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Home > Headache Education > NHF HeadLines Excerpts > Reader's Mail Archive > Reader's Mail Archive Issue #166 - January/February 2009
Early Morning Headache
Q: For about a year now I have periodically woken up in the morning with a headache smack dab in the front of my forehead. I have been trying to figure out the cause. I wonder if too much salt could cause this type of headache. Could pituitary gland problems cause headaches?
A: Morning headaches can be from different origins. Migraine attacks typically start in the morning or wake a person up from sleep. Hypnic headaches also can wake a patient, usually between 1 a.m. and 3 a.m. These last for about one hour and typically occur in people aged 65 and older. Hypertension that is not well controlled may cause morning headaches as well. Salt does not trigger headaches, but too much salt in the diet may be responsible for high blood pressure. You should see your healthcare provider to monitor your blood pressure, especially in morning hours. The pituitary gland, if enlarged due to a tumor, may also cause headache and other symptoms.
George Urban, MD, Diamond Headache Clinic, Chicago, IL
Headache Causing Disability Probably Not Tension
Q: I am under the care of my doctor for headaches. After reading about tension-type headaches, I feel like these are what I have been having. I have mild-to-moderate headaches for two weeks at a time. No over-the-counter (OTC) medicine helps. My doctor gave me a sample of migraine medications, but they didn’t help. I don’t know what to do from here or how to get treatment. Exactly what should I tell my doctor so that he can help me? Do you have any advice to help prevent the headaches? I work full time and I’m a wife and mother to two kids. I can’t continue having these headaches.
A: Tension-type headache can last from a few hours to many days and even weeks, but tension-type headache is rarely, if ever, bad enough to cause disability or impairment in one’s ability to function. What is most important is whether you ever have headaches that truly meet the diagnostic criteria for migraine. These are episodic, recurrent headaches that are moderate to severe in intensity, pulsing or throbbing in quality, are worsened or aggravated by routine activity (like bending over or climbing a flight of stairs), predominantly on one side of the head, and associated with either nausea (even if mild) or sensitivity to light and sound. To meet the criteria for migraine, only two of the four pain characteristics and one of the two associated symptoms need to occur.
If someone has a history of migraine, then almost all of their headaches are probably due to the same underlying migraine process—even if the headache seems to be more like a tension-type headache. People can get “stuck in a migraine” (what we call status migrainosis) when a headache lasts longer than 72 hours. The fact that you have been having recurrent headaches that are impacting your life strongly suggests they are migraine, but you should seek a more detailed evaluation.
There are also other causes of protracted headaches to be considered. Reflect on whether you had a recent illness (typically viral) just prior to the onset of this headache or any other symptoms of illness, or if you have had other problems such as hormone changes, anemia, high blood pressure or even thyroid problems. Are you having any specific neurologic symptoms such as weakness and/or numbness on one side of your body, deterioration of your coordination, or changes in vision, hearing, speech or swallowing? Careful review of your recent history and your symptoms will probably be the most helpful thing you can share with your healthcare provider to come to a correct diagnosis and treatment.
J. W. Banks, MD, Ryan Headache Center, St. Louis, MO
What Could Be Causing Vertigo?
Q: I have had severe vertigo (requiring hospitalization twice) and have had other bouts of dizziness. Could this be related to foods, outdoor molds or allergies? I suspect tyramine was involved in both of the severe episodes. I have been tested for infection, tumors and more, but everything comes out negative.
What can help? Meclizine seems to help somewhat as does sleep. Still I have been home for two and a half weeks with dizziness, earaches, head pain and weakness.
A: Vertigo or dizziness is a symptom that can occur by itself or in association with migraine and can occur even in the absence of headache. It is thought to be a variant of migraine. Treatment is symptomatic relief using medications and rest. Spells of labyrinthitis (inflammation in the inner ear) can occur without any triggers and can last for days to weeks. Most important is to rule out any other causes. If the symptoms persist for a couple of weeks, and particularly if the symptoms are getting worse, seek evaluation (usually from an Ear, Nose and Throat specialist). Treatment typically involves use of medications, like meclizine, and possibly some specific head and neck exercises.
J. W. Banks, MD, Ryan Headache Center, St. Louis, MO
Headache Began Suddenly and Hasn’t Gone Away
Q: My wife has been suffering from a new daily persistent headache since January 1, 2008. At least, this is the latest diagnosis; she was first diagnosed with hemicrania continua. The headache began when she was washing dishes. Suddenly, she suffered a pain like an ice pick poking through her right eye. Since then, she has spent time in the hospital, undergone numerous CT scans and pretty much any other test you can imagine. She has also tried all of the popular migraine medicines and some not so popular. Basically, none of the doctors have known what to do.
