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Frequent headaches, cheek pain, pounding like a heartbeat, grinder by profession. Treatment ?

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Internal Medicine Specialist
Practicing since : 1998
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I am having frequent headaches at different times of the day. Thought they were allergy related since its in my forehead.Cheeks hurt but its pounding like a heartbeat. I am a grinder so I have a mouthpiece, and so I'm not waking up with headaches but they still creep up on me during the day. Any ideas?

26, 310 ib.
Posted Sat, 5 May 2012 in Headache and Migraines
 
 
Answered by Dr. Jasvinder Singh 1 hour later
Hello,

Thanks for posting your query. On careful evaluation of your symptoms and history, four possibilities are there for your headaches.
1)The first possibility is of headaches due to teeth grinding and bruxism. Bruxism headaches are probably chronic and travel from the eyes and temples to the back of the head and neck.

2)Headaches are frequent side effects of sertraline and Lyrica but are more so pronounced in users of sertraline and are present in about 25 % patients. Talk to your doctor and get the dose of sertraline reduced. this may help with the headaches.

3)The third possibility (based on your symptoms of air borne allergies and asthma) are sinus congestion because of air borne allergens. To completely rule out any sinus congestions, better will be to get an ENT examination and a X-RAY/ CT sinuses done.

4)     Less likely the headaches can be due to tension headache or neurological causes and a CT head will completely rule out any neurological cause. So it is better to get it done.

Till the time you get these investigations done, remain indoors on windy days. You can also use a pollen and dust mask. Use a clothes dryer instead of hanging the wash outside, where it acts as a filter trap for air borne allergens. Make sure to clean and replace your air conditioner and air cleaner filters regularly. Also effective are various types of air-filtering devices, which can be added to the heating and cooling systems in the home. To reduce dust mites in your home, remove drapes, feather pillows, upholstered furniture, non-washable comforters and soft toys. Replace carpets with linoleum or wood. Vacuum soft furniture and curtains as well as floor and don't use mattress pads. Cover mattress and pillows with plastic covers.

Also avoid foods and drinks that contain caffeine, such as colas, chocolate, and coffee and hold a warm washcloth against your cheek in front of your earlobe. You can also take some good health.



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Follow-up: Frequent headaches, cheek pain, pounding like a heartbeat, grinder by profession. Treatment ? 1 hour later
1)The first possibility is of headaches due to teeth grinding and bruxism. Bruxism headaches are probably chronic and travel from the eyes and temples to the back of the head and neck.
R: I have a professional biteguard now. Will the headaches not go away? I've tried cold packs and heat pad. Seems to help temporarily til I no longer have ice/heat applied.
2)Headaches are frequent side effects of sertraline and Lyrica but are more so pronounced in users of sertraline and are present in about 25 % patients. Talk to your doctor and get the dose of sertraline reduced. this may help with the headaches.
R: I've been on the same dose for a year. These "clusters" started about 3 weeks ago. Up until then only allergy headaches. Clearly allergies. These are weird...it's pulsing (literally)in my forehead.Never had before.

3)The third possibility (based on your symptoms of air borne allergies and asthma) are sinus congestion because of air borne allergens. To completely rule out any sinus congestions, better will be to get an ENT examination and a X-RAY/ CT sinuses done.
R: I had a CT/Chest x-ray done in XXXXXXX and Feb. Nothing showed up in either.

4) Less likely the headaches can be due to tension headache or neurological causes and a CT head will completely rule out any neurological cause. So it is better to get it done.

Till the time you get these investigations done, remain indoors on windy days. R: Been home 95% of the time since March due to undiagnosed throat problem. Been to 7 doctors maybe...losing count. At university level now. Have to go back in July for voice evaluation. You can also use a pollen and dust mask. R: Done during high pollen time. Use a clothes dryer instead of hanging the wash outside, where it acts as a filter trap for air borne allergens. (Done)Make sure to clean and replace your air conditioner and air cleaner filters regularly.(I replace once a month and use allergy friendly kind) Also effective are various types of air-filtering devices, which can be added to the heating and cooling systems in the home. (Will look into)To reduce dust mites in your home, remove drapes,(Done) feather pillows,(Done. Allergen pillows that I put in dryer for 30 minutes once a week) upholstered furniture, (I have a leather couch which I wipe down regularly, and I have one rocker that the cushions go in the dryer once a week.)non-washable comforters and soft toys.(I wash comforter once a week as well as sheets) Replace carpets with linoleum or wood.(last resort. I love my carpet...) Vacuum soft furniture and curtains as well as floor and don't use mattress pads. Cover mattress and pillows with plastic covers. (Done.)

Also avoid foods and drinks that contain caffeine, such as colas,(20 oz. a day down from 2 liters) chocolate,(limited to occasionally) and coffee (none)and hold a warm washcloth against your cheek in front of your earlobe. (tried)You can also take some non steroidal anti inflammatory pain killers after getting them prescribed from your doctor.(I just took a Flexeril. I have them for emergencies due to chronic pain from fibro. only downside is it makes me loopy for bout 24 hrs.)


I feel like I'm living in a glass experiment tank. Experimental steroids and antibiotics, and I hate it. The headaches are an additional pain that should be fixable. As long as it's not blood pressure/blood sugar related Im ok. Just concerned since I am at my heaviest weight ever due to a month and a half of Prednizone 3x day

Thanks for your help. :)
 
 
Answered by Dr. Jasvinder Singh 7 hours later
Hello,

Thanks for the clarification. Clearly it looks like allergy related headaches given your history and symptoms. High blood pressure seems unlikely at your age and fluctuation in blood sugar can lead to lightheadedness and less likely headaches.

It is good that you are using dental guards. You can also use a NTI-tss (nociceptive trigeminal inhibitor) dental guard. Last option would be botox shots. Another simple treatment option would be steam inhalation. You may also find that adding some menthol crystals, or eucalyptus oil, to the water, helps to ease the symptoms.

It is also better to get a CT scan and MRI head done to completely rule out neurological causes of these headaches.

Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.

Wishing you good health.
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