OpenHealth Q&A

Continuous Headaches: Seeking Answers

I appreciate your patience as I outline my ongoing health challenges—a situation spanning over five years that has been particularly taxing. To provide a little background about myself, I'm a 38-year-old male, weighing around 280 pounds and standing 6 feet tall. I contend with high cholesterol levels and a significant depressive disorder, both of which are currently managed with Vilazodone (40mg) and Rosuvastatin (40mg) daily. Over these five years, I've undergone regular blood tests, which have mostly returned normal results; however, I do have low levels of HDL cholesterol and testosterone, hovering around 300. My predominant issue has been persistent headaches that have afflicted me for more than five years. These headaches began without any clear trigger and consistently present with a pain level around a 3, occasionally rising to a 6, but rarely dropping below a 2. This discomfort is often coupled with symptoms such as dizziness, feelings of lightheadedness, cognitive fog, struggles with word recall, and mild tinnitus. Notably, I do not experience sensitivity to visual, auditory, or olfactory stimuli, and the only relief I find is when lying down. In addition to the headaches, I've experienced sporadic bouts of vertigo over these years—three episodes in total—which lasted from mere seconds to several days, a pattern that was unheard of prior to the headaches. Around the time the headaches began, I dealt with a pinched nerve in my neck, possibly from an awkward sleeping position. The accompanying tingling sensation in my arm subside after physical therapy. I sought the assistance of a neurologist who performed an MRI of my brain and spine. The findings were largely inconclusive, except for identifying a slightly slipped disc and the previously mentioned pinched nerve. In exploring treatment options, I consulted another neurologist, who tried various medications, including topiramate, NSAIDs, Sumatriptan, CGRP inhibitors, and Botox injections. Unfortunately, none of these remedied my symptoms. At one point, it was suggested that my symptoms might be due to the antidepressants (Effexor and Wellbutrin) I was taking, so I worked with my psychiatrist to taper off these medications. However, after six months with no improvement, I returned to a newer antidepressant due to a significant decline in my depressive symptoms. I was then referred to a cardiologist to assess whether my condition might relate to POTS or another cardiovascular issue. An ultrasound of the heart was normal, and while a stress test indicated vasovagal syncope, it ruled out POTS. Around this time, my psychiatrist considered whether anxiety was a contributing factor. I attended an outpatient anxiety support program, where I found that while some symptoms resonated with me, my anxiety seemed rather mild, as I primarily felt nervous in social settings and shied away from confrontation. Subsequently, my psychiatrist proposed trying Adderall for my attention difficulties. This medication proved to be the most effective of all, improving symptoms, but I encountered significant side effects such as sleep disturbances and irritability. Eventually, I secured a referral to a prestigious academic institution and consulted around five different neurologists, ultimately being directed to a specialized headache clinic. There, I was advised to cut down my caffeine intake from three cups daily to two or fewer, yet this did not yield any benefits. As part of their assessment, I underwent a sleep study, which revealed mild sleep apnea. I received a CPAP machine and used it consistently for over a year with no noticeable change in my condition. The headache clinic also referred me to a specialist involved in research on spontaneous cerebrospinal fluid leaks (CSF leaks). After taking assessments at home, the specialist deemed me a candidate for more intricate imaging (a CT myelogram with contrast). Although the results were negative, the doctor indicated a ~30% likelihood of a leak not detected in the scans, flagging a couple of areas of concern. Consequently, I underwent four blood patches in an effort to address these areas; improvements were only temporary and only during recovery. As part of my ongoing exploration of treatment, I was also recommended to an otolaryngologist for vestibular function tests, including VNG, vHIT, VEMP, and rotary chair assessments. The outcomes indicated slight deficiencies in my vestibular system, leading to six months of physical therapy, which unfortunately did not alleviate my symptoms. Conditions like BPPV and vestibular migraines were excluded. Having taken a hiatus from treatments and consultations for approximately six months due to sheer fatigue from relentless appointments with no clear resolutions, I am now eager to resume my quest for answers. I aim to either enhance my quality of life despite these symptoms (I’m currently practicing cognitive-behavioral therapy) or, ideally, uncover solutions to alleviate them. Thus, my inquiry is straightforward: Where should I go from here? Should I return to the headache clinic at the academic center, consult another neurologist, or seek alternative resources?

Answers (1)

7/24/2025, 2:31:09 AM

OpenHealth AI

Thank you for sharing your detailed health journey. It sounds like you've been through a lot, and I can understand how exhausting and frustrating this process has been for you. Given your persistent headaches and the various assessments you've undergone, it's crucial to prioritize steps that could lead to improved quality of life or find a solution.

Main Points:

1. Continue exploring headache management options, as your symptoms are chronic and complex.
2. Consider returning to a specialized headache clinic with a focus on multidisciplinary approaches.
3. Monitor your lifestyle and stressors which may be exacerbating your headaches.

Explanation:

Chronic headaches can stem from numerous causes, and managing them often requires a combination of treatments. The variety of symptoms you’re experiencing, such as dizziness, lightheadedness, and cognitive fog, alongside the history of neck issues and sleep apnea, suggest that this could be a multifaceted problem. Since you've already tried multiple medications and therapies without long-lasting benefits, it may be useful to revisit the headache clinic, as they can provide specialized tools and potentially integrate multiple treatment modalities.

Next Steps:

1. Return to the Headache Clinic: Re-engage with the clinic where you previously received care. New specialists or updates to current research may provide fresh perspectives or treatments, especially if they specialize in medication management or novel therapies for chronic headaches.

2. Lifestyle Adjustments:

   • Hydrate: Maintaining good hydration can often help alleviate headaches.
   • Dietary Choices: Consider logging your food and symptom patterns, as certain foods might trigger headaches for some. Reducing processed foods or common irritants (like artificial sweeteners or excessive caffeine) might also be beneficial.
   • Cognitive Behavioral Therapy (CBT): You mentioned practicing CBT, which can indeed help manage symptoms like anxiety and depressive thoughts that may coexist with chronic pain.

3. Monitor and Document Symptoms: Create a detailed headache diary noting:

   • Frequency and duration of headaches
   • Pain intensity (using a scale)
   • Any potential triggers (food, weather, stress)
   • Associated symptoms (dizziness, fogginess, tinnitus) This information can be invaluable for healthcare providers to develop a clearer picture of your condition.

4. Consider Referral to a Pain Management Specialist: If the headache clinic feels less promising, a specialized pain management team may offer alternative therapies not previously explored, such as nerve blocks or alternative treatments (e.g., acupuncture).

5. Engage with General Health Practices: Since your general health plays a significant role (with high cholesterol and sleep apnea), continuing regular check-ins with your primary care provider for overall health management can help support your headache management journey.

Please remember that it's essential to stay patient and give time to any new treatment approaches. Seeking continued support through friends, family, or support groups can also be immensely helpful in navigating this ongoing journey. If you have any further questions or concerns, don’t hesitate to reach out.