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What Causes Headaches?

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Posted on Thu, 27 Nov 2014
Question: Hello Dr. Rynne . . I have been a headache suffer most of my life (female age 66 now). Later in life I realized that they are mostly rebound due to the caffeine in all the Excedrin taken daily for most of my life. Imitrex works well for me (25 mg) but I don't want to take that daily either. So, starting this past Oct 1, I started winging myself off of the caffeine, only 165 mg per day for 2 weeks, then dropped to 100 mg every 24 hours and then on Nov 1, I stopped entirely. I was taking about 300-400 mg of caffeine when I started the winging off. I was doing real well most of last week with tolerable headaches but then in the last few days, the headache are still here and nagging (not painful but annoying). Will go away on its own most days but others not. I have 2 questions .. I'm on day 10 with no caffeine and still having the headaches. Does it just take longer for others than the usual after nine days for most. 2nd question, it seems 1 mg or even a half of Lorazepam will stop it right away so I'm wondering if I'm having anxiety headaches just worrying about when and if these headaches will ever go away entirely along with the depression and doomed feeling while I have the headache. They warn you about Lorazepam (Activan) use long term but a life being depressed and fighting the dragon daily is not a life either. Any advise you can offer would be appreciated. Thanks so much, my name is XXXX
doctor
Answered by Dr. Shafi Ullah Khan (1 hour later)
Brief Answer:
Migraine headaches

Detailed Answer:
Thank you for asking

These are classic migraine headaches and many etiologies including coffee beans and all other stimulants and anxiety altogether trigger it.

I can understand your agony about its depressing effects. It needs modifications from diet , lifestyle, routine and preferences all put together to avoid triggers.

Its three way management.

1)Reduction of migraine triggers (eg, lack of sleep, fatigue, stress, certain foods)

2)Nonpharmacologic therapy (eg, biofeedback, cognitive-behavioral therapy)

3)Integrative medicine (eg, butterbur, riboflavin, magnesium, feverfew, coenzyme Q10)

I also want yout o know that When headache is episodic and recurrent and follows a well-established pattern, the patient likely has a primary headache disorder (ie, headaches with no organic or structural etiology). Differentiating migraine from other primary headaches (eg, muscle contraction tension headache, cluster headache) is important, as optimal treatment may differ.

Migraine may also may simulate or be simulated by secondary headache disorders or coexist with a secondary headache disorder. Any of the following features suggest a secondary headache disorder and warrant further investigation:

The first or worst headache of the patient's life, especially if rapid in onset
A change in frequency, severity, or clinical features of the attack
New progressive headache that persists for days
Precipitation of headache with Valsalva maneuvers (ie, coughing, sneezing, bearing down)
The presence of associated neurologic signs or symptoms (eg, diplopia, loss of sensation, weakness, ataxia)
Onset of headaches after the age of 55 years
Headache developing after head injury or major trauma
Persistent, 1-sided throbbing headaches
Headache accompanied by stiff neck or fever
Atypical history or unusual character that does not fulfill the criteria for migraine
Inadequate response to optimal therapy

Common dietary triggers which you need to avoid include the following:

Alcohol - Particularly wine and beer
Caffeine overuse or caffeine withdrawal
Chocolate
Aspartame - eg, NutraSweet and Equal
Monosodium glutamate (MSG) - May be found in Asian food, canned soup, frozen or processed foods, and the seasoning product Accent
Fruits - Citrus fruits, bananas, avocados, and dried fruit
Nuts - Peanuts, soy nuts, and soy sauce
Tyramine, a biogenic amine that accumulates in food as it ages, may provoke migraine. Sources include the following:

Dairy - Aged cheese
Meat - Bacon, sausage, luncheon meat, deli meat, pepperoni, and smoked or cured meat
Pickled foods
Heavily yeasted breads - Eg, sourdough
Vinegars - Especially wine vinegar
Some types of beans
Nutraceuticals shown to be effective in randomized clinical trials include the aforementioned vitamin B2, CoQ-10, magnesium, and butterbur (Petadolex)

Get a neurologist and let them help you in this regard. Biofeedback, cognitive behavioural therapies, acupressure also help. Pharmacotherapy is always an option.

I hope it helps. Take good care of yourself and dont forget to close the discusison please.

may the odds be ever in your favour.

