Headaches, again

brewmonkey · 07-30-2005, 09:43

I have been having headaches for some time and they seem to be getting worse with time. Now the doc has me on Inderal 3X a day and then midrin for the breakthrough as well I am on Oxycontin 40mg X2 and Oxycodone as needed for breakthrough for the back. Round that out with Lidoderm patches for 12 hours a day (night time) & robaxin for the muscle spasms.

There is no warning for the headaches and I am not light sensitive when they hit. If they are not caught in time I become disoriented and vomit in addition to the pain which is a 10.

I have had several CT scans (no MRI's) through the years but none of them have shown anything wrong with the noodle but none of them have been done with contrast. I am growing concerned with the frequency/intensity and their lack of diagnoses. I understand doctors are not miracle workers and sometimes there is no explanation.

I want to ask my doctor to do a CT Scan with contrast but I am curious as to how much better the scan might be with contrast then without it. My concern with contrast material is that my readings suggest that they use an iodine based dye and that they inject it intrathecally. For me this is a concern as I have arachnoiditis which may have been caused by a similar dye used during a myelogram.

In fact the doctors do believe that perhaps the arachnoiditis itself might be the culprit for the headaches. Our last conversation on this was along the lines of the scar tissue displacing CSF and causing the headaches. However I was curious as if that were true would I not experience the headaches constantly as the pressure building up from the scar tissue is constant.

Is the contrast done intrathecally or by IV? Should I ask the doctor for a CT with contrast to see what is there or should we go for the MRI? If we do an MRI wouldn't they still need to do the contrast?

I appreciate any info you folks might have and I look forward to not spending more nights in the ER not knowing who or where I am.

ccrn · 07-30-2005, 17:49

Has aneurysm ever crept up in any of the discussions youve had with your providers?

brewmonkey · 07-30-2005, 20:59

Quote:

Originally Posted by ccrn

Has aneurysm ever crept up in any of the discussions youve had with your providers?

Not at all that I can recall. I guess this is something I should ask the doctor about as well. To tell the truth I have never really felt like I have been given serious attention on this matter. I go for a CT scan and 5 days later I have to call the doc to see what is going on only to be told the radiologist saw nothing abnormal. Compared to CT scans for my back which have invovled in depth discussions with radiologists and docs together I feel like when it comes to my head it is just business as usual with them and that scares me.

**Eagle5US** · 07-30-2005, 22:06

You may consider also asking about the condition "temporal arteritis" and perhaps having an arteriogram gram.

Keep us posted, HA's SUCK

Eagle

mfos2 · 07-30-2005, 22:50

Is the pain all on one side?

swatsurgeon · 07-31-2005, 07:09

Brew,
could be a narcotic headache. A good number of patients will develop headaches while using opioids...yes, this seems crazy, but it's true. Tylenol, ibuprophen, etc will help but as the opioids increase in strength, so do the headaches. We see this every day on our service. I use the 'big guns' for pain relief and it is a common complaint.....sorry to give bad news.

ss

jatx · 07-31-2005, 10:15

Brew,

I'm very sorry to hear that you're having what sounds like a real break-out w/ your HA's. Been there, done that. My migraines have mostly subsided over the years, but Midrin is my friend when they do reappear.

You're getting plenty of good medical advice from others, but I'll add one bit of folk wisdom that's served me well, FWIW. Keep several damp washcloths in the freezer and, when the pain hits, take one out and place it directly over your eyes. Your eyes should be closed, but let the rag thaw in direct contact with your eyelids. This sometimes seems to help me more than meds, though it sounds like you've stepped up to a whole 'nother level. In any case, having that coolness begin to radiate through your skull can give you something more pleasant to focus on for awhile.

Hang in there.

DoctorDoom · 08-02-2005, 03:47

x

mfos2 · 08-02-2005, 18:42

I don't know what kind of headaches you have but I had the nerves burnt and lesioned a couple years ago. It worked pretty well for a while but the cause of mine has to due with a holethat has been worn in the main branch of the trigeminal nerve. I'm having surgery to repair it in a couple weeks. Good luck with your headaches. I know how bad they can be.

And I know that oxycontin and percocet and methadone actually add to the headaches. I have been better since I stopped taking pain medicine. I pass out with pain more often but I deal with it much better off the stuff for the most part.

