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Dr. Andrew Rynne

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Suggest remedy for persistent headache

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Dr. Ajay Panwar

Neurologist

Practicing since :2007

Answered : 1794 Questions

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Posted on Fri, 23 Oct 2015 in Brain and Spine
Question: I am a 38 yo female with Factor V Lieden. I am on Coumadin for life following bi-lateral PEs nearly 6 years ago. I had a full hysterectomy just over a year ago due to a cancer scare. Pathology came back with no cancer. Still have my ovaries but no fallopian tubes. Recently, I have been diagnosed with three small basal ganglia (not acute) strokes via MRI after I complained of an ongoing headache that I have had for 3 1/2 months now. No history of headaches before. These headaches are worse with movement and much worse when I exercise. The headaches seem to move around my skull. Sometimes in my face (jaw, nose, eyes), sometimes in the side or back of my neck, sometimes in the back of my head or on the side of my head. Sometimes my scalp is tender to touch. I have tinnitus which is also worse when the headache is worse. Pain scale varies day by day. Today I am at a 7. I knew today would be bad as I went to bed with the headache at a 2 but I could feel it getting worse. I woke with the headache at a 5 then went running and headache spiked to a 9. My headache doctor has given me muscle relaxants to help but they have not touched the headache pain at all. They simply make me drowsy. My neurologist suggests I have tension headaches but I am doubtful as I have been using his meds, calling him once to change the meds (Feurecet and flexoral) a month in to treatment to different muscle relaxants (Tinzindine) (not sure of the spelling of these meds).
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Answered by Dr. Ajay Panwar 51 minutes later
Brief Answer:
Amitriptyline trial may help.

Detailed Answer:
Hi xxxxx,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.

I have gone through your comprehensive clinical history.There are a few points which are worth mentioning-
1)Basal ganglia strokes are not the likely cause of headache.
2)Character of the headache(as described by you) closely resembles 'Tension type headache'.So,that's the probable diagnosis.
3)Drug of choice for TTH is Amitriptyline,which you have not mentioned in your treatment history.It definitely deserves,a try.Please discuss with your treating neurologist regarding this.
4)MRI rules out structural causes of headache,which again tilts the diagnosis in favor of primary headache-likely to be TTH.

If you have any further questions,I shall be glad to have you in follow-up.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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