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Ive been having burning headaches and insomnia. What could

 
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  • Answered by:neuromd2012
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Customer Question

I've been having burning headaches and insomnia. What could be the cause?

 

Optional Information:
Person's Gender: Male
Person's Age: 36

Already Tried:
Doxycycline

Submitted: 347 days and 10 hours ago.
Category: Neurology
Value: $48
Status: CLOSED

Accepted Answer

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Expert:  neuromd2012 replied 347 days and 10 hours ago.


neuromd2012 :

HI I am a neurologist and can attempt to answer your question

neuromd2012 :

I am waiting for you to come on a chat line

Customer : Thank yuo
neuromd2012 :

hi

neuromd2012 :

no problem so tell me your story and I will read it

Customer : Hi
neuromd2012 :

hi

Customer : Ok.... For the past three months I have been having recurring burning headaches and 2-4 hours of sleep a night. One hour last night. Just recently I started having some hot flashes when try to sleep.
neuromd2012 :

where is it burning?

Customer : The headaches seems to migrate from the sides to the back. Which causes stiffness in my neck
neuromd2012 :

do you have high blood pressure

Customer : No... I went to the doctor all vitals were normal/ within range.
neuromd2012 :

why did you choose doxycycline?

neuromd2012 :

are you stressed out?

Customer : I had a tick bite but no attachment. The doc thought that may be the best treatment
Customer : Not necessarily.
neuromd2012 :

well, I mean if you put those two things together , you get concerned about meningitis, but not for 3 months. Do you have this thing called kernig's sign

neuromd2012 :

if you lay flat on a bed, and then just lift your head up a bit, do you have neck pain?

Customer : Some, but I never had symptoms like this in more stressful situations in the past
Customer : Slight
neuromd2012 :

really. so did anyone consider an MRI with gadolinium?

neuromd2012 :

have you ever had aseptic meningitis in the past? there is a thing called Mollarets meningitis which is a recurrent form

Customer : Not yet... What is gadolinium?
Customer : No.
neuromd2012 :

could you have lyme meningitis, you would be much sicker

neuromd2012 :

gadolinium is a contrast agent used in MRI, we would be looking for enhancement in the coverings of your brain, the meninges for lyme meningitis

neuromd2012 :

very rare and u have to be immunocompromized, I think I am off the tract and want to switch it

Customer : Ok
neuromd2012 :

there is a headache syndrome which classically makes your head hot and red, and can classically also wake you up from sleep, and that is cluster headache

neuromd2012 :

it makes your head hot and red because it affects the autonomic system.

neuromd2012 :

anyway, this is a headache of type 1A driven men, obsessive types, is that you?

Customer : Oh, ok.
neuromd2012 :

it is also often familial, following the male lines

Customer : Some what
Customer : But never had before.
neuromd2012 :

ok. well the treatment is a medicine called Imitrex or sumitryptan for the initial trial,

Customer : Ok
neuromd2012 :

you should call your gp and ask him if you can have cluster headaches and ask for a sample pack of imitrex, he should have it and will give you a tab or two to try

Customer : Ok
neuromd2012 :

do you think this headache thing has come in a "cluster" and then will go away for awhile

Customer : Yes... But when you say " cluster" what are those symptoms?
neuromd2012 :

well cluster headache get their name because of the frequency of headache, they usually come on strong for two to three weeks, allmost daily, and then dissapear for a while

neuromd2012 :

they have an autonomic effect, so sometimes you get an unequal pupillary response, if you look in the mirror one pupil will be smaller than the other, and the headache can also

neuromd2012 :

effect that eye, causing it to tear and turn red. have you seen that?

