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Medical Forum / General / General / November 2009

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Best specialist for chronic headache?

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Don Marco - 05 Nov 2009 13:43 GMT
I've been suffering from headaches almost daily for a long time.  They
do not seem to be migraines, more like tension type.  My primary care
doctor casually mentioned seeing a neurologist; but others have
mentioned pain specialists.  Is there any consensus about what is the
best type of specialist to see for this problem?
Zombywoof - 05 Nov 2009 17:12 GMT
>I've been suffering from headaches almost daily for a long time.  They
>do not seem to be migraines, more like tension type.  My primary care
>doctor casually mentioned seeing a neurologist; but others have
>mentioned pain specialists.  Is there any consensus about what is the
>best type of specialist to see for this problem?

If you have an organic cause for the headaches, then yes a Neurologist
is probably a good place to start, but most can't/won't do diddle for
a person with Chronic Daily Headache.

Review
http://www.mayoclinic.com/health/chronic-daily-headaches/DS00646 and
if your symptoms match-up with what they are talking about seek out a
Pain Management Specialist.  He/she may still want you to see a
Neurologist to have organic causes ruled out, which amounts to a bunch
of really expensive tests -- CAT Scan, MRI, X-Rays, etc.

Taking good care of yourself can help prevent chronic daily headaches.
See if any of these "don't need a Doctor" methods help you.

-- Avoid headache triggers. If you're not sure what triggers your
headaches, keep a headache diary. Include details about every
headache. When did it start? What were you doing at the time? What did
you eat that day? How did you sleep the night before? What's your
stress level? How long did the headache last? What, if anything,
provided relief? Eventually, you may begin to see a pattern — and be
able to take steps to prevent future headaches.

-- Get enough sleep. Go to bed and wake up at the same time every day
— even on weekends. If you're not tired at bedtime, read or watch
television until you become drowsy and fall asleep naturally.

-- Don't skip meals. Start your day with a healthy breakfast. Eat
lunch and dinner at about the same time every day. Avoid any food or
drinks, such as those containing caffeine, that seem to trigger
headaches.

-- Exercise regularly. Physical activity causes your body to release
chemicals that block pain signals to your brain. With your doctor's
OK, choose activities you enjoy — such as walking, swimming or
cycling. To avoid injury, start slowly.

-- If you Smke, stop. Smoking can trigger chronic migraine and chronic
tension-type headaches. Higher levels of nicotine are also associated
with increased anxiety and depression.

-- Reduce stress. Get organized. Simplify your schedule. Plan ahead.
Stay positive.

-- Relax. Try yoga, meditation or relaxation exercises. Set aside time
to slow down. Listen to music, read a book or take a hot bath.
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"Gustatus Similis Pullus"

Juba - 05 Nov 2009 18:21 GMT
> I've been suffering from headaches almost daily for a long time.  They
> do not seem to be migraines, more like tension type.  My primary care
> doctor casually mentioned seeing a neurologist; but others have
> mentioned pain specialists.  Is there any consensus about what is the
> best type of specialist to see for this problem?

Perhaps you are suffering from rebound headaches? Have you been taking
OTC medicines for the headaches? Maybe you just need to take a break
from them and suffer through a week or so of bad headaches so that your
brain chemistry has a chance to rebalance itself.

I suffer from daily headaches as well and if it's a choice between
neurologist or pain specialist, I'll always take a neurologist. But I
prefer a GP who is comfortable with prescribing opiates and triptans
because unlike neurologists and pain specialists, GPs are much less
likely to treat patients as guinea pigs.

If you determine that your headaches are not rebound, then you will need
an MRI just to make sure you don't have a tumor or something.

Signature

Juba
www.masterjuba.com

Don Marco - 06 Nov 2009 23:26 GMT
>> I've been suffering from headaches almost daily for a long time.  They
>> do not seem to be migraines, more like tension type.  My primary care
[quoted text clipped - 15 lines]
> If you determine that your headaches are not rebound, then you will need
> an MRI just to make sure you don't have a tumor or something.

Thanks to all for your thoughtful replies to my query.  I probably
should try tapering off my pain meds (Ultracet and OTCs) before going to
a specialist, since that's something they'll suggest anyway, though I
think I've tried this before.

