OpenHealth Q&A

Coping with Persistent Headaches: A Journey Through Diagnostics

Age: 38 years Height: 6 feet Weight: 280 pounds I manage high cholesterol and major depressive disorder effectively with daily doses of Vilazodone (40 mg) and Rosuvastatin (40 mg). I appreciate your patience as I share my lengthy and challenging story. Over the past five years, I have undergone routine blood tests, revealing only a few notable issues: low HDL cholesterol and suboptimal testosterone levels (around 300), but no further significant findings emerged. For more than five years, I’ve been plagued by relentless headaches, beginning gradually without any clear trigger. The discomfort typically hovers around a level 3 on the pain scale, occasionally escalating to a 6, but never dropping below a 2. Accompanying these headaches are feelings of dizziness, light-headedness, cognitive fog, difficulty with word recall, problems focusing, and mild ringing in the ears. I do not experience sensitivity to stimuli like noise, light, or odors. My condition is slightly alleviated when lying down. In addition, I have encountered a few short episodes of vertigo over the same timeframe, lasting anywhere from several seconds to a couple of days, with a total of three episodes during this period—none prior. Around the same time that my headaches started, I also suffered from a pinched nerve in my neck, which seemed to arise out of nowhere—possibly due to an awkward sleeping position. Fortunately, the associated tingling in my arm disappeared after undergoing physical therapy. I initially consulted a neurologist for my neck issue, who recommended MRI scans of my brain and spine. The outcomes were unremarkable aside from noting a mildly herniated disc and the previously mentioned pinched nerve. Following visits to another neurologist, I underwent multiple treatments for my headaches, including a variety of medications such as topiramate, NSAIDs, Sumatriptan, CGRP antagonists, and Botox, yet none provided relief. The second neurologist suggested a possible relationship between my symptoms and the antidepressants (Effexor and Wellbutrin) that I was taking. With approval from my psychiatrist, I carefully tapered off these medications over six months, only to find no improvement. Consequently, I transitioned to a newer antidepressant as my depressive symptoms began to intensify. A referral to a cardiologist followed to determine if my symptoms were related to POTS or another cardiovascular issue. Test results from a cardiac ultrasound came back normal, while a stress test indicated vasovagal syncope but ruled out POTS. At this stage, my psychiatrist considered that my complaints may be stemming from anxiety. I joined an outpatient support group for anxiety management, where I discovered that, while I could identify with some aspects of anxiety, my own experiences were relatively mild (such as nervousness in social scenarios and avoidance of conflict). Subsequently, my psychiatrist tried addressing my attentional difficulties with Adderall. This medication proved to be the most effective in alleviating any symptoms, though I struggled with its side effects, including insomnia and irritability. Eventually, I persuaded my primary care physician to refer me to a leading academic health center. I consulted with about five different neurologists there, each with unique specialties, and was directed to a headache clinic. The clinic suggested I cut back on caffeine, dropping my intake from three cups of coffee to two or fewer daily, but saw no notable improvement. They referred me for a sleep study, which identified mild sleep apnea. I utilized a CPAP machine faithfully for over a year, yet my symptoms persisted unchanged. The headache clinic also connected me with a specialist researching spontaneous cerebrospinal fluid (CSF) leaks. After completing several home assessments, it was proposed that I might benefit from more advanced imaging, resulting in a CT myelogram with contrast and an epidural blood patch procedure. While the imaging results were negative, the physician indicated a lingering chance of a CSF leak that might not have been detectable through imaging, noting a few areas of concern. I received four blood patches in an attempt to treat these problematic areas. Though I did experience temporary symptom relief shortly after each procedure, these improvements were short-lived. The neurologists at the academic medical center also recommended I pursue vestibular testing through an ENT specialist, involving tests like VNG, vHIT, VEMP, and rotary chair assessments. The findings revealed minimal vestibular dysfunction, leading to a recommendation for vestibular rehabilitation therapy. After completing approximately six months of therapy, I was disappointed to notice no change in my symptoms. Conditions such as BPPV and vestibular migraines were ruled out during this phase. I may be forgetting some additional tests or treatments I’ve undergone. I took a hiatus from medical visits and treatments for around six months due to sheer exhaustion from the frequent consultations and lack of answers. However, I am now prepared to re-engage in seeking solutions, aiming to enhance my quality of life while managing my symptoms (I am currently practicing Cognitive Behavioral Therapy for this purpose) or ideally to uncover answers and alleviate these persistent issues. Now, I find myself wondering about the next steps. Should I revisit the headache clinic at the academic center? Would it be wise to consult with another neurologist? Or is there an alternative resource I should consider?

Answers (1)

8/29/2025, 2:42:58 PM

OpenHealth AI

It sounds like you’ve been through an extensive journey with your persistent headaches and associated symptoms over the past five years. You've taken many proactive steps, including consulting various specialists and trying multiple treatment options. The complex nature of your case is understandable, and it's commendable that you're seeking further strategies to enhance your quality of life while managing your symptoms.

Main Points:

1. Continue Coordination with Current Specialists: Revisit the headache clinic at your academic center.
2. Consider Additional Neurology Consults: Seeking a fresh perspective from another neurologist could provide new insights.
3. Explore Multidisciplinary Approaches: Consider integrative therapies or consultations with specialists in related fields (e.g., pain management, psychology).

Explanation:

Your symptoms, including chronic headaches, dizziness, cognitive fog, and past experiences with neck pain, can be interlinked. Despite extensive testing and treatment, no definitive diagnosis has been established, and the complexity of your case may require a multi-faceted approach. Your experience with various medications and treatments indicates that you have tried many conventional routes, so it may be beneficial to keep looking for the right fit for your unique situation.

Recommended Next Steps:

1. Revisit the Headache Clinic: It could be beneficial to go back, especially since they are familiar with your history and previous interventions. Discuss any new symptoms or changes in your condition, and mention your ongoing symptoms despite treatment so they can reassess your case.

2. Seek a Second Opinion from Another Neurologist: A fresh neurological perspective might reveal new avenues for investigation or treatment. You might consider someone specializing in headache disorders or chronic pain management.

3. Consider a Multidisciplinary Approach: Given the complexity of your symptoms, consulting with other specialists may be helpful. You could explore:

   • Pain Management Specialists: To discuss alternative pain relief strategies.
   • Psychologists or Therapists: To further support your mental health as you continue with Cognitive Behavioral Therapy, which may help manage associated anxiety or depressive symptoms stemming from chronic pain.
   • Dietitians or Nutritionists: Although you've reduced caffeine, a broader dietary review may reveal additional changes that could help alleviate symptoms.

4. Lifestyle Modifications: Continue to engage in practices that promote relaxation and well-being, such as regular exercise (as tolerated), adequate hydration, and potentially exploring mindfulness meditation or yoga.

Recognizing the fatigue that comes from ongoing medical visits, ensure to take breaks as needed and to practice self-care throughout your journey. Your resolve to seek answers is commendable, and there are still options available to explore. Please communicate your experiences openly with your healthcare team; they will appreciate your insights and can tailor their approach accordingly.