Hi, I am Neuro Doctor, an American Board Certified Neurologist with vast clinical experience.
Have you had this type of headache ever before, or is it the first time you are having this?
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Yes, I have had this before but not for some time now. I also take Gabapentin for left sided numbness that developed about 9 years ago. The diagnosis at that time was post viral neuropathy.
Okay I see
Is the headache continuous or intermittent type?
I am otherwise very healthy.
Okay I got it.
The headache has been basically continuous, only dulled with medication.
Is there sensitivity to light or sound?
not really if any it is slight
Is there any nausea or vomiting?
Okay I got it
Have you recently had a Brain scan like CAT scan or MRI scan?
no, I had a scan and angio 9 yrs ago when this numbness started
Is the headache pressure like, or is it pulsatile (throbbing) type?
Is there any fever?
i don't think so, but I didn't take my temp. I did have chills yesterday so I may have had a fever
Okay I see, and is there any neck pain or stiffness?
yes, but I was working very hard in the garden on Sunday and my muscles are pretty much all sore.
Are you having any chills today, any possibility of fever today?
Okay, and do you have any sinus symptoms (cold, congestion etc)?
Okay, and do you have a history of migraine headache or tension type headache?
yes, it more frequent when |I was working. I have been retired for 4 years and since then the headaches have drastically reduced.
Are you recently having excessive stress? And do you have any history of depression?
Is the blood pressure you mentioned in your question normal for you, or is it high?
it's about my norm, maybe a little elevated. it's really the increased pulse ans beating in my ears that is the most disconcerting
How much is your usual normal pulse?
Are you mentioning pulse rate, or just pulse?
probably between 70 and 80. somewhat more with exercise
When you mentioned increased pulse did you mean increased pulse volume or increased pulse rate?
increased rate but somehow with the beating in my ears it makes me think that maybe the volume is also increased. how would I judge that?
I got the answer, the beating feeling in the ear tells that the volume seems increased too, so both volume & rate increased
it is also worse when I lie down and try to sleep. somehow when I'm up and about it symptoms seem to be less severe
And you are sure except possibly yesterday you did not have fever on other days, agree?
And where is the numbness from the post viral neuropathy?
initially it was my total left side, but now I really only notice it in my left leg. Initially it was hypersensitive, but now with the Gabapentin my left leg fells large and heavy. I have normal reflexes and am able to ski and do everything. I do have a sensory problem with my left side. I have some difficulty knowing just where my leg is. I bump into things on that side more than on the other side. So I am very careful when sitting at a table with a table cloth that I don't pull the whole thing off.
I will now discuss the possibilities and the management plan
You are welcome
First of all I am not suspecting any serious conditions (like tumor etc)
Headache is a very common symptom and most often it is due to some non-serious cause
This could be what we call as tension type headache
this is due to build up of muscle tension in the head region
But considering this is going on for several days you may get a head scan too (like a CAT scan or MRI scan)
Just to make sure there is nothing else
You need a clinical examination too to check your pulse, heart, blood pressure etc
Do you have thyroid issues?
Okay I see, when was thyroid tested last time?
this past August
Because thyroid too can cause this kind of headache, but your thyroid was normal, so this is not the cause
You mainly need a clinical examination & a brain scan as pointed above
Coming to the treatments;
This type of headache responds to medications like Amitriptyline + Flexeril
Before that let me ask another question
Do you feel the Gabapentin ever helps with your headache?
hard to say since the Gabapentin is a regular med that I take bid. I know it is supposed to be q8h but I was always forgetting the middle dose, so this seems to work okay
Are you satisfied with Gabapentin's benefit for left sided neuropathy symptoms?
yes. I was on the highest dose for some time, but I have been able to reduce the dose to 1200 mgm bid. I tried to go lower, but the symptoms were more bothersome
Okay I got it. You did the correct thing of not reducing it further.
Okay I will now come back to headache discussion
Coming to treatments;
I was mentioning about Amitriptyline + Flexeril
The amitriptyline can actually help for the neuropathy symptoms too
Amitriptyline will help with the headache too
So this pill can help for both conditions
Flexeril helps for headache
The above combination is mainly as preventive agents
to prevent headache occurring
For acute severe headache attacks you need separate med
I see you tried Ibuprofen & Zomig etc
You may try some other treatments in place of them which can alleviate this headache
For example Tramadol
or Tylenol#3, or Lortab etc
The last 2 are either codeine containing or hydrocodone containing pills
These meds are stronger than the ones you are currently using
I once again reassure you this does not sound like anything serious
However see your clinic Dr ASAP for clinical exam, and Brain scan etc
And you may discuss with your Dr about the above treatment options too
Please go through the above information and let me know if you have any further questions.
no, you have been very thorough. What do you think causes the increased pulse with the beating in the ears? Do you think it is just the stress of having the severe headache?
I am very glad to be of help. I will explain more about the increased pulse and beating feeling in the ear symptom.
Your blood pressure is bit more it seems compared to your usual normal
this can cause the pulse related symptom
and this may be in turn from stress
the headache is causing lots of stress in you
headache is causing more stress, more stress is raising the blood pressure, and also pulse related symptoms
Unlikely this symptom is from anything serious
as the headache resolves the stress will subside, along with all your symptoms too will subside
thank you. I feel better already.
You are very welcome!
Wishing you a quick and complete recovery, all the best!
I am very glad to hear that you are feeling better already.