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
Hi doctor,
I have had occasional headaches since September, which usually last a few days. The first time was just before I was diagnosed with COVID-19, so I attributed it to that. However, it has happened three to four times since and I have always tested negative. This time, I have had the headache now for around three weeks. Some days are worse than others, but it is generally there all the time. I would describe it as usually a dull ache in the middle of the head, with tender spots that come and go around the temples or slightly further back. The main pain however feels like it is deeper inside. For the last week, I have also had neck pain and a little stiffness. I am worried about neck stiffness with headaches, but I do not have any other worrying symptoms like nausea or fever.
I have a private appointment with a neurologist but it is only in three weeks' time, but as this headache and neckache are not subsiding, I am eager to get an opinion from a neurologist much sooner.
Thank you.
Hi,
Welcome to icliniq.com.
I would like to know some details of your symptoms.
1. How frequently have you had those headaches? How many times in a month approximately?
2. One episode of headache usually lasts for how long duration? Is it associated with any nausea or vomiting or fever or nasal blockage, or nasal discharge in the throat?
3. What type of headache do you feel, Is it heaviness, bursting, throbbing, stretching, pricking, or something else?
4. In this duration, have you ever noticed any triggering factor for headaches like stress, sleep disturbances, fasting any particular food, any weather, or something else?
5. As your headache became constant for three weeks, is it the same character as previous headaches or different?
5. How is your sleep these days usually? How long time does it take to get sleepy after you lay in bed? Once sleepy, do you have frequent awakenings from sleep?
6. How is your day-to-day mood in these periods? commonly happy, worried, sad, or something else?
7. How is your vision for far and near?
Regarding follow up please revert to the above-mentioned details for better understanding and further judgment.
Thank you.
Patient's Query
Hi doctor,
Thank you for your answer.
To answer your questions,
1. The first headache was in mid-September, with subsequent ones in October, December, and January.
2. The ones before this one have lasted maybe four to five days. No, I have not noticed any other symptoms the other times, other than feeling a little more tired than usual.
3. It is a dull constant ache, not throbbing. Sometimes feels like pressure inside, and often feels worse in the evenings. Occasionally I feel a momentary sharp shooting pain that takes my breath away as it is so sharp, but it is a split second each time. The neck pain is also constant and is mostly at the top of the neck just below the skull. I have also felt some stiffness in the same area.
4. I have been looking for patterns and triggers, but have not identified any.
5. It feels like the same headache but worse, and it is constant. This is the first time I have felt neck pain too, and I feel unusually tired even though I am sleeping well.
6. My mood is good. I am not stressed, I am fitter now than I have been my whole adult life. I sleep very well and rarely wake up during the night.
7. I am a little short-sighted in one eye and usually wear glasses just for driving or watching tv. I had my eyes tested just a few months ago. My eyes do not feel strained at all.
Thank you.
Hi,
Welcome back to icliniq.com.
With your description, your headache is not associated with any other features, there may be a possibility of your headache being a tension-type headache.
Though to look or rule out some other possibilities, I would suggest some investigations.
Investigations to be done
1. MRI (magnetic resonance imaging) Brain MR (magnetic resonance) venography with contrast.
2. CBC (complete blood count).
3. T3, T4, andTSH (thyroid stimulating hormone).
4. Serum vitamin B12.
5. Serum vitamin D3.
6. ECG (electrocardiography).
7. Ophthalmologist consultation to look for refraction of Intraocular pressure (IOP) and fundus.
Preventive measures include,
1. Daily jogging for 20 to 30 minutes in the morning.
2. Maintain regularity in sleep, wake, and meal timings.
3. Avoid alcohol and smoking.
4. Try to figure out trigger factors for your headache, if feasible.
Treatment plan,
You can try Amitriptyline 10 milligrams once a night, after ruling out organic causes and consulting with your physician.
Regarding the follow-up review SOS.
Thank you.
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Neurology
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