HomeAnswersInternal MedicineheadacheWhy do I have headaches even after having a normal vision and good sleep?

I have normal vision and good sleep. Why do I have 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.

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Published At August 3, 2016
Reviewed AtJuly 6, 2023

Patient's Query

Hi doctor,

I am suffering from throbbing, dull pain in my left eye, which is shooting down to the left nostril. I feel pressure when I bend forward and also some discharge from the nose with a salty taste. I am getting the pain while watching television and when working in the computer. I am having a good sleep and my vision is also normal. But, when I press my forehead just above my left eye, I feel throbbing pain. I have consulted two neurologists. They did not recommend for any scan. One suggested Gabapentin and another Sibelium 10 mg once a day at night for a month. Both asked me to do some physical works like closing eyes, stretching hands, walk and step one foot after another. What is my problem? Please explain.

Hello,

Welcome to icliniq.com. I have gone through all the details you have posted, and the differential diagnosis for your problem would be as follows. First is frontal sinusitis, as you have mentioned pain when you press above the left eye. Normally, the frontal sinus drains into the nasal cavity in an upright posture, so the headache tends to be worse in the morning and decreases as the day progresses, often referred to as an "office headache." To diagnose this condition, an X-ray of the paranasal sinuses (PNS) waters view is needed. Second is migraine. The neurologists who started you on Gabapentin or Sibelium likely considered migraine as the cause, as these medications are commonly used for migraine treatment. In case of migraine, the headache is one sided, throbbing, lasts for more than 4 hours and decreases with rest. The history of photophobia or phonophobia may be present. Also, nausea or vomiting at the time of attack. Treatment for migraine involves both acute attack management with NSAIDs like Naprosyn (Naproxen) and preventive therapy using medications such as beta blockers, Sibelium (Flunarizine), Gabapentin, or Topiramate. The diagnosis of migraine is made clinically and other potential causes must be ruled out. If the headache persists or worsens, a CT scan of the brain may be necessary to rule out intracranial pathology. Third is a refractive error, so it is advisable to get your eyesight checked. Fourth is tension headache, although this possibility seems unlikely in your case. Lastly, cluster headache is another consideration. These headaches are also unilateral but occur in clusters, with attacks happening at the same time of day for several days followed by symptom-free intervals lasting several months before the attacks start again. During a cluster headache, symptoms such as red eye, tearing from the eyes, and a runny nose may be present. A complete neurological examination would be necessary to further evaluate this possibility.

Patient's Query

Thank you doctor,

I underwent thorough eye checkup and all are normal. My sinus x-ray is also normal. When I wake up, I do not have any headache and it comes only in the day time. Which medicine shall I take now?

Hello,

Welcome back to icliniq.com.

  • Sibelium has side effects and drug interactions.
  • Than Gabapentin, I suggest Topiramate 25 mg twice daily. Consult your specialist doctor, discuss with him or her and take the medicine with consent.
  • Use Naxdom (Naproxen) 250 mg at the time of the acute episode, if it is severe.
  • Try to maintain a headache diary and note down the frequency of occurrence. Also, write the number of times you had to take Naxdom due to the severity.
  • Avoid stressors like sunlight exposure, tensions, prolonged TV watching, eating chocolates and groundnuts.

For further information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

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

Dr. Naresh Kumar M.
Dr. Naresh Kumar M.

Internal Medicine

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