Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Do Persistent Headaches And Throbbing Pressure Behind The Eyes Indicate?
Question: My daughter, a 32-year-old woman, was referred for headaches that had begun in her teens.
She describes her headaches as a throbbing or pressure sensation that began behind one eye and then rapidly spread to the ipsilateral temple.
Although the headaches usually occurred on the left side, on rare occasions they were right-sided. The severity of pain ranged from moderate to severe, and the pain often began within 1 hour of waking. The headaches were associated with photophobia and phonophobia and tended to worsen with movement.
What is your list of differential diagnoses at this point and what additional questions might you ask or testing might you do.
She describes her headaches as a throbbing or pressure sensation that began behind one eye and then rapidly spread to the ipsilateral temple.
Although the headaches usually occurred on the left side, on rare occasions they were right-sided. The severity of pain ranged from moderate to severe, and the pain often began within 1 hour of waking. The headaches were associated with photophobia and phonophobia and tended to worsen with movement.
What is your list of differential diagnoses at this point and what additional questions might you ask or testing might you do.
Brief Answer:
Additional questions explained below.
Detailed Answer:
Hello and thanks for using HCM.
I have read your query and understand your concerns.
Additional questions that I can ask at this point are:
- is there any eye redness, excessive lacrimation at the eye the same side with headache?
- is the headache accompanied by stuffy or runny nose?
- what is the minimal and maximal time of headache duration?
- how is the frequency of headaches distribution during a six month or one year period?
- is there any nausea or vomits?
-the headache starts gradually (increasingly), or abruptly?
- any activity or situation that relieves or worsen the headaches?
- what drugs you used and their effects on headaches?
If your daughter was my patient, at this point I would categorize headaches in two groups: cluster headaches and migraines.
If there are any doubts left about headaches type after answers of above questions, I would ask for brain imaging studies (MRI) in order to evaluate/exclude any organic cause of headaches.
Hope this helps. I remain at your disposal for further questions and clarifications.
Best regards.
Additional questions explained below.
Detailed Answer:
Hello and thanks for using HCM.
I have read your query and understand your concerns.
Additional questions that I can ask at this point are:
- is there any eye redness, excessive lacrimation at the eye the same side with headache?
- is the headache accompanied by stuffy or runny nose?
- what is the minimal and maximal time of headache duration?
- how is the frequency of headaches distribution during a six month or one year period?
- is there any nausea or vomits?
-the headache starts gradually (increasingly), or abruptly?
- any activity or situation that relieves or worsen the headaches?
- what drugs you used and their effects on headaches?
If your daughter was my patient, at this point I would categorize headaches in two groups: cluster headaches and migraines.
If there are any doubts left about headaches type after answers of above questions, I would ask for brain imaging studies (MRI) in order to evaluate/exclude any organic cause of headaches.
Hope this helps. I remain at your disposal for further questions and clarifications.
Best regards.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
The following is a more detailed history of my daughter's condition: During her teens, her headaches had always been associated with nausea and vomiting. For the past 10 years, although nauseated, she no longer vomited with her headaches. She felt an overwhelming sense of exhaustion and craved sweets the night before most of her headaches.
When she was younger, she had missed an average of 1 day of school per month because of her headaches, having to remain in her bedroom with the lights out and the shades drawn. Her pediatrician recommended treating the pain with ice packs and acetaminophen, which afforded little or no relief. She believed the headaches resolved on their own, usually within 12 hours of onset.
Her headaches were often triggered by stress, weather changes, and too little sleep, but these triggers were not consistent. Each month, however, usually 1 to 2 days before the onset of menstruation, sht experienced a severe headache that could last for up to 2 days. These headaches were more severe than her other headaches and occurred each month.
Over the years, her headaches have recurred at varying intervals. During her 2 pregnancies, however, she was relatively headache-free.
At the present time, she reports 2 or 3 headaches monthly, one always in association with her menses. Because of these headaches, she consulted with her gynecologist, who recommended treatment of the acute attacks with naproxen sodium. However, the treatment worsened the nausea. He then gave her a prescription for a combination product containing acetaminophen, butalbital, and caffeine, which made her drowsy but did not abort the headaches.
Past Medical History
Unremarkable.
Family History
Positive for a mother and grandmother with "sick" headaches.
Medical and Neurologic Examinations
Normal.
Diagnostic Workup
She has never undergone a neuroimaging procedure and her doctor feels it is not warranted at this time.
What is your primary diagnosis now? What medication therapy would you initiate?
