[btmspox]

I suffered a TBI in a motorcycle accident 7 years ago. A few years ago, after I moved back to the country, I started getting tension headaches most mornings. Occasionally they get bad enough to upset my stomach and cause vomiting. The doctors seem convinced it's from not sleeping well, e.g. auto-pap prescription, but since they haven't made much progress I keep researching all the possibilities. I posted more in the member introduction forum this morning.

There's one weird symptom that I've had a hard time communicating, I'm curious if anyone has had a similar experience or has any idea what I'm talking about. If I lay on my back with the back of my head not completely evenly supported, I usually get a woozy feeling in the back of my head. If I sit up and pull a hard book against different places on the top or side of my head, it will happen too. A couple years ago I realized it would happen if I held my head back against the car headrest while trying to neck exercises while driving. Any ideas?

Bryan

[Dr. Smith]

Hi Bryan, welcome.

I suspect what you're describing is pressure on a nerve that is either causing or interfering with a signal, similar to the way pressure on a nerve can cause a limb to "fall asleep". I'm reminded of the old cornball joke:

Patient: Doctor, it hurts when I do this.

Doctor: Then don't do that.

I do know how chronic headaches can be baffling and infuriating. The nausea/vomiting factor suggests (to me) that there may be a migraine element. It is not uncommon to get both kinds of headaches—tension-type and migraine—separately and/or together at the same time. I get those, and they're among the most difficult to treat, as each type requires a different type of intervention and choosing the wrong type of intervention can allow the headache to get a stronger "grip".

My suggestion—if you haven't already tried it—would be to seek out a headache/migraine specialist (i.e. board-certified in headache medicine); not just a neuro who says they can treat headaches (I bounced around through several neuros who made that claim, and none of them knew their .... y'know. Preferably one whose practice is limited solely to headaches/migraines—they treat nothing else.

Doc

[btmspox]

Thanks Doc.

I'd like to figure out what's going on with that feeling because it's awfully hard to sleep without triggering it. Of course, being asleep, it doesn't consciously bother me until I wake up. And it's hard to describe.

Family practitioner #1 prescribed me imitrex, but ibuprofen consistently seemed to help more. I haven't had other migraine symptoms like auras, one-sided headaches, or light sensitivity. Chiropractor #2 attributed the nausea and vomiting to the tense neck muscles constricting my vagus nerve. He diagnosed me with a calcium deficiency using Applied Kinesiology, which weirded me out a little, so I don't know.

I'm off to see Osteopath #1 later this week. Looking for a Neurologist #2 after sounds like a good plan.

[Dr. Smith]

Originally Posted by btmspox

I haven't had other migraine symptoms like auras, one-sided headaches, or light sensitivity.

Not all migraines include those symptoms; in fact, there's one group—acephalgic migraine (also called "silent migraine", optical migraine) that doesn't involve pain.

Not responding to Imitrex (sumatriptan) isn't unusual; everyone is different. My migraines don't respond to it either, but there are many more migraine meds in the same class—triptans—and another may work much better. Rizatriptan (Maxalt) works very well for me (not saying it will for you—just an example of another working when Imitrex doesn't).

You mentioned a cpap prescription; are you using one? If so, is it possible that the strap(s) are the problem? That would be an easy fix, as there are a multitude of mask & strap configurations. I know very few (none?) cpap users who are using the gear they started with.

I'm not crazy about using ibuprofen more than occasionally due to the possibility/risk of cardiovascular, gastro-intestinal, & renal damage. It can also cause (albeit less likely than some meds) medication rebound headaches; has that been mentioned/discussed/eliminated?

Overusing painkillers to treat [Tension-Type Headache (TTH)] can cause chronic daily headaches to develop. These headaches usually occur early in the morning, and their symptoms include: poor appetite, nausea, restlessness, irritability, memory or concentration problems, and depression. Chronic daily headache is usually resistant to painkillers, and most sufferers experience migraines as well as an almost permanent TTH. The headache can vary in intensity, duration, and location, and the symptoms can be more severe than in people who have occasional TTH.
http://www.migrainetrust.org/factshe...headache-10884

Doc

[btmspox]

Originally Posted by Dr. Smith

You mentioned a cpap prescription; are you using one?

No. I've used it for up to a few weeks at a time over the last year or two. Once I get settled fiddling with the humidity and temperature business so it's not producing an uncomfortable environment, I still can't get through many consecutive nights without taking it off in my sleep. I have yet to wake up after a night of solid use and feel any better than any other day. So I'm not very motivated to keep fighting with it every night.

Originally Posted by Dr. Smith

I'm not crazy about using ibuprofen more than occasionally due to the possibility/risk of cardiovascular, gastro-intestinal, & renal damage. It can also cause (albeit less likely than some meds) medication rebound headaches; has that been mentioned/discussed/eliminated?

I've considered it. I don't take Ibuprofen on a daily or even a weekly basis. Usually I know my morning headaches will fade after a while so I get up, make a cup of coffee, and rest upright for a while before I get going. When my neck is really sore, I'll take 400-800mg, depending on how sore it is, on my neurologists recommendation.

The past 10 days or so have been out of the norm because I've been sick. I had a bad cold last week, which lead to a lot of time on the couch and a bit of vomiting that seemed headache related. I've had more varied cold medicine rather than an uptick in ibuprofen usage though. I've had sore cheekbones in the morning most days this week. I had my dentist check me out yesterday and he didn't find anything so I'm pretty sure it's a sinus infection and hopefully will pass soon.

[Dr. Smith]

Originally Posted by btmspox

I have yet to wake up after a night of solid use and feel any better than any other day. So I'm not very motivated to keep fighting with it every night.

I get that. It took me a long time (coupla months) to be able to get through a whole night. Now that I'm used to it, I usually don't notice it unless I get congested, in which case I can't sleep anyway.

When my neck is really sore, I'll take 400-800mg [ibuprofen], depending on how sore it is, on my neurologists recommendation.

Do you find > 400 mg makes a significant difference?

In controlled analgesic clinical trials, doses of MOTRIN (ibuprofen) tablets greater than 400 mg were no more effective than the 400 mg dose.
http://www.rxlist.com/ibuprofen-drug...ons-dosage.htm

I've had more varied cold medicine rather than an uptick in ibuprofen usage though. I've had sore cheekbones in the morning most days this week.

I'm sure you know to check the labels. A common cause of overdose of NSAIDs & acetaminophen (Tylenol), etc. is taking them on top of cold/flu meds that already contain them. I got myself into a jam that way (back when I was young & invincible )—wound up giving myself a bad case of IBS and almost lost half my bowel. Now I can't take any NSAIDs more often than once.

The sore cheeks sounds familiar, but I can't put my finger on it (not prone to sinus problems)....

If you're considering a headache/migraine specialist, one thing that will help move things along a bit quicker is to start & keep a headache diary/journal/log. An initial visit often includes having the patient do that, and then come back after a few months of headache tracking. Each doctor's requirements may be a bit different, but you may be able to save some time in getting to some meaningful dx & treatment.

Doc