Customer : Oh ok. They have been off and on daily since March.
neuromd2012 :

that is possible for cluster. If you get a response from the imitrex that will help to confirm it. there are also other treatments that work like nasal oxygen via a nasal cannula at 6 l/min

Customer : No
neuromd2012 :

other meds to, but they have more side effects.

neuromd2012 :

you can have cluster and not have the "oculocephalic" presentation with the eye and all that

Customer : Ok... Nasal cannula?
Customer : Oh ok.
neuromd2012 :

but it is one of the few headaches that can wake you up from sleep, is the headache waking you from sleep or are you an insomniac?

neuromd2012 :

it is that green tubing that runs in your nose, you see old people wearing them

neuromd2012 :

you dont have to wear it all the time, just when the headache starts, and you can kill it then. do you feel the headache coming on?

Customer : Yes..
Customer : I have difficulty getting to sleep lately.
neuromd2012 :

then it is a vascular headache, either cluster or common migraine, but I am betting cluster because you don't ususally wake from a migraine.

neuromd2012 :

do you have the headache or fear that you will get it?

Customer : Yes.
neuromd2012 :

well maybe that is it cluster, but I wanted to ask one more thing, do you snore a ton, or have wild leg movements at night while sleeping in bed,has anyone noticed that you stop breathing while you sleep?

neuromd2012 :

are you obese with a big collar on your shirt (like an 18 or something)

Customer : Yes yes yes and no. I am not obese and work out regularly.
neuromd2012 :

wow, so if you look at your two statements, you have insomnia and you have headaches, (not so much burning though) then you could have a central type of sleep apnea

neuromd2012 :

do you feel groggy during the day? do you have EDS, excessive daytime sleepiness?

Customer : They are burning somewhat...
Customer : I do feel groggy during the day
Customer : Not really excessive
neuromd2012 :

I think you should consider cluster headaches, and if the imitrex doesn't do anything, then consider a sleep study to exclude sleep apnea and the resultant headaches

neuromd2012 :

yes, central apnea is rare, if you arent' obese, that pretty much kills that diagnosis, if you run, then forget it

Customer : I was diagnosed with moderate to severe sleep apnea back in 2000 when I was in the military.
neuromd2012 :

That is about all I can come up with, could you please hit the accept button if you feel I answered your question as that is how I get credited for this work. Please get back to me if you have further questions

Customer : But never experienced symptoms like this
neuromd2012 :

Hey.. so maybe that was it, number 3!!! headaches and insomnia.,,

neuromd2012 :

it can change, you need another polysomnogram

neuromd2012 :

that will tell you for sure, go to a good lab, though, there are many shady ambulatory type labs floating around the US making money

neuromd2012 :

do you humidify your air where you sleep?

Customer : Oh ok... Would imitrex give me relief in the meantime?
Customer : No
neuromd2012 :

not for sleep apnea headaches , you probably know the treatment is cpap

Customer : Yes...
neuromd2012 :

so I have to go, please hit the accept for me if you can. and come back with your polysomnogram, how many hypopneas, O2 sat. drop, whatever, your eeg recording

Customer : Just never experienced this type of thing...
neuromd2012 :

well you wont kill yourself with the imitrex trial, then you can get the polysomnogram???

Customer : Ok
Customer : Thanks for your suggestions.
neuromd2012 :

ok see you,,no problem

Customer : Can I get a copy of our conversation?
neuromd2012 :

You can print it, if the chat doesn't print, I am going to switch this to a q and a format which might print betteer, and you can always come back to ask more questions, ok?

Customer : Ok thanks
neuromd2012 :

bye

Expert TypeBoard Certified Physician
Category: Neurology
Pos. Feedback: 95.3 %
Accepts: 5269
Answered: 4/28/2012

Experience: General Adult Neurologist. Board Certified. Experimental Neuroimaging and Neurodiagnostics

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Expert:  neuromd2012 replied 342 days and 13 hours ago.

Hi. Please let me know how it worked out. Sometimes you need to go with Imitrex injectable at 6 mg for cluster, so if you get a positive response from the 100mg oral dose, but not 100% try the injectable. good luck

 
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