HomeAnswersInternal MedicineheadacheWhat are the possible causes of my terrible headache?

What are the possible reasons for my terrible headache?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. K. Shobana

Published At February 1, 2017
Reviewed AtFebruary 14, 2024

Patient's Query

Hi doctor,

I am an 18 year old girl. My height is 5'7" (171 cm), and weight is 135 pounds. Around five months back, I started becoming extremely fatigued and had occasional headaches. As headache was not often and not bad enough, I never really thought much about it. The fatigue was the worst part. It would cause me to become extremely tired throughout the day, and I would be ready to fall asleep at 7 PM every night. Waves of fatigue would come and go. I went to the doctor about this on two occasions for blood tests, and nothing came out of the ordinary. Two months later, I developed a pressure headache in the front of my head one night. It did not feel like a migraine. It was just a terrible pressure mostly centered in my forehead. The feeling was a tightness or like something was pushing on my head. It was frustrating and aggravating. The pressure did not go away for two weeks. It was almost constant, and sometimes the pressure would lessen, but never entirely go away. It would get to the point where I would cry every night because it felt like my head was going to burst open.

I went to a neurologist who recommended getting my ferritin levels tested. I had a level of 7, and I was prescribed with Ferrous sulfate and Vitamin C supplement. Over the next six weeks, the fatigue disappeared almost entirely. The headaches seemed to be improving, not constant and not as bad. Again, by last month, the pressure in my forehead began to return. Over the course of a couple of weeks, it became more constant and with higher intensity. I can feel the pressure even when I write this. After a couple of weeks (now), the pressure became just like it was before the ferritin treatment. It is not present all the time, but the majority of the time. I first notice the pressure anywhere from 10 minutes to 1 hour after I wake up. The pressure is often around for so long that it makes me frustrated and moody. My parents think that my headaches have to do with the hormones. In fact, the reason I am so upset is because the headaches have been plaguing me. If the pressure disappeared, I would not be so upset. I am now starting to think that the fatigue and headaches were not related and that the Ferrous sulfate only fixed my fatigue.

I went back to the neurologist, and she was very unhelpful. She only spoke to me for less than 10 minutes and asked me what we should do next. She believes that my problem can be fixed with different kinds of medicine and is not looking anywhere else. As of two weeks ago, my ferritin is at a 22, and I am continuing to take it. I tried Topamax for a couple of days before two months, but I stopped because the side effects made me feel five times worse. Two weeks ago, I tried Amitriptyline but stopped that because of the strange side effects. As of four days ago, I have been taking Propranolol, but nothing has changed. The neurologist seems to believe that I have anxiety and this is what is causing my headaches. I have my head screwed on tight as my dad says, and I truly do not have any depression or anxiety. I am not abnormally stressed, and I do well in school. I go back to the neurologist after a month, but I do not think I want to continue seeing her. I am looking for answers. I do not know what else to do. My parents are underestimating me and chalking it up to hormones. These pressure headaches have been plaguing me ever since three months, and it is starting to affect my social life and attitude. I cannot live like this anymore, and I just need help. Any of your advice is appreciated. Thank you.

Hi,

Welcome to icliniq.com. Most probably it is a tension headache, even if you do not have any apparent stress or anxiety. The type of headache you're experiencing is quite common. It's essential to first check your hemoglobin levels; if they're low, correcting them can be crucial in addressing the issue. Also, consider if you've been dealing with recurrent running nose, nasal congestion, or sinus problems. Increased pressure upon bending down might indicate sinusitis as a potential cause of the headache, requiring a different approach to treatment.

For your current situation, two effective medications are Amitriptyline and Propranolol. While you faced side effects with Amitriptyline previously, restarting it at lower doses like 5 mg or 10 mg before bedtime might help minimize side effects, gradually increasing the dose. Propranolol may take up to two weeks to show results. If needed, the dose can be increased to 40 mg if your blood pressure and pulse rate remain stable.

Medications like Ibuprofen or Tramadol 50 can be taken as needed. However, it's crucial to consult a specialist doctor, discuss your situation, and take medication only with their consent.

Exploring relaxation techniques such as deep breathing and yoga, especially Bhramari, can be effective for chronic headaches. Strong coffee during a headache might offer relief for some individuals.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Sagar Ramesh Makode
Dr. Sagar Ramesh Makode

Cardiology

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