A: I am sorry to hear about the difficulties your wife has experienced with her headaches. Both hemicrania continua and new daily persistent headaches are relatively uncommon headache problems compared to migraine and tension-type headache and even cluster headache. Little is known about their causes and certainly, there have been no controlled trials of treatments for them. Diagnosis of these conditions is based on the history of the headaches and appropriate examinations as your wife, it would seem, has been through.
New daily persistent headache is something that appears to develop almost literally out of the blue and once it is present, it remains there daily, unflinching, until a suitable treatment is found. Hemicrania continua appears to be one of the cluster headache-related syndromes that responds to indomethacin. While it typically has cluster headache-like features to it, any headache that is strictly locked to one side of the head and never shifts sides may be considered to be hemicrania continua unless an adequate dose and treatment schedule of indomethacin fails to help. Your wife’s case is one that may be best managed by a healthcare provider with additional training and certification in headache management since they have the most experience with these rare disorders.
Frederick Freitag, DO, Diamond Headache Clinic, Chicago, IL
(To find a headache specialist in your area, check out the NHF’s Physician Finder on our Web site, www.headches.org. The one-step search will help you locate a specialist in your area. The NHF also has free lists of physician members for most states. Call 1-888-NHF-5552 to get a copy.)
Stabbing Headaches
Q: I read a letter in a back issue of NHF Head Lines about “stabbing” headaches. I get one of these on an average of every two months, so that doesn’t sound so bad. However, mine are a little different. I get this very bad stabbing pain in the middle of my forehead and in the middle my breastbone. Usually both pains are gone in a few minutes. However, about 16 months ago the pain didn’t go away and I ended up in the emergency room. I had an EKG, an MRI and other tests, and saw a gastroenterologist. Nothing was found wrong. The attacks do not happen at a particular time of day or during any particular activity. This has been going on for over nine years.
A: Primary stabbing headache is typically a one-sided pain (usually around the eye, temple or forehead) of very short duration (only a few seconds) that occurs irregularly once to many times a day. It is not associated with other symptoms and cannot be explained by another disorder. Your attacks sound like they lasted longer than just a few seconds. Your letter states that these attacks have been going on for over nine years, which strongly suggests that these are not secondary to any other problem.
You may try treating with indomethacin or melatonin, but the infrequent, short nature of your attacks may make the risks of treatment not worth the possible benefits.
J. W. Banks, MD, Ryan Headache Center, St. Louis, MO
Reader's Mail Archive #166 - January/February 2009
Early Morning Headache
Q: For about a year now I have periodically woken up in the morning with a headache smack dab in the front of my forehead. I have been trying to figure out the cause. I wonder if too much salt could cause this type of headache. Could pituitary gland problems cause headaches?
A: Morning headaches can be from different origins. Migraine attacks typically start in the morning or wake a person up from sleep. Hypnic headaches also can wake a patient, usually between 1 a.m. and 3 a.m. These last for about one hour and typically occur in people aged 65 and older. Hypertension that is not well controlled may cause morning headaches as well. Salt does not trigger headaches, but too much salt in the diet may be responsible for high blood pressure. You should see your healthcare provider to monitor your blood pressure, especially in morning hours. The pituitary gland, if enlarged due to a tumor, may also cause headache and other symptoms.
George Urban, MD, Diamond Headache Clinic, Chicago, IL
Headache Causing Disability Probably Not Tension
Q: I am under the care of my doctor for headaches. After reading about tension-type headaches, I feel like these are what I have been having. I have mild-to-moderate headaches for two weeks at a time. No over-the-counter (OTC) medicine helps. My doctor gave me a sample of migraine medications, but they didn’t help. I don’t know what to do from here or how to get treatment. Exactly what should I tell my doctor so that he can help me? Do you have any advice to help prevent the headaches? I work full time and I’m a wife and mother to two kids. I can’t continue having these headaches.
A: Tension-type headache can last from a few hours to many days and even weeks, but tension-type headache is rarely, if ever, bad enough to cause disability or impairment in one’s ability to function. What is most important is whether you ever have headaches that truly meet the diagnostic criteria for migraine. These are episodic, recurrent headaches that are moderate to severe in intensity, pulsing or throbbing in quality, are worsened or aggravated by routine activity (like bending over or climbing a flight of stairs), predominantly on one side of the head, and associated with either nausea (even if mild) or sensitivity to light and sound. To meet the criteria for migraine, only two of the four pain characteristics and one of the two associated symptoms need to occur.
If someone has a history of migraine, then almost all of their headaches are probably due to the same underlying migraine process—even if the headache seems to be more like a tension-type headache. People can get “stuck in a migraine” (what we call status migrainosis) when a headache lasts longer than 72 hours. The fact that you have been having recurrent headaches that are impacting your life strongly suggests they are migraine, but you should seek a more detailed evaluation.