In a way, I'm surprised to hear that neurologists aren't worth much in
managing pain.  OTOH, the ones I've briefly talked to seemed more
concerned with organic disorders like Parkinson's.  But the pain
specialty centers I've contacted seemed more focused on treating
disorders like spinal cord injury and arthritis.
Mike Berkowitz - 07 Nov 2009 03:26 GMT
>I've been suffering from headaches almost daily for a long time.  They
>do not seem to be migraines, more like tension type.  My primary care
>doctor casually mentioned seeing a neurologist; but others have
>mentioned pain specialists.  Is there any consensus about what is the
>best type of specialist to see for this problem?

Don,

I have a combination of Migraine, chronic daily headache and pain
associated with cervical degenerative disc disease. I started by
seeing a neurologist. Be forewarned: They will ask you to try
anti-seizure medication and/or anti-depressants. The anti-seizure
medication will dull your thinking and make you gain weight. The anti-
depressant medication will make having an orgasm almost impossible and
most will make you gain weight. You can also expect slowed thinking
from most of the anti-depressants but not as bad as with the
anti-seizure med's. Another favorite is beta blockers. This is a wise
choice with the fewest side effects (unless you have asthma).

Are your headaches one sided?
How long do they last?
What medications have you tried including OTC?
Can you describe the pain as the headache progresses?
Do you experience pounding?

Best regards,

Michael H Berkowitz
Don Marco - 08 Nov 2009 15:21 GMT
>> I've been suffering from headaches almost daily for a long time.  They
>> do not seem to be migraines, more like tension type.  My primary care
[quoted text clipped - 24 lines]
>
> Michael H Berkowitz

Thanks for the tips.  I figured any doctor would ask questions like that
because I've got them before.  My headaches are bilateral, practically
continuous, not pounding (just differing in severity), no auras or
nausea, so I don't think they're migraine but tension-type.  OTOH, the
veins in my forehead are swollen, so maybe there is a vascular part.

I'm already on beta-blockers for hypertension, and have tried all OTC
meds and herbals like cordylis and skullcap.  I've found that naproxen
works best, but like most analgesics, you can't take it too often or you
get tolerance or rebound.

That's why I thought these anti-seizure or anti-psychotic meds in low
doses sounded promising when I recently read of them--if you can take
them daily.  I don't mind feeling a little sleepy or gaining weight as
long as the meds stop this damn pain.  Did you find anything that worked
well for you?
Happy - 08 Nov 2009 19:34 GMT
>>> I've been suffering from headaches almost daily for a long time.  They
>>> do not seem to be migraines, more like tension type.  My primary care
[quoted text clipped - 41 lines]
> the meds stop this damn pain.  Did you find anything that worked well for
> you?

For me, and based on reading here for quite a long time I seem to be in the
minority - maybe a minority of one!, I have had success with topamax, 100 mg
daily.  I have taken it for a little over 4 yrs.  it's available in generic
form now.  I suffer from migraines and had gotten up to 2 to sometimes 3 per
week.  Now I have only 4 per year that require additional intervention, and
the maybe 6 others are so mild that OTC meds are adequate.  The only side
effect for me was weight loss, result of the loss of appetite - however I
already have daily nausea with my chronic pain condition so this is not a
big deal for me.  Adding the supplement ensure to my diet keeps my weight
up.

Others have had horrid side effects, resulting in topamax being called
dopeamax.  I feel lucky, and grateful.  So, I may be one of the few who
would say its worth a try - for migraines.

Happy
Zombywoof - 09 Nov 2009 21:53 GMT
>>>> I've been suffering from headaches almost daily for a long time.  They
>>>> do not seem to be migraines, more like tension type.  My primary care
[quoted text clipped - 58 lines]
>
>Happy

I had absolutely great success in mitigating my headaches with
Topamax, but unfortunately fell into the wicked side-effects
conundrum.  Matter of fact so of the side-effects never went away even
after discontinuing the medication.

All of these drugs are worth at least a try because some people have
to experience success with them or Dr's wouldn't be prescribing them.
Unfortunately like most things, not everything works 100% for 100% of
the people.
Signature


"Gustatus Similis Pullus"

Michael B - 10 Nov 2009 01:22 GMT
Make yourself more familiar with the "cluster headache" concepts.

> I've been suffering from headaches almost daily for a long time.  They
> do not seem to be migraines, more like tension type.  My primary care
> doctor casually mentioned seeing a neurologist; but others have
> mentioned pain specialists.  Is there any consensus about what is the
> best type of specialist to see for this problem?
 
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