OpenHealth Q&A

Persistent Headaches: Seeking Answers

Height: 6 feet, Weight: 280 pounds, Age: 38 I maintain a regimen that includes medications for high cholesterol and major depressive disorder, specifically taking Vilazodone at 40 mg each day and Rosuvastatin at 40 mg daily. I apologize for the extent of detail that follows; the journey has been long and filled with frustration. Over the last five years, I have had consistent blood tests, revealing a low HDL cholesterol level and somewhat reduced testosterone (around 300), but otherwise, the results have been largely unremarkable. For over five years, I have faced relentless headaches that started gradually, with no apparent trigger. The pain is consistently around a 3 on a scale of 1 to 10, occasionally reaching a 6, but never dropping below a 2. Alongside the headaches, I deal with dizziness, a feeling of lightheadedness, cognitive fog, word-finding difficulties, challenges with concentration, and very mild ringing in my ears. There is no sensitivity to light, sound, or smells; lying down is the only time I find slight relief. Additionally, I have experienced intermittent episodes of vertigo, lasting anywhere from a few seconds to a couple of days, occurring three times in the previous five years. Shortly after the headaches began, I also had a pinched nerve in my neck, which seemed to arise without clear reason, perhaps from sleeping awkwardly. The tingling sensation in my arm disappeared after physical therapy. After consulting with a neurologist for the neck issue, I underwent MRI scans of my brain and spine. The findings were mostly normal, aside from a slight disc herniation and nerve compression in my neck. A subsequent neurologist tried multiple headache treatments, including topiramate, various NSAIDs, Sumatriptan, CGRP inhibitors, and Botox, yet none yielded any positive changes in my condition. This neurologist suspected my symptoms might relate to the two antidepressants I was using at the time—Effexor and Wellbutrin. Under professional guidance, I gradually weaned off these medications, but there was no improvement after six months. This led me to start a different antidepressant, as my depressive symptoms significantly worsened during that period. I was then referred to a cardiologist to explore possibilities of Postural Orthostatic Tachycardia Syndrome (POTS) or other cardiovascular issues. My cardiac ultrasound was normal, and a stress test indicated vasovagal syncope but ruled out POTS. Around that time, my psychiatrist considered anxiety as a contributing factor to my symptoms. I participated in an outpatient anxiety support group, where I recognized some of the symptoms, but ultimately concluded that my anxiety was minimal—mainly feeling nervous in social settings and avoiding confrontation. Following this, the psychiatrist suggested a trial of Adderall to help with my focus issues. Interestingly, I found this to be the most beneficial medication in alleviating some of my symptoms, though drawbacks like sleeplessness and irritability became significant challenges for me. Eventually, I managed to get a referral to a prominent academic medical center, where I consulted five different neurologists of varying specializations and was sent to a headache clinic. The clinic recommended I reduce my caffeine intake from three cups to no more than two per day, yet this did not lead to any improvement. They suggested a sleep study, which revealed mild sleep apnea. I received a CPAP machine and used it consistently for over a year, but it did not alleviate my symptoms. Additionally, the headache clinic referred me to a specialist involved in studying spontaneous cerebrospinal fluid (CSF) leaks. After performing some home assessments and suggesting I might benefit from more advanced imaging (a CT myelogram with spinal contrast), the doctor proposed an epidural blood patch. Despite negative imaging results, the physician believed I had around a 30% chance of having an undiagnosed CSF leak. Areas of concern were identified, leading to four separate blood patches to address these suspicious regions. While I experienced brief symptom relief during recovery, lasting improvement was not achieved. The neurologists at the academic center also referred me for vestibular function testing (including VNG, vHIT, VEMP, and a rotary chair assessment). These tests indicated minor vestibular deficits, prompting a referral for vestibular physical therapy, which I completed over six months without any noticeable improvement. Conditions like Benign Paroxysmal Positional Vertigo (BPPV) and vestibular migraines were dismissed. I may have overlooked some aspects of my evaluation and treatment history. I took a hiatus from medical appointments for the past six months due to feeling drained by the number of consultations and the ongoing uncertainty. However, I am ready to resume seeking answers or find ways to enhance my quality of life despite the persistent symptoms I endure (I have been undergoing Cognitive Behavioral Therapy for this). Now, I find myself wondering about my next steps. Should I return to the headache clinic at the academic medical center? Is it time to seek out another neurologist? Or should I explore different resources?

Answers (1)

7/30/2025, 2:21:10 AM

OpenHealth AI

It sounds like you are enduring a challenging and complex situation with your persistent headaches and accompanying symptoms. First and foremost, it’s important to acknowledge the extensive effort you’ve put into seeking a diagnosis and treatment. Here’s a structured approach based on your concerns:

Main Points:

1. Persistent Headaches with Additional Symptoms: Headaches lasting this long, accompanied by dizziness and cognitive fog, warrant further exploration.
2. Prior Treatments: Many treatments you've tried seem not to yield lasting results; this can be frustrating.
3. Next Steps: Exploring further evaluations or treatments may help, potentially with a fresh perspective.

Explanation:

• Chronic Headache: Headaches can arise from various underlying issues, including tension, medication overuse, neurological, or vestibular disorders, among others. Conditions like tension-type headache or migraine could be considered, especially given the duration and recurrence of symptoms.
• Associated Symptoms: Dizziness and cognitive difficulties could suggest an interplay of factors, including medication side effects, vestibular issues, or potential issues with cerebrospinal fluid dynamics that were suggested in earlier assessments.
• Impact of Current Medications: It’s useful to consider the effects of your antidepressant medication on your headaches, especially since they were previously highlighted during evaluations.

Next Steps:

1. Returning to the Headache Clinic: Given your history and the complexity of your case, revisiting the headache clinic may be worthwhile. Discuss the symptoms and treatments you’ve tried, and express your concerns about the lack of improvement. An updated assessment could lead to new insights or alternative therapies.

2. Look for a Multi-disciplinary Approach: Consider seeking a center that applies a multi-disciplinary approach to chronic headaches, integrating neurology, pain management, psychological support, and physical therapy. A fresh set of specialists may provide innovative solutions.

3. Evaluate Your Medication: Discuss your current medications, including Vilazodone and others, with your healthcare provider. Adjustments or changes in your medication regimen may alleviate symptoms that are persisting or worsening.

4. Journal Symptoms: Keep a headache diary to track occurrences, triggers, severity, and any associated symptoms. This can provide valuable insights for your healthcare provider about your condition’s patterns.

5. Continue Cognitive Behavioral Therapy (CBT): While CBT may not directly solve the headache issue, continuing therapy can provide valuable coping strategies and help reduce anxiety, which might indirectly assist with your symptoms.

6. Consider Lifestyle Adjustments: Evaluate factors such as diet (look for potential triggers), hydration, sleep quality, and stress management techniques that may influence your headache patterns. Regular physical activity could also be beneficial for overall health.

If you feel overwhelmed, it's okay to take small steps. Engaging in one or two of these strategies at a time can provide you with a sense of control as you navigate your ongoing health journey. Remember, seeking continued support is crucial, so don’t hesitate to reconnect with your healthcare resources. You deserve to find relief and improve your quality of life.