What is the treatment for my chronic headache without nausea?

Question

Hi doctor,

I have had the headache issue for over 12 years, which seems to worsen. The onset of this headache starts with pressure getting built up in my head, like stress for no reason, and all of a sudden, the headache begins at the back of the head, and within minutes, it gets severe.

If I have to describe the location, it is above the base of the skull and below the top. The pain is so intense that I have to take a painkiller, otherwise it will not subside. There are no other symptoms like vomiting, dizziness, nausea, or speech imbalance.

The pain is pulsating or throbbing, increasing with any movement or when applying pressure. This headache also comes on while having alcohol and, on a rare occasion, during ejaculation while having sex with my partner (once in a blue moon scenario).

My cervical spine CT (computed tomography) scan was done, and the reports were normal. The onset of a headache has to do with time as well. It also gets triggered sometimes when I wash dishes or cook food requiring focus. I do not know the pattern, but all I know is that it is ruining my quality of life. These frequent headaches and consuming painkillers have started affecting my digestive system. I want to get rid of this problem. Please suggest.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

Your headache is most likely a migraine since it has been going on for the last 12 years. Another less likely possibility is occipital neuralgia. One thing that is not clear from your description is whether the pain is localized to one side or occurs on either side.

Nevertheless, I would recommend the following: MRI of the brain to rule out structural abnormalities that could be causing the headache. Start on tablet Topiramate 25 mg twice a day and build up to 50 mg twice a day.

Maintain a headache diary- note the time, duration, and character of pain in a diary each time you have pain. Consider tablet Pregabalin 75 mg twice a day if Topiramate is not effective.

I hope this information will help you.

Thanks.