Brief Answer:
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Detailed Answer:
I read your question carefully and I am sorry about the symptoms you have been feeling.

It is true that medication of the nortriptyline class can cause constipation. On the other hand I must say that I am a little perplexed by your finding that Nortriptyline has made you very emotional. The original use of this type of drug was in depression and anxiety, its use should not cause such side effects, on the contrary it should improve them if already present. So before attributing that side effect to nortriptyline you should consider how much were those symptoms present before you started nortriptyline, whether they were present before and perhaps some stressful event in your life happened to worsen them now. I am not excluding nortriptyline to be a cause, neurotransmitter balance in the brain is tricky and these drugs can have paradoxical effects at times, but it would be an unusual side effect in this case.

Also you should be aware that the effect of Nortriptyline is not immediate. It necessitates several weeks to come into place. You do not mention when have you started it, not more than a month since you speak about pain returning mid July. So if it has been started less then 3 weeks ago I would give it at least a month before evaluating its benefit.

Now what to do in the case you've already tried it long enough without benefit, or simply can not tolerate constipation. So other management options should be considered. If it was felt that the headaches were triggered or exacerbated by stress and anxiety then one possible option would antidepressants of the SSRI class which have fewer side effects then nortriptyline class. Also lifestyle measures like relaxation techniques, yoga can be helpful.
One other option would be an anticonvulsant drug, such as gabapentin. Also I wonder if some other type of pain has been considered about from muscle tension. Shooting pains on upper neck and head, especially on one side can be also in the setting of occipital neuralgia, compression of upper nerve root. In that case gabapentin can again be effective to prevent pain, physical therapy, local nerve injections as well.

I remain at your disposal for further questions.

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Brief Answer:
No reason whatsoever to think of death.

Detailed Answer:
Thank you for your feedback.

You really have no reason to fear for your life, there is no indication in your history towards any life threatening issue. The fact that CT scan came back normal confirms that. I do not think you need an MRI. It is true that MRI at times can detect abnormalities a CT can miss but your symptoms not suggesting something like stroke or brain tumor (I suppose that is what is scaring you), their evolution in time neither. So unless it is to reassure you, I do not regard a MRI as a necessary test if there are no additional symptoms or signs noticed by your doctor.
On the other hand anxiety is an obvious contributing factor judging by how you feel about the matter.

Occipital neuralgia is a clinical diagnosis, meaning it is made based on the description of the symptoms, it is to be thought as I said if the shooting pains are only one side.

I do not think the steroid injection has any role on your temple pressure. Bilateral temple pressure is a very common feature of tension type headache, the initial diagnosis made.
At home you can do relaxation exercises, light physical exercise like walking or jogging outdoors, activities like yoga in order to relieve anxiety which is the main trigger of this type of headache.
As I said before if Nortriptyline continues to have side effects another anti anxiety medication like a SSRI (citalopram, escitalopram etc) can be used, less side effects. They too take some weeks to exercise their effect so may be accompanied in the initial couple of weeks by a benzodiazepine.

I hope to have been of help.

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Brief Answer:
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Detailed Answer:
Hello again!

By evolution of symptoms I mean the evolution you describe in the beginning of your query. The fact that it stopped for a period at the beginning of July makes a brain tumor unlikely. Its symptoms grow progressively in intensity as the tumor grows, do not subside for a couple of weeks just like that. Stroke would be unlikely as well, has a sudden onset reaching it's peak soon to later improve.

11 days of taking Nortriptyline are not enough to judge whether it was effective or not. Of course you do not have to force yourself to go through the whole month if side effects are very bothering, but it is a little early to dismiss it as ineffective.

Anxiety can cause many different types of symptoms including reduced appetite. Whether your lack of eating justifies your weight loss is relative or some other cause should be sought, that depends by how much weight have you lost, calories you take and physical activity.

As for what the neurologist will do, at first he will take a detailed history and physical neurological exam. The first thing we want to do when evaluating a patient with headache is to determine whether it's a primary headache (primary meaning no identifiable cause), or a secondary one due to stroke, tumor, infections etc. For that a neurological exam evaluates whether there are other signs which might indicate brain lesions, it tests cognition, motor and sensory function, balance and coordination, movement, eye fundi etc.
Of course I am assuming primary physician already has excluded other general signs like blood pressure alterations, ear infection, dental issues, neck spine problems etc.
If no such signs are found and it is considered a primary headache (like tension type headache which I think is most likely in your case), he might decide that no further tests are needed and discuss straightaway management.
If he finds some abnormality on exam then he might decide to ask for more imaging tests like a MRI.

Wishing you good health.

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Brief Answer:
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Detailed Answer:
It is good that your doctor has conducted a neurological exam of his own, reinforces the fact that your brain should be fine.

Regarding the dehydration question, while it can cause headache, it doesn't look likely to be your case where you have a chronic headache. Dehydration might be responsible for one episode of headache lasting one or two days until fluid and electrolyte balance is restored, it wouldn't persist beyond that.

Nortryptiline can affect weight at times, but it causes weight gain, not weight loss. Also effect on weight wouldn't be evident in less then a couple of weeks you've been taking it.

As for the headache after massage, it could be an indicator of neck arthritis. It would be a little early for your age though, but a neck xray might be done. Occipital neuralgia as I said usually has shooting, lancinating pain attacks, lasting for seconds on the one side.

While I was the one to suggest occipital neuralgia, I must say that during the course of our conversation I began to veer away from that possibility as it became clear that you have some anxiety issues which need to be dealt with and which would explain your symptoms. However it is good that a neurological visit has been scheduled will serve to make sure.

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Brief Answer:
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Detailed Answer:
Anxiety is treated through antidepressive medication which have also anti anxiety properties and are the most used medication for that purpose.

Nortriptyline was a good first choice, that is why I said that it might be given a full trial before considering it ineffective.

The other option as I said are SSRIs class of antidepressives which have fewer side effects.

Other options may include an antianxiety medication called buspirone. For short term benzodiazepines are often used as well, might be used for a couple of week in your case as well, but shouldn't be used regularly long term due to potential for dependence and tolerance.

Of course if the neurologist agrees on that diagnosis you'll discuss these options with him in the Tuesday's visit I suppose as well.

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Brief Answer:
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Detailed Answer:
Hello again!

The base of the skull is one of the most common locations of pain. I had already understood it was involved by your description of upper neck being involved they usually go hand in hand.
In terms of diagnosis it doesn't change much in my opinion.
It is common in anxiety due to increased muscle tension in the neck and scalp causing pain, as I said anxiety is one of the main triggers of tension type headache.
The already mentioned neck arthritis with or without occipital neuralgia is commonly associated with such neck and occipital (base of the skull) pain and soreness as well.
So basically my recommendations remain the same.

If I'm not mistaken today's your appointment with the neurologist. I hope things work out for the best.

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