Q. What causes dull headache that does not shift?

 

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Hello doctor,

Three weeks ago, I had headache in late night. I managed to sleep, but it was still there in the morning. It was unilateral headache on the left side of my head. Pain is in my temporal area which sometimes radiates across my cheek and even down my jaw, as well as on the top left of my head. I have occasionally felt discomfort on my chin too, almost like a bruised bone feeling when pressed. The pain subsided with Paracetamol and Ibuprofen, but returned the following evening. Medication no longer had any effect on it. After a week of non-stop pain, I went to my doctor. He could not work out why I was having the pain when I have absolutely no other symptoms. I feel fine other than the pain. He sent me to other hospital for further evaluation. My bloods were taken and came back normal and I passed all of the doctor’s strength, reflex and cognitive tests. It was a mystery to him too. He referred me to a specialist who said it was likely a benign tension headache and I was discharged. While the pain is not generally as bad as it was, it is still there every day. I get a few moments of pain every now and then, as well as head pressure. But, some days the pain lasts all day, a dull ache that does not seem to shift. The most annoying part of is that within a minute of my head hitting the pillow at night severe pain suddenly kicks in my left temporal region and back of the head. I could not sleep without taking medication. At home, I have tried three different pillows, yet I still get pain. The only medication I take for it is a combination of Paracetamol and Aspirin. I am currently taking it each night about 30 minutes before bed to ensure the pain will not kick in. If I do not do this I simply cannot sleep. I do not want to be reliant on these pills or take too many, so I am trying to limit myself to just two of each before bed. I still have no other symptoms other than the unilateral pain and pressure. I do not suffer with migraines and do not feel anxious or stressed at the moment. The only anxiety I have recently felt was during hospital visits as my pulse rate went a little high, but returned to normal later. Is it really a tension headache or something else? I must stress that despite days where the pain has subsided; the discomfort has been constant throughout. I am always conscious of it. Please help me out of this. Thank you.

 

 

Answered



Hello,

Welcome to dr.sitehome.info.

My main concern here would be trigeminal cephalgia, the most common being trigeminal neuralgia.

Trigeminal neuralgia is a sharp shooting unilateral headache that becomes extremely worse with nerve irritation that could be caused by shaving, brushing (hair or teeth) or any one touching the scalp or wearing cap.

The other important fact could be medication induced headache (extremely common); it happens if you are using painkillers for 15 to 30 days a week.

  • It may very well be tension headache, but usually they are band like around the head and not unilateral.
  • I am assuming that you have no other neurological deficits.
  • Eye checkup is always a good idea since astigmatism and close angle glaucoma can cause similar symptoms.
  • I am assuming you have no eye or nasal discharge from the same side as the headache.
  • Again I would still not rule out migraine being a cause of your headache.

  • Investigations to be done:

    1. MRI of the temporomandibular joint (TMJ) to rule out TMJ arthritis.

    2. MRI of the brain.

    3. NCS (nerve conduction studies) and EMG (electromyogram).

  • Probable diagnosis:

    Trigeminal neuralgia.

  • Treatment plan:

    Gabapentin 300 mg three times a day. Start from 300 mg at bedtime and increase it to three times a day for one or two weeks as tolerated.

  • Preventive measures:

    Avoid any irritation to the scalp.

  • Regarding follow up:

    Revert back after a month with the reports to an internal medicine physician online.—> https://www.dr.sitehome.info/ask-a-doctor-online/internal-medicine-physician



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