Dr. Hitesh Kumar
Neurology
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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Patient's Query
Hello doctor,
I am a 27-year-old male. My height is 180 centimeters, and I weigh 165 pounds. I have been having migraines for over a year every day. The symptoms of these migraines include fatigue, pulsating vision, tingling, impairment in judgment, and mood swings.
Thank you.
Hi,
Welcome to icliniq.com.
I would like to know some further details about your headache.
1. Since when have you started to have these headaches? Did these start for one year only? Or were you used to it occurring intermittently before also? If before, since when?
2. In which part of your head do you feel headaches? (you can attach your photo, clicked from a little distance, with your hand kept over part of the head where you feel a headache. Please attach two to three pictures from the front sides if the headache area is large).
3. What kind of headaches do you feel - heaviness, bursting, squeezing, stretching, throbbing, or some other category?
4. Since the beginning your headaches been intermittent or persistent?
5. If intermittent, one episode of headache lasts for how long duration (without pain killer tablet)?
6. Do you feel any nausea or vomiting during headache episodes?
7. Is headache associated with any redness in eyes, watering eyes, or nasal blockage?
8. Have you noticed any specific trigger factor for this headache till now?
9. As you mentioned, these headaches have been daily for one year. Are these 24-hour seven days? Or it lasts a few hours in a day and then subsides.
10. Do you take any regular medicine for your headache? If yes, please tell us the name and dosage, and frequency.
12. How is your vision for distant objects or near objects?
13. I could not understand your symptom of pulsating vision. Please describe in detail.
13. Have you any other significant medical history? If yes, please tell me.
Other information:
1. How is your sleep routine? Do you get sleepy soon after laying in bed? or it takes a long time? Once got sleepy, do you have frequent awakenings during sleep? Do you feel fresh on awakening from rest in the morning?
2. How is your usual mood in day-to-day activities? Happy, sad side (thinking about past events), worried about future things, irritable, or something else)?
Thank you.
Investigations to be done
Regarding follow up
Patient's Query
Hi doctor,
1. Migraines and headaches started around three to four years ago. The migraines and headaches over the last year and a half are debilitating everyday occurrences where functioning is a struggle.
2. The site of the migraines can move, but it is mostly on my left side above the eyebrow to the temple. The exact location is the right side of the forehead. In some rare cases, the pain will follow down the neck.
3. Usually, they are heavy and squeeze like a rubber band wrapped around them.
4. They have been intermittent. Everyday occurrence is usually worse in the morning and at night.
5. They usually will last about four hours, then a little relief or I get accustomed to the pain and try to ignore it.
6. Yes, there is usually nausea or dizziness associated with the headaches.
7. Occasionally, I will see redness in my eyes.
8. I have noticed a sensitivity to light and sound that can make them worse during the day or night, but there really is no trigger in the mornings.
9. I am still determining. Sometimes, they go all day; other times, I am either accustomed to the symptoms being there and try not to notice, or they go away.
10. I try not to rely on medication since I do not want to overuse or depend on it. I recently started trying Qulipta, but the problems have not seen any progress. Qulipta is 60 milligrams.
12. I wear glasses, and my vision is blurry and worse for distant objects.
13. The pulsating vision feels slightly blurry, and the objects almost blink or pulse with my heartbeat.
Other Information:
1. No problems with sleep. Feel rested usually. Sometimes it's harder to go to bed.
2. My life is becoming unmanageable with the symptoms in my day-to-day life and marriage. I would lean towards having more irritable mood swings and fatigue on the sad side. Signs have made it hard to perform cognitive functions like judgment, decision-making, and memory.
Thank you.
Hi,
Welcome back to icliniq.com.
With your description, possibilities can be
1. Chronic migraine with daily headaches.
2. Tension-type headache.
If atonement (quality) is not working, you can try,
1. Tablet Propranolol long-acting 40 mg once a day.
2. Tablet Amitriptyline 10 mg once at night (after discussing with your doctor).
Investigations to be done,
Ophthalmology consultation to look for refraction, intra-ocular pressure, and fundus.
Differential diagnosis,
Chronic Migraine.
Tension type headache
Preventive measures,
1. Daily jogging for 20-30 minutes in the morning.
2. Maintain regularity in sleep-wake and meal timings.
Regarding follow up,
Review SOS.
Thank you.
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