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Q. I am a 29-year-old male with a morning headache since 10 years. What could be the reason?

Answered by
Dr. Hitesh Kumar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Apr 02, 2022

Hi doctor,

I am a 29-year-old male. I have been experiencing morning headaches for 10 years, I wake up with a headache and tired feeling when I sleep for less than eight hours, but I do not get headaches when I sleep for more than eight hours; I just have a tired feeling. The headache occurs only on waking up and relieves in the evening, and the intensity increases with lesser hours of sleep. It happens mainly on the right side of my forehead and the backside of my head. I have issues falling asleep and waking up as well; I have tried meditation which has helped to an extent. I have a history of constipation and a nasal septum deviation since childhood due to which the right side of my nose gets blocked at night. I underwent various tests, which turned out to be normal. I was under antidepressants for five years and stopped taking them for a year now as I did not see any difference.

Please help.

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#

Hello,

Welcome to icliniq.com.

I have read your query and understand your concern.

I would like to know more about your headache. Please answer the questions below;

1) Since when did you start having these headaches? Is it for 10 years only, or has it occurred before that?

2) Does the headache always happen on the right side only? Or does it happen in variable locations?

3) What kind of headache do you get? Is it heaviness, bursting, squeezing, stretching, throbbing, or another?

4) How long does an episode of a headache last without taking a pain killer?

5) Do you feel nausea or vomiting during headache episodes?

6) Is the headache associated with any redness in the eyes, watering from eyes, or nasal blockage?

7) Have you noticed any other specific trigger factors for this headache apart from sleep deprivation?

8) How is the usual intensity of headaches? Is it mild or moderate, or severe?

9) How frequent are these headaches? How many times in a day or week?

10) Do you take any medicines when you get a headache, and do you get neck pain? If yes, please mention the tablet name, dosage, and frequency?

12) How is your vision for distant and near objects?

13) Have you ever got CT (computed tomography) or MRI (magnetic resonance imaging) of the head? If yes, please share the reports.

Also, please add more information on the following;

1) How is your sleep routine? Do you get sleepy soon after lying in bed, or does it take longer to fall asleep? Once you get sleepy, do you have frequent awakenings during sleep? Do you feel fresh on awakening from sleep in the morning?

2) How is your usual mood for the day-to-day activities? Is it usually a happy mood or towards the sad side thinking about past events or worrying side thinking about future things, or do you feel irritable?

3) How is your appetite?

Please revert with the answers to the above questions.


Investigations to be done:

MRI (magnetic resonance imaging) brain and MRV (magnetic resonance venography) intracranial.

Ophthalmology consultation to check refraction, IOP (intraocular pressure), and fundus examination.

Preventive measures:

1) Maintain proper sleep, wake, and meal timings.

2) Avoid habits such as alcohol and sedatives, if any.

3) go jogging for at least 20 to 30 minutes in the morning.

Regarding follow up:

Revert with the above-requested information for a better understanding of the problem and to formulate a proper treatment plan.

Hi doctor,

Thank you for the reply.

Below are the answers to your questions;

1) The headache started 10 years ago, and I did not have any before that, and the intensity of the headache used to be less.

2) No, the headache does not occur only on the right side; it is felt all over the head but predominantly on the right side, forehead, and behind the eyes.

3) I feel heaviness, tightness, and pain as if something has physically hurt my head. There is no sharp pain; it is all over the head. I struggle to open my eyes and concentrate after experiencing a headache.

4) I wake up with a headache, and it continues till I fall asleep again. Although the intensity reduces in the evening, it can last for a whole day.

5) No, I do not feel any nausea or vomiting during the headache episode.

6) Sometimes, I get watery eyes during the headache.

7) If I wake up with a headache, it continues until I sleep again. For example, say I wake up at eight in the morning after seven hours of sleep; I will have a headache. But if I sleep again for half an hour or more, the headache gets reduced or is completely gone based on how long I sleep.

8) The lesser I sleep, the more is the intensity of headache. I do not get any headaches if I have slept for eight hours or more.

9) The headache does not have any trigger points other than lack of sleep.

10) No, I usually do not take any medicines for headaches and manage by meditating.

11) I do not have any vision problems and work on my laptop without issues.

12) No, I never got a CT or an MRI done.

13) No, I do not sleep easily after lying in bed; it usually takes one to two hours to fall asleep after meditating for about 10 to 20 minutes. No, I do not wake up in the middle of sleep and do not snore.

14) I am happy most of the time. I do my office work and house chores efficiently. Although I feel lazy, I do not feel stuck.

15) I do not feel hungry much and can remain without eating for five to six hours; I have constipation issues.

#

Hello,

Welcome back to icliniq.com.

Based on your description, I suspect you have a tension headache although tests need to be done to confirm the diagnosis.


Investigations to be done:

MRI brain and MRV intracranial.

Serum vitamin B12.

Serum vitamin D3.

Thyroid test - T3, T4, and TSH (thyroid-stimulating hormone) levels.

ECG (electrocardiogram).

Ophthalmology consultation to look for refraction, IOP, and fundus.

Differential diagnosis:

Tension headache.

Treatment plan:

I suggest you take tablet Amitriptyline Hydrochloride 10 mg once daily at night.

Preventive measures:

1) Daily jogging 20 to 30 minutes in the morning.

2) Maintain regularity in sleep, wake & meal timings.

3) Avoid habits like alcohol and smoking.

Regarding follow up:

Revert with the suggested investigation reports and eye examination reports.


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