Any thoughts or suggestions appreciated
 

I am writing on behalf of my husband. He is 58, had no known health issues and rarely experienced headaches until this past February. Now he is having daily headaches, often multiple headaches in one day. They are of short duration and mostly a tolerable pain level individually but the consistency is wearing on him. We are working on a headache diary but they occur all times of day/night with no discernible triggers as yet.

He initially thought they were stress related since his father (and last parent) died last year and we have only just finalized his estate. He thought they would go away when things calmed down so didn't seek immediate attention or even mention them to me until he had an anxiety attack so medical assistance has only just been sought recently. He was prescribed Alprazolam: .25 mg x 3/day, Amitriptyline: 10 mg 1-2/night and was found to have a slight thyroid issue so Levothyroxine 25 mg/morning.

In reality, after 3 weeks, he is handling the Levothroxine fine as far as we can tell but the drowsiness of the Alprazolam is an issue and he hasn't even started the Amitriptyline because of it. He has had to cut the Aprazolam back to a trace amount in the morning to function at work and only a quarter of a dose at night to be able to get up in the morning. He doesn't use any form of caffeine.

He will be calling to make his follow up appointment but wondered if anyone had any thoughts/experiences on his type of headaches.

Thank you and may your day be pain free!

:Wave-Hello: Welcome Concern4DH.

Someone will be along to help.

Hi Concern, welcome.

Does DH have a diagnosis yet? Some reading/detective work may be necessary; here's a start: headache types

Diary is good—stick with it, and modify as necessary (if you haven't, take a look at some samples) headache diary.

IME, despite what they say, neurologists don't know enough about treating headaches. If you can, try to find one board-certified in headache medicine, preferably one whose practice is limited solely to headaches/migraine.

Doc

Thanks for the welcome Kitt and Doc.

I had a reply written but apparently took too long and I timed out so I'll have to try again tomorrow.

When you log-in, be sure to check the box that says Remember me ;)
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Doc

Thanks Doc.

No diagnosis yet but during our internet research the blanket term "short duration chronic daily (tension) headache" fits best. DH has a follow up appointment on Saturday but we are still with his GP. He has started the Amitriptyline at night but had to reduce it to 5 mg to function. I know it may take a while to see any benefit to any underlying depression but the drowsiness factor kicked in right away.

Since starting with the meds, he is typically having only two headaches a day across his forehead rather than multiple times a day and the pain level is less than before the meds. While the times still vary, he usually has one in the morning during a busy time at work and before he has eaten anything (not a breakfast eater but will have a late morning snack) and one in the afternoon before leaving for the day. He is off this weekend so I'm curious to see if that changes the time or frequency.

I'm glad the meds are working out a little better.

I take alprazolam and amitriptyline as needed too. I found that .25mg of alprazolam (the lowest dose made) is too strong for me as well, so I split them into halves or quarters, and titrate as necessary for extreme anxiety. For sleep, I only use 5 or 10 mg. of amitriptyline, and I don't take the two together or I'm wiped out the whole next day. I only take the amitriptyline for sleep, and it always makes me drowsy.

I wouldn't necessarily rule this out yet unless you have a good reason (some other finding). The effects of stress can last long after the reason/source stops; PTSD is just one example of this. (I'm not saying I think your husband has PTSD—it's just an example of how stress effects can outlast impetus. There are other kinds of after-effects.)

If it helps, he may consider changing eating/other habits. I can't believe some of the things that have changed (that I thought never would) at this age.

Does he work at a desk/computer? Is there any neck pain involved? Did he have a virus when/just prior to the headaches coming on?

Doc

Thanks Doc! We appreciate the support. How are you doing?

To follow up on DH's situation: At his Saturday appointment, we discussed the drowsiness and that while the headaches were better, they still occurred. The GP discussed some possible follow up testing such as MRI, as well as just switching meds to see if there was a better combination. In the end, DH decided to try adding Zoloft for now. He will stay on the trace amount of alprazolam for the mornings until the Zoloft has a chance to build up in his system. Didn't realize it until I read the paperwork but the Zoloft may have an added benefit in helping with his minor OCD. While it only certain things, he must straighten/clean them daily and he counts under duress.

We do still lean toward the headaches being stress related. No neck pain. He is on his feet all day for his job but always has been so that isn't new. He doesn't use the computer at home and has had his eyes tested recently so eye strain doesn't seem to be a factor.

He does have ongoing work stress in that he works with some "high drama" individuals including superiors so he never knows what the day will bring and he doesn't have any control over the situation when something or someone blows up. There was a change that occurred in January that might be adding to his work stress. It could be that this on top of the death of his dad and a year long estate process have overtaxed his system. Constant cortisol responses may also be causing his current low thyroid numbers.

He doesn't smoke or drink. He has a tendency toward junk food but maintains a healthy weight. He has been actively eating better recently since he realizes diet could be playing a part in the headaches.

I have some strong feelings about SSRI (and SNRI) antidepressants; they can be as/more difficult to get off of as narcotics and/or benzodiazepines. My own DW is still going through HELL—SSRI discontinuation syndrome—several months after coming off of them. No disrespect meant to anyone or their doctors, but some doctors just don't know about this phenomenon—or aren't aware of the severity/prevalence—and some don't/won't acknowledge it. PLEASE—for both of your sakes—do some homework on this and decide for yourselves. I know these meds do wonders for some folks, and that's great, but unless they are likely to be on them for the rest of their lives, I think alternatives should be sought/tried first. IMO, L-tryptophan, 5-HTP (both also good for OCD), and a few others are worth investigating/trying first.

antidepressant alternatives

Eye strain/tests don't necessarily exclude things like computer headache, and I was surprised when I learned some of my headaches were posture related; those responded quite well (though it took some time) to corrective physical therapy—one specific chin-tuck exercise in particular.

Things like cortisol can be checked with a blood test, and supplemented if necessary (I was found to be low in several adrenal hormones; supplementing them has helped me feel better in a number of ways.) Has anyone checked his testosterone levels? Low T has been found to cause daily headaches in some.

low testosterone causing daily headache

I asked about the virus, etc. because some of my headaches were determined to be caused by a virus (head cold) I got in my late 40s reactivating the EBV from having Mono as a teen! :eek: That kind often resolves in time (albeit several years).

My migraines are a different story...

Doc

Multiple daily headaches
 

Hi,

I hope your husband has managed to find some relief?

His symptoms sound familiar to my own:

-In the base of my skull where it meets the neck
-Sometimes radiating to ears, throat (occasionally i can feel a related sensation in my nose)
-Intense throbbing, pressure, burning pain
-Base of skull feels swollen and tender
-Sometimes affects hearing - similar sensation to ear popping
-I feel dazed and I don't want to talk

-Period where i have the headaches/neck pain will last roughly 1 week - sometimes 2 weeks
-I can go for months without any symptoms

-Lasting around 5-10 minutes a time
-Come on quickly and escalate to maximum pain within 1 minute
-They come and go roughly 10-20 times a day
-Wake me from my sleep roughly 4 times a night and in the morning
-Ibuprofen / paracetamol / ice help

After my own research i realise that the headaches are somewhat tension related but also quite random. I wonder if you have looked into occipital neuralgia or cerviacogenic headaches?