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Suggest treatment for severe head pain

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Posted on Fri, 4 Nov 2016
Question: I had extreme pain in my head on 6/27/16 that started in my forehead and went to the back of my head. I was told I had physical & mental exhaustion which caused this pain. I was given several medicines and I now do not have the extreme continual pain in my forehead are, but I have pain in the right side of my face from my cheek bone through my right eye and into the front part of my head. I was told to just ignore the sharp pains I have several times a day on occasion but it really is taking a toll on me as I have such extreme pain it takes a lot out of me. Any suggestions?
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Answered by Dr. Dariush Saghafi (55 minutes later)
Brief Answer:
Possible TRIGEMINAL AUTONOMIC CEPHALGIA

Detailed Answer:
Good afternoon. Although it is true that STRESS is considered possibly the most frequently identifiable risk factor for all types of headaches....I'm afraid that in my opinion there are far too many healthcare providers who are willing to chalk up unusual presentations of headache/facial pains to that as opposed to doing some degree of a workup and consider other types of problems...or if necessary refer the patient to a headache or other specialist as appropriate.

In your particular case a couple of things strike me right away about your problem that raise red flags that should be considered.

One is that you have a SPECIFIC DATE that even 3+ months later you still recall very well to the point of mentioning it in this question.

Secondly, you've not said anything about having any significant history of headaches either in your younger years or at present. To me that is another red flag that needs to be taken notice of as opposed to ignored.

Third the localization of your pain is in the orbital region described as a very painful type of problem which gives me the flavor of a sharp or stabbing type of problem, potentially in the center or feeling as if it were behind the right eye.

Finally, you mention something very typical of Trigeminal Autonomic Cephalgias (TAC's) which is that you suffer from at least SEVERAL OF THESE VERY PAINFUL right orbital pain episodes at a time. My guess is that the duration of these episodes are no less than 15 minutes and no more than 3 yrs. at a time. There is probably no nausea, no vomiting, there is possibly a lot of redness, tearing, and stuffiness or even running nose on the right side only. The left nose is likely clear and unblocked if in the fact the nasal passages are being affected by this problem.

I would also guess that you may prefer walking/moving about as opposed to trying to stay perfectly still. You may even feel improvement in the head pain by squeezing the head or even striking it to some extent as opposed to trying to let it ride out on its own.

If anything I've described sounds similar to any of your symptoms then, I would ask to be referred to a headache specialist immediately, I'd expect to get an MRI of the brain with gadolinium contrast in order to rule out an architectural problem within the brain itself, and if all that is clear the most efficacious treatment will be to STOP all the JUNK medication they're trying out since none of that will do anything but make you drowsy, sick to your stomach possibly, and leave you with these headaches.

The acute treatment of choice to get rid of these types of headaches (again assuming nothing inside the head causing it) would be OXYGEN THERAPY using a NON-REBREATHER FACIAL MASK (NOT nasal canula) flowing at a minimum of 7-10L/min. which can if necessary be increased to 12-15L/min.

Medication that has a reasonable chance of working would be INDOMETHACIN although the limitation of that medication is GI distress and even possible spontaneous gastric bleeding which is noted by a change in color of the stool to dark or melanic in nature. Other possible medications could be TRIPTAN DRUGS such as Imitrex, Maxalt, and Zomig.

If I've adequately answered your questions could you do me a huge favor by CLOSING THE QUERY and being sure to include some fine words of feedback along with a 5 STAR rating if you feel my answers/suggestions have helped? Again, many thanks for posing your questions and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 22 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dariush Saghafi (24 hours later)
Do you have any suggestions to a headache specialist in my area which is XXXXXXX XXXXXXX or the Middletown, OH. I have been seeing a Dr. Wadwha here in Middletown who has told me when the pain strikes it only last a second and just to forget about it and go on. When at the Atrium Medical Center in XXXXXXX when the pain was so severe my blood pressure went to 191 over 93. I would like to get this taken care of as I have had several pains over the last week. I also saw a Dr. Schaublin (spelling?) at the Atrium Hospital and gave me so much medication I have other issues and that was in 2012. I do not take any other medications other than the ones I listed on my original question. My health is very good except for this head problem. Thank you for any help you can offer.
doctor
Answered by Dr. Dariush Saghafi (3 hours later)
Brief Answer:
I know of a neurologist by the name of Dr. Svetlana Svetic

