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What causes intermittent and severe headaches?

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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 734 Questions

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Posted on Wed, 8 Mar 2017 in Headache and Migraines
Question: Out of knowhere, starting Saturday, I started getting intermittent, extremely painful headaches, along with pulsing pain in my low back. It has slowly started to get worse. The head comes and goes, but is getting worse, my brain feels swollen. The low back pain is unlike anything I've had before. No amount of ibuprofen is helping.The extreme headaches started out intermittently, and would just disappear out of nowhere, but I feel like its all getting worse. In the last day, I've begun to get nauseous, and feeling sick. Even my vision is incredibly blurry. The pain has kept me from sleeping much the last couple of nights. Thank you Doctor


I just wanted to add that my chest has had somewhat of a burning sensation here and there also. I have somewhat high blood pressure, but I don't think too bad to cause this, but who knows... Used to take Propranolol, but it didn't help me so I was taken off it. Thanks again
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Answered by Dr. Dariush Saghafi 3 hours later
Brief Answer:
You MAY need to be examined now

Detailed Answer:
Good afternoon. Sorry that you're feeling so unwell.

Several things need to be clarified.

1. If this headache is in isolation historically (meaning this is the very first time you're having headaches of ANY significant or memorable nature) and you are suffering with any sort of stiffness of the neck, fever, nausea, vomiting, light sensitivity, and the low back pain is excruciating to the point of ridiculousness (as it seems you're describing) then, you need to get to an ER because there could be some very bad things going on from lumbar territory abscesses to meningitis. I would scramble to the closest ER.

2. If things are not as dramatic as I've described them and you've actually had bad headaches before and these are simply a notch (or 2 or 3) worse and if you've got a history of back pain and this is really really bad but not accompanied by all the things I told you up top.....then, the need for an ER at this minute...may not be necessary but that doesn't mean you shouldn't be seen by a doctor and preferably a HEADACHE SPECIALIST because you've made a couple of comments that really a headache specialist is likely to appreciate much more so than a non specialist. First, you said, "No amount of ibuprofen is helping" which suggests to me that you use that at least on a regular basis and lately have been using it in very escalated doses. This is not good. High dose IBUPROFEN can cause something called an ASEPTIC MENINGITIS which is not contagious.....but boy does it give you a headache and all the other symptoms you mention.....but a lumbar puncture will reveal no infectious source. Secondly, TOO MUCH of any abortive medication for headache can cause REBOUND headaches which means that you may be actually CAUSING THE WORSENING of your baseline headaches if what you're doing is simply taking or changing from one medication to another to another, etc. etc.

You must get to a headache doctor who can sort this out and put you on a logical and reasonable regimen of something while checking to see if you don't have something called STATUS MIGRANOSUS which generally requires hospitalization to break it.....I also notice that you take trazodone which is a medication that most neurologists really don't like at all.....one of the main reasons is because up to 30% of users report MIGRAINE LIKE headaches. Not to mention that it gives you rebound insomnia which can also feed into the headaches and stoke the fire as it were.

You also said "Also on Levothyroxine for hypothyroidism, although the levels may be off right now." This can definitely cause or exacerbate headaches so you should see your endocrinologist or whoever is controlling your hormonal schedule, and make sure everything is up to snuff. Typically, in my headache patients I always screen them with a TSH and an FT4 in order to be more certain that everything is good. Most docs might just do a TSH...but in the face of unbalanced and severe symptoms as you're having I would do at least a few more tests.

At the same time I'd throw in a serum Magnesium (Total) and Magnesium (Free) in case you happen to be a Mag deficient headache type of individual in which case IV infusions of Magnesium may fix you up in a jiffy...oral is OK....but rapid relief is in the form of an infusion which should be done under supervision.

Buspirone also has a reputation to cause headaches but not nearly as much as trazodone does....so if it's really not making you feel that much HAPPIER?....or LESS DEPRESSED....not sure what term to use.....I'd ask my doctor if it's really necessary to take. Also, if you look at the drug to drug interaction listing for buspirone + trazodone....it is really not a good idea to be taking these 2 drugs at once when you're in the throws of a severe headache that just won't quit....did you just RECENTLY start one of these 2 drugs? If so, then, that may be the problem.....

I have a very simple philosophy when it comes to taking medications....For 99% of drugs on the market that are prescribed for medical or psychiatric conditions....if the condition fails to demonstrate any noticeable or measureable improvement either by clinical standards or by hard laboratory measurement (EKG, echocardiogram, EEG, BP, labs, etc. etc.) then, I believe they should be left on the pharmacy shelves. Don't be afraid to ask your doctor for GOOD advice as much as GOOD pills....unfortunately, doctors are not as accustomed to giving the former as opposed to the latter.....also, the culture of patients these days as influenced by drug company commercials on TV is that there HAS TO BE a drug to fix my issue or issues.....this concept goes back to the 1950's when Big Pharma (that was just getting started) coined the phrase, "A Pill for Every Ill"....and so the revolution began and doctors became door to door salesmen for drug companies and their office practices became profitable overnight.....the problem is we started teaching people to become indulgent if not dependent upon everything in the world to fix them except the basics that nature meant for us to use without pills, capsules, and injections....CLEAN DIET, PLENTIFUL AND CONSTANT EXERCISE, XXXXXXX FROM TOXIC SUBSTANCES including ALCOHOL, TOBACCO, SUGARS, and illicit DRUGS.

Only use medications that clearly and unmistakably IMPROVE whatever the condition is they are supposed to be helping....use them properly, use them in high enough doses (that's your doctor's decision not yours), use them compliantly. But after giving THEM the old college try and ya find that ya ain't gettin' healthier, thinner, stronger, better lookin', or more intelligent.....OH WELL....treat them like you'd treat an old boyfriend who had enough chances..."Hhit the road XXXXXXX and don't let the door punch you in the petute!"

You definitely gotta get into A GOOD CLEAN DIET, PLENTY OF GOOD DAILY EXERCISE, STRESS RELIEF, TAI CHI, MEDITATION, WARM STOCK BROTH, AND, treating yourself to something you haven't done in a long time. After all, today is VALENTINE'S DAY.....Change it up on the relaxation side...I know you've got a bad headache and terrible backache....but those pains are only going to leave if you DEMAND them to leave.....right? That's the mental part of the equation which is in addition to all the scientific stuff that needs to be done that I told you up top...including quite possibly an imaging study of the back if the doctor finds neurological signs of weakness or asymmetry, cranial nerve dysfunction, etc.

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry 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 39 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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