn't find anything so I went home with stupid pain pills. And lately it's been worse my right eye gets completely blood shot and the back of the right side of my head feels...well, almost like a heaviness to it. I have no clue what it could be. I'd rather not waste a trip to the doctor or the neurologist since he is two hours away. And my regular physician is my childhood pediatrician. No medicine even helps it. I've had but-apap-caf tabs, lortabs, regular OTC drugs, and my migraine meds. I can't concentrate on my studies it's really bothering me.
Doctor's Answer
by CCFNeuroMD JT, MD, Nov 28, 2007 12:20AM
, Nov 28, 2007 12:20AMTo: xbrookexnicolex
Thank you for your question. I must preface my answer by stating that it is important that you recognize that my impression is based entirely on the information you have provided in your posting and is by no means a substitute for an office visit with a neurologist or neurosuregeon. Diagnosis is contingent on detailed history and physical exam and as such, the following information should be considered solely for educational purposes.
I'm sorry to hear that you are having more frequent headaches- you have provided me with quite a bit of useful information, although I would be interested in learning about some more of the details. Specifically, the severity of the headaches is of utmost interest; that is, is the pain maximal at onset? Does the headache come on very quickly without warning or is it slowly worsening pain, possibly preceded by an aura? The symptoms you describe, especially the unilateral quality with redness of the eye, make me think of a headache variant known as cluster headache. Please allow me to desribe this headache subtype in greater detail.
Cluster headache is one of the less common headache variants and unlike migraine, it is more common in males than females with a peak age of onset between the 3rd and 5th decade of life (i.e. 20's-40's). Cluster headache pain is by definition, unilateral and generally has a very quick onset reaching maximal intensity within a matter of minutes. Associated symptoms include a "blood-shot" appearance of the eye, eye tearing, sometimes a runny nose, facial pallor, and changes in pupillary size. Pain is described as excrutiating, often of explosive quality. Some have described a sensation as though someone were sticking an icepick through the head or eye. Patients with these headaches are usually very agitated and restless, often pacing the room and figiting about. Each headache may be brief (about 15 minutes) but multiple headaches tend to occur over a short period of time.
The name, cluster headache, refers to the pattern of headaches in this particular condition. This headache subtype is characterized by repetitive headaches occuring in clusters for weeks to months at a time. As you have noted, your headaches are unresponsive to typical migraine medications. If you are in fact suffering from cluster headache, typical migraine medications have variable efficacy and the first choice for abortive treatment is 100% oxygen therapy. Preventative therapies include medications such as calcium channel blockers, lithium, ergot alkaloids, and steroids.
Again, I caution you that the above information is strictly that. . .information. I urge you to seek further evaluation by a neurologist, preferrably within a headache center such as the one at the Cleveland Clinic. I wish you the best of luck with your headache management. Thanks again for your question.
Best,
JBT, MD
I'm sorry to hear that you are having more frequent headaches- you have provided me with quite a bit of useful information, although I would be interested in learning about some more of the details. Specifically, the severity of the headaches is of utmost interest; that is, is the pain maximal at onset? Does the headache come on very quickly without warning or is it slowly worsening pain, possibly preceded by an aura? The symptoms you describe, especially the unilateral quality with redness of the eye, make me think of a headache variant known as cluster headache. Please allow me to desribe this headache subtype in greater detail.
Cluster headache is one of the less common headache variants and unlike migraine, it is more common in males than females with a peak age of onset between the 3rd and 5th decade of life (i.e. 20's-40's). Cluster headache pain is by definition, unilateral and generally has a very quick onset reaching maximal intensity within a matter of minutes. Associated symptoms include a "blood-shot" appearance of the eye, eye tearing, sometimes a runny nose, facial pallor, and changes in pupillary size. Pain is described as excrutiating, often of explosive quality. Some have described a sensation as though someone were sticking an icepick through the head or eye. Patients with these headaches are usually very agitated and restless, often pacing the room and figiting about. Each headache may be brief (about 15 minutes) but multiple headaches tend to occur over a short period of time.
The name, cluster headache, refers to the pattern of headaches in this particular condition. This headache subtype is characterized by repetitive headaches occuring in clusters for weeks to months at a time. As you have noted, your headaches are unresponsive to typical migraine medications. If you are in fact suffering from cluster headache, typical migraine medications have variable efficacy and the first choice for abortive treatment is 100% oxygen therapy. Preventative therapies include medications such as calcium channel blockers, lithium, ergot alkaloids, and steroids.
Again, I caution you that the above information is strictly that. . .information. I urge you to seek further evaluation by a neurologist, preferrably within a headache center such as the one at the Cleveland Clinic. I wish you the best of luck with your headache management. Thanks again for your question.
Best,
JBT, MD