There are also other causes of protracted headaches to be considered. Reflect on whether you had a recent illness (typically viral) just prior to the onset of this headache or any other symptoms of illness, or if you have had other problems such as hormone changes, anemia, high blood pressure or even thyroid problems. Are you having any specific neurologic symptoms such as weakness and/or numbness on one side of your body, deterioration of your coordination, or changes in vision, hearing, speech or swallowing? Careful review of your recent history and your symptoms will probably be the most helpful thing you can share with your healthcare provider to come to a correct diagnosis and treatment.
J. W. Banks, MD, Ryan Headache Center, St. Louis, MO
What Could Be Causing Vertigo?
Q: I have had severe vertigo (requiring hospitalization twice) and have had other bouts of dizziness. Could this be related to foods, outdoor molds or allergies? I suspect tyramine was involved in both of the severe episodes. I have been tested for infection, tumors and more, but everything comes out negative.
What can help? Meclizine seems to help somewhat as does sleep. Still I have been home for two and a half weeks with dizziness, earaches, head pain and weakness.
A: Vertigo or dizziness is a symptom that can occur by itself or in association with migraine and can occur even in the absence of headache. It is thought to be a variant of migraine. Treatment is symptomatic relief using medications and rest. Spells of labyrinthitis (inflammation in the inner ear) can occur without any triggers and can last for days to weeks. Most important is to rule out any other causes. If the symptoms persist for a couple of weeks, and particularly if the symptoms are getting worse, seek evaluation (usually from an Ear, Nose and Throat specialist). Treatment typically involves use of medications, like meclizine, and possibly some specific head and neck exercises.
J. W. Banks, MD, Ryan Headache Center, St. Louis, MO
Headache Began Suddenly and Hasn’t Gone Away
Q: My wife has been suffering from a new daily persistent headache since January 1, 2008. At least, this is the latest diagnosis; she was first diagnosed with hemicrania continua. The headache began when she was washing dishes. Suddenly, she suffered a pain like an ice pick poking through her right eye. Since then, she has spent time in the hospital, undergone numerous CT scans and pretty much any other test you can imagine. She has also tried all of the popular migraine medicines and some not so popular. Basically, none of the doctors have known what to do.
A: I am sorry to hear about the difficulties your wife has experienced with her headaches. Both hemicrania continua and new daily persistent headaches are relatively uncommon headache problems compared to migraine and tension-type headache and even cluster headache. Little is known about their causes and certainly, there have been no controlled trials of treatments for them. Diagnosis of these conditions is based on the history of the headaches and appropriate examinations as your wife, it would seem, has been through.
New daily persistent headache is something that appears to develop almost literally out of the blue and once it is present, it remains there daily, unflinching, until a suitable treatment is found. Hemicrania continua appears to be one of the cluster headache-related syndromes that responds to indomethacin. While it typically has cluster headache-like features to it, any headache that is strictly locked to one side of the head and never shifts sides may be considered to be hemicrania continua unless an adequate dose and treatment schedule of indomethacin fails to help. Your wife’s case is one that may be best managed by a healthcare provider with additional training and certification in headache management since they have the most experience with these rare disorders.
Frederick Freitag, DO, Diamond Headache Clinic, Chicago, IL
(To find a headache specialist in your area, check out the NHF’s Physician Finder on our Web site, www.headches.org. The one-step search will help you locate a specialist in your area. The NHF also has free lists of physician members for most states. Call 1-888-NHF-5552 to get a copy.)
Stabbing Headaches
Q: I read a letter in a back issue of NHF Head Lines about “stabbing” headaches. I get one of these on an average of every two months, so that doesn’t sound so bad. However, mine are a little different. I get this very bad stabbing pain in the middle of my forehead and in the middle my breastbone. Usually both pains are gone in a few minutes. However, about 16 months ago the pain didn’t go away and I ended up in the emergency room. I had an EKG, an MRI and other tests, and saw a gastroenterologist. Nothing was found wrong. The attacks do not happen at a particular time of day or during any particular activity. This has been going on for over nine years.
A: Primary stabbing headache is typically a one-sided pain (usually around the eye, temple or forehead) of very short duration (only a few seconds) that occurs irregularly once to many times a day. It is not associated with other symptoms and cannot be explained by another disorder. Your attacks sound like they lasted longer than just a few seconds. Your letter states that these attacks have been going on for over nine years, which strongly suggests that these are not secondary to any other problem.
You may try treating with indomethacin or melatonin, but the infrequent, short nature of your attacks may make the risks of treatment not worth the possible benefits.
J. W. Banks, MD, Ryan Headache Center, St. Louis, MO