How to treat a right-sided headache in a physically active 36-year-old male?

Hi doctor,

My husband is 36, 5 feet tall, and 180 pounds. He is healthy, with no history of medical issues or headaches. He is an avid runner and runs an average of miles daily. He has recently gained weight due to a poor diet in the last two years. His blood pressure comes in around 120/80 mmHg before this issue. He takes a multivitamin supplement, vitamin D, occasional fiber supplement, and the tablet Propranolol (for the past one week). He is well-hydrated. He is usually reluctant to take medication, especially OTC medicines or supplements not advised by a doctor.

Also, I am sharing some of his medical histories. He underwent a vasectomy four months back, took allergy shots as a teen, had a few broken bones as a young adult, had wisdom teeth removed in his early 20s, and had a knee issue from running about four years back. A few odd things in the past, including whooping cough twelve years back and severe poison oak reactions. Recurrent shingles occur (first time before twelve years and more than five times since) usually when stressed. No known allergies other than to Ceclor. He has a family history of stroke, thyroid, lymph node, and cervical cancer. Also, dementia, diverticulitis, and high blood pressure. His mom had migraine when she was young, but cutting caffeine stopped them, and they have not returned even with resuming caffeine.

My husband has been having complex issues for a few months now. Two months back, he developed a right-sided headache around his ear or temple region. But occasionally, it radiates slightly. The headache is an intractable dull pressure which is typically a 1 to 2 on the pain scale, and while lying down or in the morning, he gets a pain of 3 on a scale of ten, which goes away for 1 to 2 hours after running. Headache is constant, always in the same area and on the same side. He visited his GP, who initially tried him on the tablets Ubrelvy, then Flexeril, and ordered a CT scan with a neurology referral. Neither medication helped, nor did the OTC medicines. The CT report was negative for anything except sinus cavity cysts (considered unrelated).

However, last month he began experiencing different symptoms, including severe fatigue, mild left-side weakness (he describes feeling like his arms and legs fell asleep but have just now woken up, also as being heavy), and severe anxiety. We went to the ER, where they assessed him for stroke, and he passed that test (he forgot how old he was, 26 0r 36, but otherwise scored a 0). No real effective weakness. They ordered a CT scan, which was also negative. His blood pressure was very high and has been high since this issue started, and the reading on that day at 143/101 mmHg at 5 PM, 135/92 mmHg at 8 PM, and 142/93 mmHg at 11 PM. At the ER, they were not concerned about his BP. We left the ER with no answers and another neurologist referral. We were able to get into a neurologist a few days later. His BP was 146/103 mmHg at the neurologist's office. The doctor had a few theories but started him on the tablet Propranolol that day and ordered a group of blood tests and an MRI. The MRI came back with nothing remarkable other than a DVA on the right side, approximately where the headache is present. The bloodwork was also unremarkable other than basophils absolute, which was 0.09 10^3/uL. However, we are following up with the neurologist tomorrow to start the tablet Indomethacin potentially. The neurologist's three primary guesses were high BP, hemicrania continua, or long COVID (he contracted a mild COVID eight months back).

However, in the last few days, he has developed an ongoing stomach upset (primarily diarrhea). Has also been burping for a few months, but we did not think it was related. The burping gets worse with stress. He is really scared. He never feels poorly, so this is not very pleasant for him. He is also extremely concerned that the focus is on the mild head pain, while his big concern is the fatigue and right side feeling. He has been taking the tablet Propranolol and has cut on caffeine and alcohol (he takes caffeine daily and is a social drinker). He has untreated anxiety and depression, which may exacerbate the issue, but I do not think it causes these issues. There seems to be an intermittent nature to the issue, with him perceiving a greater effect on some days than others. There is no pattern to this that I can see (that it is worse after eating or drinking, worse or better with highly anticipated events, etc.).

We have ordered a BP monitor; his BP today was 108/74 mmHg. We are a bit lost with what to do next beyond continuing to follow up with the neurologist. This has been going on for two months now and seems to worsen, and he is extremely disheartened. We would appreciate any thoughts or suggestions for specialists to check with.

Kindly give your suggestions.

Hello doctor,

Thank you for the quick reply.

The CT and MRI were both done with and without contrast. Nothing showed up that caused his doctor's immediate concerns, though the sinus cysts and developmental venous anomalies were marked on the reports. There are no joint pains, mouth ulcers, or dry eye. There are no classic migraine symptoms like photophobia or light sensitivity. Normally he sleeps very easily and does not wake up unless I snore. He lays down, is usually asleep within 10 to 20 minutes, and sleeps most nights from 8:00 PM to 11:30 PM or later. He is having some trouble getting sleep this week, but I think that relates to his anxiety which has been massively elevated since this health issue began. His normal disposition is primarily happy, with some cynicism but, overall, fairly basic. He has been sadder on average since the lockdowns, primarily due to situational issues. In the past week or so, his anxiety has skyrocketed, primarily in response to undergoing so many medical tests with no answers. He also has financial anxiety, so utilizing the healthcare system is exasperating.

The headache is constant and has not stopped on its own in the last two months. He noticed the pain was worse after sleeping or lying down. He says the headache usually reduces after running for approximately 1 hour. About running, he says the frequency of his runs has been off the last week or so (since starting the tablet Propranolol and since he developed left-side weakness).

Kindly give your suggestions.