“My sister is having a lot of headaches, which are not subsiding with any medicine. What should we do?”
My sister is suffering from intense headaches which just do not subside in spite of all the medication being given. We are not understanding what the problem could be. Any advice?
4 Answers
Richard Grant Hunter
Neurologist
Most headaches are controllable. She needs a neurologist to sort this out.
Treatment of the headaches is very complex as well as the diagnosis. Frequently, we see headache as a symptoms of many disorders. We call this headache secondary since it it due to some other disorder. The list of the disorders accompanied by headaches is very long. I will mention just a few that I would rule out first and then progress to more extensive testing if indicated. Some of the disorders most likely were already ruled out in your sister. Here is the list of possibilities: anemia, kidney and liver
disorders, thyroid disorders, autoimmune disorders as lupus or vasculitis, and nutritional and hormonal deficiencies and excess. Brain MRI and blood vessel studies would always rule out a possibility of a mass lesion, vascular abnormalities as fistulas, aneurysms or arteriovenous malformations. Ophthalmology exam is also very helpful since it rules out increased intracranial pressure. At times, a lumbar puncture with cerebrospinal fluid testing can be indicated with particular clinical symptoms. In my practice, I've seen how just vitamin D and magnesium supplements spared patients from taking medication with serious side effects. It all depends on what we find.
If no causes of headaches are found, than it is most likely a primary headache, like migraines and cluster headaches, or paroxysmal hemicranias. The medication choice is completely different. There are over 100 medications and many supplements to treat this type of headaches. A trial is needed, sometimes a combination work instead of a single medications.
Besides oral medications, these days we widely use trigger point injections and Botox injections with different regimens. Recently, a sphenopalatine ganglion block gave us a new hope successfully treat some forms of headaches.
Also, there are other procedures as massage, stretching, physical therapy for the headaches, particularly the ones that originate in the neck. There is a lot to look for and just as much to try, in any way optimism is very important as well as open mindedness. Let me know if I can clarify some facts. I can go and discuss headaches for days.
Thank you,
Olga Kozlova, MD
disorders, thyroid disorders, autoimmune disorders as lupus or vasculitis, and nutritional and hormonal deficiencies and excess. Brain MRI and blood vessel studies would always rule out a possibility of a mass lesion, vascular abnormalities as fistulas, aneurysms or arteriovenous malformations. Ophthalmology exam is also very helpful since it rules out increased intracranial pressure. At times, a lumbar puncture with cerebrospinal fluid testing can be indicated with particular clinical symptoms. In my practice, I've seen how just vitamin D and magnesium supplements spared patients from taking medication with serious side effects. It all depends on what we find.
If no causes of headaches are found, than it is most likely a primary headache, like migraines and cluster headaches, or paroxysmal hemicranias. The medication choice is completely different. There are over 100 medications and many supplements to treat this type of headaches. A trial is needed, sometimes a combination work instead of a single medications.
Besides oral medications, these days we widely use trigger point injections and Botox injections with different regimens. Recently, a sphenopalatine ganglion block gave us a new hope successfully treat some forms of headaches.
Also, there are other procedures as massage, stretching, physical therapy for the headaches, particularly the ones that originate in the neck. There is a lot to look for and just as much to try, in any way optimism is very important as well as open mindedness. Let me know if I can clarify some facts. I can go and discuss headaches for days.
Thank you,
Olga Kozlova, MD
Assuming she has had proper diagnostic testing and all are normal, she most likely is suffering from migraine headache since the vast majority of headaches are migraine based. If migraine meds are ineffective, Botox may help.
If it's chronic headache, it could be migraines. Should see a neurolgist for appropriate management.