Again good luck.

brewmonkey · 08-03-2005, 17:52

Thanks for all the answers. I have an appointment with the torture rack on the 10th so we will see what they come up with.

**Kyobanim** · 08-03-2005, 20:32

Good luck, Brew, and keep us informed.

Detcord · 08-06-2005, 02:16

Brew, sorry to hear about your condition.

You're on lots of potent meds and the doctors have not found any real cause of your headaches. Most likely, there's nothing wrong with your head.

Your body has developed a certain tolerance to your exisiting meds, meaning when you feel pain of any kind, it's going to take progressively higher and higher doses to kill the pain, if it will at all. You say the I.V. meds didn't touch the pain when you went to the hospital. Your body's tolerance to narcotic analgesics is probably why you did not get any pain relief.

Big question: Do you drink lots of soda or coffee? Many people experience migrane-like pain when they stop or cut down on caffine intake. Sounds too simple and easy, but the body can react quite strongly to caffine withdrawls in the form of intense headaches.

Headaches are often caused by too much blood flow to the head. Dialated blood vessles around the head and eyes can press on nerves causing severe pain. caffine is a "vasoconstrictor" meaning it causes blood vessels to reduce in size. Over the hours in a day, your body will metabolize the caffine and the levels in your blood will decrease. When this happens, the blood vessels will start dialating again. When this happens, a bad headache can occur rather quickly.

Most people drink sodas and coffee at regular times every day (e.g. meals), so caffine levels tend to stay relatively constant. However, if one cuts down dramatically on the quantity of caffine consumed or quits ingesting caffine alltogether, severe headaches can develop.

Excedrin is one of the best headache medicines out there. Plus, it's OTC. Use the "extra strength" or "migrane" formulas. Tylenol (acetaminophen) is a poor pain reliever by itself, especially for headaches.

Excedrin "extra strength" and "migrane" formulas contain:
250 mg of asprin
250 mg of acetaminophen
65 mg of caffine

Those 3 compounds together create a synergistic effect which can provide relief from severe headaches. It's possible you may find more relief from Excedrin than an I.V. in the E.R.

Hope you find something that works.

Good luck!!!

brewmonkey · 08-14-2005, 11:40

No, caffeine intake is low to nothing and has been for some time. We found that the amount of coffee I was drinking during the day had an effect on the CNS that amplified the pain in the back and legs. However I have seen the effects a sudden decrease or stop can have on someone. The pain doc has me on Inderal and Midrin for the headaches and while it is not 100% effective it works (85-90%) well enough to tolerate the pain.

I saw the crackpots I swore I would never go back to. My last visit with them ended with the doctor talking about licking frogs as pain meds and insisting that I get an epidural.

Now I know that meds can come from a variety of sources. I have even read some interesting stuff on the meds that can possibly be developed from the secretions of reptiles like the poison dart frogs, however the doc went a bit far into strangeland to suit my needs. When he insisted on an epidural to "fix" my problem I decided to move on to another doc.

Well after several months of not going back I caved in and went. I talked to a different doctor there this time and was not surprised when I got the same efforts on the epidurals. My concern with the epidurals is that I have arachnoiditis. There is no cure for this and epidurals may not only be one of the causes they tend to be ineffective in providing relief. This is not like when I was first diagnosed with Spondylolisthesis and they had a chance to work. However I decided to see if there was merit to this doctors reasons as he presented much better then the doc before.

This was THE MOST painful epidural (Caudal) I have ever had. It was like he did not bother to use a local at all and just plunged the needle in. In the past it has also taken several minutes from the injection until all the meds were delivered, like the doctors would pump a little in and let it settle before doing a bit more. Not this time, the needle went in and BAM! so did the meds.

I could literally taste the stuff the next day and while a slight increase in pain can be expected this was much different then the last 9 I have received. My back was on fire the next morning and my foot felt like someone plugged it in. It has been several days since and most of the pain has subsided but I do not feel any relief from the first one, not even a tiny bit.

Anyway, the epidural is over and done with. I will not let them do a second or third one.

We did discuss the headaches and on the 22nd when I go back they are going to do an MRI of basically the whole back and head. They are going to check on the progress of the arachnoiditis as well as see what if anything might be causing the headaches.

I will follow up once we get the MRI results. The good news is that this place has their own radiologist who will be there doing the MRI with the tech. My doctor said he wants the results ASAP so hopefully I will have preliminary results that afternoon.