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I have had daily headaches for the past three years.

I have had daily...

I have had daily headaches for the past three years. Mitigation of the pain has been unsuccessful regardless of medication used (including opoids). Aches have been accompanied by severe weight loss (193 to 150) over 2 year period

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

Daily

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

None

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Answered in 6 hours by:
1/19/2018
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,403
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 you have been having daily headaches for the past three years, but unfortunately, no medications including the opioid type medications have not been able to help you with these daily headaches. As a Neurologist I frequently diagnose & treat this type of health situation and I can certainly help you in this regard.

First of all we need to establish a proper diagnosis and find out the precise cause for this type of persistent daily headache and if any underlying cause will be identified then treating the underlying cause can help in fixing the headache permanently. I am not sure how far you have been investigated so far in this regard, what I will do now is try to provide you with a list of various neurological investigations that can help us in ascertaining the precise cause for headaches and the following are the investigations that need to be arranged (if not already done);

1) MRI Scan of the brain – to study the brain structures

2) MRI Scan of the spine – to study the spinal cord and spinal nerve structures

3) MRA (MR Angiogram) – to study the blood flow to the brain

4) MRV (MR Venogram) – another test to study the blood flow in the brain (this test studies the venous blood flow from the brain, whereas the above mentioned MRA studies the arterial blood flow to the brain)

5) Spinal tap (Lumbar Puncture) for the laboratory analysis of CSF (Cerebrospinal Fluid) – to check for any chronic infections or inflammations affecting the brain or its coverings called as meninges, the spinal tap also will help in measuring the spinal fluid pressure because persistent rise or decrease in the CSF pressure too can cause chronic daily headaches like this

6) Polysomnography – a sleep related test – certain types of sleep disorders too can cause chronic daily headaches such as this

7) Blood tests such as the following ones;

a) Comprehensive metabolic panel – to check for the electrolytes, liver, and kidney related blood tests

b) CBC - Complete Blood Cell count

c) Blood sugar, GTT (Glucose Tolerance Test), HbA1c (Glycosylated hemoglobin) – diabetes related tests

d) Serum total protein & globulin - tests for the status of nutrition, and also for status of immunity

e) SPEP (Serum Protein Electrophoresis) & IPEP (Immuno Protein Electrophoresis)

- these tests are immunological related tests

f) Antiphospholipid antibody testing - checks for the lupus anticoagulant and cardiolipin antibodies

g) Vitamin B12, Folic acid, Vitamin B6, Vitamin B1 & B2, Vitamin D - Vitamin deficiency tests

h) TSH, T3, T4 - thyroid tests

i) ESR, CRP, ANA, dsDNA, Rheumatoid factor, SSA, SSB, Serum complement assay etc - autoimmune/inflammatory disorders tests

j) Lyme antibodies, Mono, RPR etc - chronic infection related tests

k) Heavy metal screening - tests to rule out heavy metal toxicity etc

The above mentioned are the various investigations that are usually required and then treated appropriately depending upon the test results. If any of the above mentioned investigations have already been done recently then there is no need to repeat them again, rather the focus needs to be on those investigations that have not already been done. For example it is possible you have already had many of the above blood tests and a brain scan etc, so please to focus on those tests that have not already been done and no need to repeat those tests that have already been done.

Coming to the headache management; if the above mentioned investigations reveal any abnormal findings that can explain these headaches then it will be treated appropriately which can help you in getting rid of these headaches permanently, and in the meantime the following are the various treatment options recommended to help with these types of chronic daily headaches (I have not mentioned any oral medications since you seem to have tried almost all the oral medications including the opioids too);

A) Complementary and Alternative medicine treatments such as the following;

Acupuncture

Hypnotherapy

Biofeedback etc

B) Counseling/therapy such as CBT (this is applicable if lot of stress is present, not otherwise)

C) Trigger point management (this is applicable if trigger points are present, not otherwise)

D) Massage therapy to the head & scalp muscles

E) TENS (Transcutaneous Electrical Nerve Stimulation)

F) If neck also bothers then these are the additional options (if neck does not bother these below treatments may not help much);

a) Lidocaine anesthetic patches to the neck

b) Physical therapy to neck muscles

c) Massage therapy to the neck muscles

d) Diathermy

e) Laser therapy (Cold laser type)

f) Occipital nerve blocks

g) Occipital nerve stimulation

i) ESI (Epidural Steroid Injections) etc

G) Botox injections 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 these daily headaches 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.

In addition to the above, you may also consider trying certain over the counter/non-prescription nutritional supplements such as the following ones;

Methyl Guard Plus (which is a combination of active forms of vitamin b12, vitamin b9/folate, vitamin b6, vitamin b2)

Vitamin B1 (Sulbutiamine form – which has better penetration to the brain than the other forms)

Vitamin A, D, E & C

ALA (Alpha lipoic acid)

Acetyl L Carnitine

Coenzyme Q10 etc

These above mentioned nutritional supplements too can help in getting relief from the symptoms, and also assist you with faster recovery too.

And I am also sorry to see you have lost lot of weight too, sometimes the weight loss can happen due to the stress caused by the headache and not eating well etc, but there could be independent issues too that is causing this weight loss - so if you have not already been evaluated and investigated for this weight loss then this needs to be accomplished asap. Many of the tests I have mentioned above will help in looking for the cause for the weight loss too; and in addition to the above tests - if not already done – then you also require a CAT scan of the chest, abdomen and pelvis to ascertain the precise cause for the weight loss and then treated appropriately.

To summarize once again;

1) Please see there are many possibilities that can cause this type of chronic daily headache

2) A thorough investigations as mentioned earlier above can help us in finding out the precise cause for these headaches then treated appropriately depending upon the test results

3) In the meantime you may try some of the treatments mentioned earlier above and these can help in providing relief from these annoying, bothersome daily headaches you have been experiencing

4) If not already investigated for the weight loss then you also require thorough investigations as mentioned earlier to ascertain the precise cause for the weight loss and then treated appropriately depending upon the test results

5) And also very importantly, please see these types of health issues can be diagnosed & successfully treated, so please not to be scared or not to lose hopes, an early diagnosis and treatment gives the best chance for quick & complete cure so please try to undergo a thorough neurological investigations as discussed earlier above which will help you with the best outcome and best results!

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. And please take a moment and kindly click a positive rating (preferably 5 Star/Excellent) to credit for the time & effort put by me in answering your health questions, and this is the only way I will be credited for my services to you. Rating me now does not close your question and if you have follow-up or additional questions you can ask them after the rating too!

Assuring you the best services!

Best Regards!

Dr Subbanna MD

Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,403
Experience: American Board Certified Neurologist, Internal Medicine
Verified
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