What frequency of follow up and what non-pharmacologic options do you recommend to help in decreasing the severity and frequency of her headaches?
When she was younger, she had missed an average of 1 day of school per month because of her headaches, having to remain in her bedroom with the lights out and the shades drawn. Her pediatrician recommended treating the pain with ice packs and acetaminophen, which afforded little or no relief. She believed the headaches resolved on their own, usually within 12 hours of onset.
Her headaches were often triggered by stress, weather changes, and too little sleep, but these triggers were not consistent. Each month, however, usually 1 to 2 days before the onset of menstruation, sht experienced a severe headache that could last for up to 2 days. These headaches were more severe than her other headaches and occurred each month.
Over the years, her headaches have recurred at varying intervals. During her 2 pregnancies, however, she was relatively headache-free.
At the present time, she reports 2 or 3 headaches monthly, one always in association with her menses. Because of these headaches, she consulted with her gynecologist, who recommended treatment of the acute attacks with naproxen sodium. However, the treatment worsened the nausea. He then gave her a prescription for a combination product containing acetaminophen, butalbital, and caffeine, which made her drowsy but did not abort the headaches.
Past Medical History
Unremarkable.
Family History
Positive for a mother and grandmother with "sick" headaches.
Medical and Neurologic Examinations
Normal.
Diagnostic Workup
She has never undergone a neuroimaging procedure and her doctor feels it is not warranted at this time.
What is your primary diagnosis now? What medication therapy would you initiate?
What frequency of follow up and what non-pharmacologic options do you recommend to help in decreasing the severity and frequency of her headaches?
Brief Answer:
Most probably migraine headaches.
Detailed Answer:
Welcome back and thanks for the clarifications.
In this case, the primary diagnosis is migraine headaches, even the aura is missing.
About medical treatment I would initiate a trial of Triptans ( sumatriptan 25 mg one tablet at beginning of the headaches ) for a couple of months.
Non-pharmacological measures to decrease duration and frequency of headaches include:
- getting enough sleep, but not oversleep
- muscles relaxation exercises ( yoga eg)
- rest in a dark, quiet room before or at headaches start
- massage therapy
- use of herbs such butterbur and high doses of riboflavin (vitamin B2).
If the medical and non-pharmacological treatment fail to improve headaches, preventive treatment should be initiated.
Preventive treatment includes use of one of three drugs class:
- antidepressants ( Amytriptiline)
- antiseizure drugs ( Valproate)
- calcium channel blockers ( Verapamil)
Since these are prescription drugs, their use should be discussed with your doughter's treating Doctor.
Hope I helped. Best regards.
Most probably migraine headaches.
Detailed Answer:
Welcome back and thanks for the clarifications.
In this case, the primary diagnosis is migraine headaches, even the aura is missing.
About medical treatment I would initiate a trial of Triptans ( sumatriptan 25 mg one tablet at beginning of the headaches ) for a couple of months.
Non-pharmacological measures to decrease duration and frequency of headaches include:
- getting enough sleep, but not oversleep
- muscles relaxation exercises ( yoga eg)
- rest in a dark, quiet room before or at headaches start
- massage therapy
- use of herbs such butterbur and high doses of riboflavin (vitamin B2).
If the medical and non-pharmacological treatment fail to improve headaches, preventive treatment should be initiated.
Preventive treatment includes use of one of three drugs class:
- antidepressants ( Amytriptiline)
- antiseizure drugs ( Valproate)
- calcium channel blockers ( Verapamil)
Since these are prescription drugs, their use should be discussed with your doughter's treating Doctor.
Hope I helped. Best regards.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Is there any possibility of Subarachnoid hemorrhage or Menengitis based on the information I have given you about my daughter?
Brief Answer:
Both are not possible.
Detailed Answer:
Welcome back.
Subarachnoidal hemorrhage starts suddenly with the worst headache ever, usually affects consciousness and doesn't last for that long.
Meningitis is accompanied by other symptoms, besides headache, such fever, stiff neck, consciousness alteration and if not treated may be fatal as the subarachnoidal hemorrhage can be too.
So, according to symptoms you described, neither of above is possible.
Hope this helps. Best regards.
Both are not possible.
Detailed Answer:
Welcome back.
Subarachnoidal hemorrhage starts suddenly with the worst headache ever, usually affects consciousness and doesn't last for that long.
Meningitis is accompanied by other symptoms, besides headache, such fever, stiff neck, consciousness alteration and if not treated may be fatal as the subarachnoidal hemorrhage can be too.
So, according to symptoms you described, neither of above is possible.
Hope this helps. Best regards.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