Detailed Answer:
I know of a neurologist who also manages headaches by the name Svetlana Svetic. I don't know her name. She is in the XXXXXXX area. You may tell the doctor that I referred you. She knows me very well.

I don't know any of the other doctors you've mentioned nor the hospital so unfortunately can't really opine on that information.

All the best and please pass on my best to Dr. Svetic if you see her.

Cheers!

Could you do me the favor of CLOSING THE QUERY and posting a few encouraging words of feedback and a 5 STAR rating if you feel the answers/suggestions I've given have helped?

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 30 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Dariush Saghafi

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Practicing since :1988

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Suggest treatment for severe head pain

Brief Answer: Possible TRIGEMINAL AUTONOMIC CEPHALGIA Detailed Answer: Good afternoon. Although it is true that STRESS is considered possibly the most frequently identifiable risk factor for all types of headaches....I'm afraid that in my opinion there are far too many healthcare providers who are willing to chalk up unusual presentations of headache/facial pains to that as opposed to doing some degree of a workup and consider other types of problems...or if necessary refer the patient to a headache or other specialist as appropriate. In your particular case a couple of things strike me right away about your problem that raise red flags that should be considered. One is that you have a SPECIFIC DATE that even 3+ months later you still recall very well to the point of mentioning it in this question. Secondly, you've not said anything about having any significant history of headaches either in your younger years or at present. To me that is another red flag that needs to be taken notice of as opposed to ignored. Third the localization of your pain is in the orbital region described as a very painful type of problem which gives me the flavor of a sharp or stabbing type of problem, potentially in the center or feeling as if it were behind the right eye. Finally, you mention something very typical of Trigeminal Autonomic Cephalgias (TAC's) which is that you suffer from at least SEVERAL OF THESE VERY PAINFUL right orbital pain episodes at a time. My guess is that the duration of these episodes are no less than 15 minutes and no more than 3 yrs. at a time. There is probably no nausea, no vomiting, there is possibly a lot of redness, tearing, and stuffiness or even running nose on the right side only. The left nose is likely clear and unblocked if in the fact the nasal passages are being affected by this problem. I would also guess that you may prefer walking/moving about as opposed to trying to stay perfectly still. You may even feel improvement in the head pain by squeezing the head or even striking it to some extent as opposed to trying to let it ride out on its own. If anything I've described sounds similar to any of your symptoms then, I would ask to be referred to a headache specialist immediately, I'd expect to get an MRI of the brain with gadolinium contrast in order to rule out an architectural problem within the brain itself, and if all that is clear the most efficacious treatment will be to STOP all the JUNK medication they're trying out since none of that will do anything but make you drowsy, sick to your stomach possibly, and leave you with these headaches. The acute treatment of choice to get rid of these types of headaches (again assuming nothing inside the head causing it) would be OXYGEN THERAPY using a NON-REBREATHER FACIAL MASK (NOT nasal canula) flowing at a minimum of 7-10L/min. which can if necessary be increased to 12-15L/min. Medication that has a reasonable chance of working would be INDOMETHACIN although the limitation of that medication is GI distress and even possible spontaneous gastric bleeding which is noted by a change in color of the stool to dark or melanic in nature. Other possible medications could be TRIPTAN DRUGS such as Imitrex, Maxalt, and Zomig. If I've adequately answered your questions could you do me a huge favor by CLOSING THE QUERY and being sure to include some fine words of feedback along with a 5 STAR rating if you feel my answers/suggestions have helped? Again, many thanks for posing your questions and please let me know how things turn out. Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others. This query has utilized a total of 22 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.