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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Suggest treatment for headache despite taking Naratriptan

Answered by
Dr.
Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3650 Questions

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Posted on Sat, 10 Sep 2016 in Headache and Migraines
Question: I'm having a severe headache that came on suddenly, naratriptan has not helped been going on for 6 hours now
doctor
Answered by Dr. Olsi Taka 58 minutes later
Brief Answer:
Read below.

Detailed Answer:
I read your question carefully and I understand your concern.

It might be useful if you provided some more detail though. I suppose you have already suffered migraine headaches in the past since you had at your disposal a prescription drug such as naratriptan which is used for migraine. So some information is needed to understand whether it is a migraine attack or more probing is needed, information such as:

Is the headache of a much higher intensity than previous episodes, worst headache ever?
Did it reach maximum intensity in a matter of seconds, minutes, hours?
Location of the headache, quality (throbbing, constant, pressing etc)?
Accompanying symptoms such as nausea, vomiting, fever, visual symptoms etc.
Any other conditions (such as high blood pressure, kidney disease etc) or other medication you are under?

With the current information at my disposal, I would say that if it was a sudden headache reaching maximum intensity in a matter of seconds or minutes, of a higher intensity than any headache in the past then you should head to the emergency department because it could be a manifestation of a vascular event such as subarachnoid hemorrhage.
If on the other hand you suffer chronic migraine and the pain is similar to other attacks in the past, then I would try a second naratriptan first. If that doesn't work and the headache is too much to bear till the end of its course (a migraine attack may last for 4-72 hours) then you could still go to the ER for treatment with intravenous analgesics.

I remain at your disposal for other questions possibly with the answers to the questions above.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 7 minutes later
it's worse than any other headache I've had, I'm nauseated, sharp pain I am epileptic on zonisamide. it reached XXXXXXX intensity within 5 minutes
doctor
Answered by Dr. Olsi Taka 11 minutes later
Brief Answer:
Read below.

Detailed Answer:
Thank you for the additional information.

That type of headache onset is not typical for primary headaches like migraine or tension headache (primary meaning with no identifiable cause). It must be looked into.

For that reason I believe that a trip to the ER is justified to check for other neurological signs indicating subarachnoid hemorrhage and possibly head CT.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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