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I had an episode end of September where out of the blue I…

Customer Question
I had an episode...

I had an episode end of September where out of the blue I felt like a knife stabbed my right temple. It was so bad to the point where I thought I was going to pass out. From there, I was dealing with serious pain and disorientation. For 3 weeks I couldn't go outside in the light, watch tv, look at my phone, listen to loud noise etc. An er dr finally gave me imatrex which subsided my headache significantly. That was taken 3 weeks into the headache episode. From then on I still had headaches but not as debilitating. Advil tended to help and some days I stopped having headaches. However, now I'm starting to experience the same pain once again. I've been taking Advil and it's not working. Have been outing icy hot on my shoulder which helps but still not fully. It hasn't spasmed yet like it did last time when it hit me hard, but I'm starting to become concerned this is going to come back. I don't know what to do. The pain starts in my right shoulder then jolts up through the back of my neck behind my eye and right temple. Please help.

Doctor's Assistant: Is the headache episodic or daily? And what about nausea?

The onset in September was definitely episodic. Now it is less severe but it is daily and am worried I'm going to have another episode.

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

No nausea

Submitted: 6 months ago.Category: Neurology
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Customer reply replied 6 months ago
No prior medical history of headaches. I do get depression, anxiety and insomnia often. I also have the skyla iud which releases progesterone. I have noticed coffee causes headaches. I think lack of sleep and stress do also.
Answered in 1 hour by:
1/4/2018
Neurologist: Dr Subbanna MD, Neurologist (MD) replied 6 months ago
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,329
Experience: American Board Certified Neurologist, Internal Medicine
Verified

Hi, I am an American Board Certified Neurologist with vast experience in diagnosing & treating all neurological as well as all other health/medical conditions, and I am very glad to help you with your health concerns.

I am sorry to hear about your health in the form of excruciatingly severe head-pain/headaches. As a Neurologist I frequently diagnose & treat this type of health situation and I can certainly help you in this regard.

Based on the details provided by you it sounds you are having a type of migraine type headaches

This is not the typical presentation for migraines but there are certain features that indicate this appears a type of migraine condition, not the usual though, but still a type of migraine (a rare type of presentation) for the following reasons;

1) There is history of sensitivity to light and sound which are features of migraine type headaches

2) You are having certain trigger factors such as coffee, lack of sleep, stress etc and this is common with migraine patients

3) Imitrex helped you in the er, imitrex is typically used to treat migraine type of headache

So all these features related to the headaches/head pains indicate you are most likely suffering from a type of migraine

While this appears migraine however if you have not had any brain scan so far then it is recommended, such as cat scan or mri scan of the brain etc. Not really suspecting any brain pathologies but it is a standard protocol to arrange for a brain scan with new onset headache, if a brain scan has already been done then there is no need to repeat it again

Now coming to the treatment for these migraine types of headaches; the treatment consists of 3 main approaches as mentioned below;

A) Treatment of the acute migraine headaches called as “Migraine abortive treatments”

B) “Migraine preventive treatments” – which are used to prevent the future migraine attacks

C) Treatment of other symptoms associated with the migraine like nausea or vomiting etc (applicable if these symptoms are occurring with the migraine, not otherwise)

I have discussed each of the above approaches in more details below here;

A) Treatment of acute migraine headache attacks;

1) Trying certain General measures OR Home remedies OR OTC/Over the counter non-prescription treatments for acute migraine attacks such as the following;

Heat or Cold therapy (Hot compress or Cold compress)

Epsom salt compress

Epsom salt bath

Application of pain relieving creams such as Myoflex or Biofreeze

Application or rubbing with Essential oils such as Eucalyptus oil or Lavender oil

Aromatherapy with Essential oils such as Eucalyptus oil or Lavender oil

Head, neck, shoulder massage etc

Over the counter pain medications such as;

Excedrine migraine

Feverfew

Gelstat Sublingual

MigraSpray Sublingual spray etc

2) Trying certain Prescription medication options for acute migraine attacks such as the following;

Stronger anti-inflammatory pain killers such as Diclofenac (Cambia), Tramadol

Triptan agents such as Imitrex, Rizatriptan, Naratriptan, Frovatriptan etc (they come in various forms including oral tablets, nasal sprays, skin patches & self- home injections etc)

Triptan agent + Anti-inflammatory pain killer combination like Tab Treximet

Midrin (this is arranged through compounding pharmacies)

Ergotamine preparations such as Ergomar Sublingual, Cafergot oral, Ergotamine suppositories, Ergotamine nasal spray, Ergotamine injection (can be self-injected at home) etc

Prochlorperazine (Oral, Suppositories, Liquid, Injections etc)