Regards
Khan



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shafi Ullah Khan (1 hour later)
I appreciate your detailed explanation of headache but this doesn't pertain to me. I simply wanted to know if some people continue to have headaches longer than the typical 9 days once going off caffeine entirely and if some of my headaches could be anxiety since Activan, even in the lowest does, relieves it almost immediately. You listed a long list of secondary factors for headaches, none of which apply to me or I would have mentioned it. For example, yesterday I got the worst headache of my life for the first time in my life. I know what all that means. I told you I've had headaches my entire life and I'm sure a large portion now are rebound. I also know all the food triggers. You provided a textbook answer that I can read online all day long. Please answer the 2 questions I asked. You said nothing of this in your long textbook explanation. Again, simple answer . . . do some people continue to have headaches well after 9 days when stopping caffeine and could my headaches be anxiety related since Activan, even in very small does, relieves them almost immediately. These are the only 2 questions I want answered. Please answer them ort credit me back my $15.
doctor
Answered by Dr. Shafi Ullah Khan (57 minutes later)
Brief Answer:
:)

Detailed Answer:
Thank you for getting back.

Caffeine withdrawal may pertain to upto 2 weeks minimum so yes headaches after caffeine withdrawal is possible after 9 days.

If anxiolytics relieves the headache then it may be the reason as anxiety causes tension headaches and also anxiety itself triggers migraines.

Yiu are not compliant to the medicine yoh take one and then you stop for no reason. That is the bigger issue. It needs constant management.

And I am sorry I tried to be sympathetic and explained everything along the answer to your question. I guess I was wrong.

Here you go. Caffeine plus anxiety plus non compliance your issue of anxiety.
You are 55. Other etiologies need to be ruled out .

Good luck .
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Shafi Ullah Khan

General & Family Physician

Practicing since :2012

Answered : 3613 Questions

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What Causes Headaches?

Brief Answer: Migraine headaches Detailed Answer: Thank you for asking These are classic migraine headaches and many etiologies including coffee beans and all other stimulants and anxiety altogether trigger it. I can understand your agony about its depressing effects. It needs modifications from diet , lifestyle, routine and preferences all put together to avoid triggers. Its three way management. 1)Reduction of migraine triggers (eg, lack of sleep, fatigue, stress, certain foods) 2)Nonpharmacologic therapy (eg, biofeedback, cognitive-behavioral therapy) 3)Integrative medicine (eg, butterbur, riboflavin, magnesium, feverfew, coenzyme Q10) I also want yout o know that When headache is episodic and recurrent and follows a well-established pattern, the patient likely has a primary headache disorder (ie, headaches with no organic or structural etiology). Differentiating migraine from other primary headaches (eg, muscle contraction tension headache, cluster headache) is important, as optimal treatment may differ. Migraine may also may simulate or be simulated by secondary headache disorders or coexist with a secondary headache disorder. Any of the following features suggest a secondary headache disorder and warrant further investigation: The first or worst headache of the patient's life, especially if rapid in onset A change in frequency, severity, or clinical features of the attack New progressive headache that persists for days Precipitation of headache with Valsalva maneuvers (ie, coughing, sneezing, bearing down) The presence of associated neurologic signs or symptoms (eg, diplopia, loss of sensation, weakness, ataxia) Onset of headaches after the age of 55 years Headache developing after head injury or major trauma Persistent, 1-sided throbbing headaches Headache accompanied by stiff neck or fever Atypical history or unusual character that does not fulfill the criteria for migraine Inadequate response to optimal therapy Common dietary triggers which you need to avoid include the following: Alcohol - Particularly wine and beer Caffeine overuse or caffeine withdrawal Chocolate Aspartame - eg, NutraSweet and Equal Monosodium glutamate (MSG) - May be found in Asian food, canned soup, frozen or processed foods, and the seasoning product Accent Fruits - Citrus fruits, bananas, avocados, and dried fruit Nuts - Peanuts, soy nuts, and soy sauce Tyramine, a biogenic amine that accumulates in food as it ages, may provoke migraine. Sources include the following: Dairy - Aged cheese Meat - Bacon, sausage, luncheon meat, deli meat, pepperoni, and smoked or cured meat Pickled foods Heavily yeasted breads - Eg, sourdough Vinegars - Especially wine vinegar Some types of beans Nutraceuticals shown to be effective in randomized clinical trials include the aforementioned vitamin B2, CoQ-10, magnesium, and butterbur (Petadolex) Get a neurologist and let them help you in this regard. Biofeedback, cognitive behavioural therapies, acupressure also help. Pharmacotherapy is always an option. I hope it helps. Take good care of yourself and dont forget to close the discusison please. may the odds be ever in your favour. Regards Khan