Dr. Prakashkumar P Bhatt
Neurology
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Patient's Query
Hi doctor,
I traveled to a different country four weeks ago and was stressed. So the doctor told me my migraine headache was due to stress and advised a CT scan of my head. I have attached the result (attachment removed to protect the patient's identity). I have high blood pressure but have been on medication for the last ten years and normal depression for 20 years, but with Escitalopram, I have had no symptoms for twenty years.
Please advise what should be done.
Hi,
Welcome to icliniq.com.
I understand your concern.
You had a headache after a lot of stress, probably aggravation of old migraine. CT (computed tomography) brain showed cerebral atrophy, commonly seen in the elderly. But it can be seen at a younger age with excessive alcoholism or smoking; if your memory and other higher cognitive functions are normal, then no need to worry. Stay stress-free, and walk daily for 45 minutes. If applicable, reduce alcoholism and smoking. Take migraine medication as per your doctor's advice.
Patient's Query
Hi doctor,
Thank you for the reply.
Kindly check the attached CT scan report (attachment removed to protect the patient's identity) for a second opinion about the diagnosis. And let me know the advisable OTC medicine for it. Paracetamol works, Ibuprofen with caffeine works. Aspirin upsets my stomach (acidity), and I dislike taking medication daily.
Hi,
Welcome back to icliniq.com.
I understand your concern.
The report looks fine. Very minimal cerebral atrophy is seen according to age, so CT (computed tomography) of the brain looks normal. I suggest taking Paracetamol or Ibuprofen; both are fine. If migraine attacks are more than three to four episodes in a month, you must take prophylaxis medication like Propranolol or Amitriptyline.
Patient's Query
Hi doctor,
Thank you for the reply.
Which one is better?
As I have been taking Escitalopram 20 mg daily for more than ten years.
Hi,
Welcome back to icliniq.com.
I understand your concern.
Propranolol 40 mg once daily is better if you can tolerate it. You can continue Escitalopram.
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