Intranasal Lidocaine 4%

Fiorinal or Fioricet

Fiorinal with Codeine or Fioricet with Codeine

Butorphanol (Stadol) nasal spray

Narcotic/opioid drugs like Tylenol #3, Percocet, Lortab

Soma compound with codeine (a combination pill of three different medications together and contains Soma a muscle relaxant Aspirin an anti-inflammatory pain killer and Codeine a narcotic (opioid) pain killer)

A course of oral steroids etc

3) Trying certain Medical Device or Special Procedure treatment options for acute migraine attacks such as the following;

Spring TMS (Transcranial Magnetic Stimulator)

SPG Block (Sphenopalatine ganglion block) with Lidocaine 4% with or without a steroid etc

B) Treatment to help in preventing the future migraine (migraine headache preventive agents);

1) Trying certain General measures OR Home remedies OR OTC/Over the counter Non-prescription treatments for preventing future migraine attacks such as the following;

Identifying and avoiding exposure to migraine triggers as much as possible (stress, lack of sleep, caffeine, certain food triggers etc)

Dietary modifications such as consuming magnesium rich diet consisting of green leafy vegetables, legumes, seeds, unrefined whole grains and brown rice, vegetable such as sweet potatoes, artichoke and okra, fruits such as apricots, kiwi fruit, yogurt and milk etc

Oral Magnesium supplements

Butturbur

Feverfew

Riboflavin (Vitamin B2)

CoQ 10 (Coenzyme q10)

Preventa Migraine

Migrelief

Migra spray or MigraSpray (can be used against for both acute attacks as well as to prevent future attacks)

Migralex

Migraclear

Migravent

Neuroline etc

2) Trying certain Prescription medication or injection treatment options for migraine prevention such as the following;

Beta blockers such as Propranolol, Metoprolol, Atenolol

Anticonvulsants such as Topiramate, Depakote, Keppra, Zonisamide, Gabapentin, Pregabalin

GABA derivatives/ Muscle relaxants such as Baclofen, Tizanidine

Tricyclic medications such as Amitriptyline, Nortriptyline

Calcium Channel Blockers such as Verapamil, Diltiazem

Cyproheptadine

Botox injections

Steroid injection

SSRI agents such as Fluoxetine, Sertraline etc

3) Trying certain Complementary & Alternative medicine treatments to help with preventing migraine headaches such as the following (these help with diluting stress, anxiety & depression, and can help with improving sleep too);

Acupuncture

Biofeedback

Hypnotherapy etc

4) Trying certain Medical Devices or Special Procedures to help with preventing migraine headaches;

Trigeminal nerve Neurostimulation with Cefaly

TENS (Transcutaneous Electric Nerve Stimulation)

Occipital nerve block

Occipital Nerve Stimulation

SPG Block (Sphenopalatine ganglion block) with Lidocaine 4% with or without a steroid

Low Level Laser therapy (Cold Laser therapy) etc

C) If migraine attacks are associated with additional symptoms like nausea and/or vomiting then the following agents may help (only if experience nausea or vomiting, otherwise not needed);

Prochlorperazine

Promethazine

Metoclopramide etc

The above are the various treatment options to consider, but please see not all these above mentioned treatments may be required in your case; I am trying to provide a list of the various treatment options like this so that you are familiar with several treatments that are available for helping with your health condition and you may try to use them as necessary. If you see any of the above treatments you have already tried please disregard them and you may explore the treatment options which you may have not yet tried.

To summarize once again;

1) Please see this appears a type of migraine headache/head-pain, not the usual type of migraine, nevertheless a type of migraine – for the reasons discussed earlier above

2) If you have not had a brain scan so far then you need one, if a brain scan has already been done then there is no need to repeat one

3) In the meantime you may try some of the treatments mentioned earlier above and these can help in providing relief from the acute severe attacks, as well as help in preventing future attacks too, and also please try to identify and avoid headache triggers as much as possible and this can reduce the number of attacks as well as severity of attacks too

4) And also very importantly, please see this type of headache/head-pain condition can be successfully treated, please try the treatments mentioned above and these can immensely help in treating both acute attacks as well as help with preventing future attacks too, so please not to be scared or not to lose hopes.

Wishing you a quick & complete recovery! And also Wishing you the best health!

All the very best!

Please let me know if you have any additional questions or if you want to discuss this further.

Assuring you the best services!

Best Regards!

Dr Subbanna MD

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Neurologist: Dr Subbanna MD, Neurologist (MD) replied 6 months ago

Hi, I am checking on your health, how are you feeling now? Have you been feeling better now?

I earnestly hope the treatment options mentioned earlier will help you immensely and you will recover quickly & completely from these annoying, bothersome & frustrating headaches that you had mentioned earlier.

Do you have any additional health questions? Do you want to discuss further the health concerns you have mentioned above, or any other health related concerns?

Please let me know and I am available here.

Assuring you the best services!

Best Regards!

Dr Subbanna MD

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