Question: My wife has had chronic headaches for some time (years but getting worse recently) and we are just going round in circles with her doctor. She is now on the seventh day of a continuous headache. It is there as soon as she wakes and still there when she goes to sleep.
I have given her maximum recommended doses of acetaminophen, naproxen and, as a last resort,, hydrocodone. They will reduce the pain for a couple of hours, but nothing eliminates it. She describes the pains as like a "scrunching" (her words) or scrubbing synchronized with her pulse.
Is this consistent with a "ballooning" blood vessel (i.e. an impending embolism - she is 58)? I am just not happy with a diagnosis of "persistent migraine" (all her doctor can come up with), especially when her headaches never respond significantly to prescribed migraine medicines and do not go away if she lays down and rests with her eyes closed.
I want to take matters into my own hands and look for second opinions. Although the "scrubbing" causes my concern about the potential of an embolism, there is a lot of circumstantial evidence that it could be allergies...
She rarely gets headaches when we are away from Minnesota, even with zero medications.
She complains of itchy eyes and (right now) "feeling like her eyes are trying to push out of head".
Her worst headaches usually coincide with my routine symptoms of allergies (I am allergic to mold spores).
It seems to be worse in the spring.
It is triggered usually by changing weather conditions (wet to dry etc.).

I am committed to taking her to an allergy specialist, but should I be getting her in for an urgent head MRI?

Thanks

I have replied to all your questions below.

My main concern right now is to get assurance that it is unlikely to be an impending life threatening problem. Hopefully, the following answers will give you a better insight.

I have started each answer in capitals to help you scan though it.

Persistent vomiting YES - significant during bad spells

visual loss (NOT LOSS but sometimes very blurred)

diplopia (YES but not often, only during very bad spells for limited time)

limb weakness (YES - she continually complains of weakness)

dysphagia (YES - she often complains about feeling like something is stuck in her throat but I have not noticed that it particularly coincides with bad headache spells)

speech abnormalities (NO - I do not think so)

gait abnormalities (NO)

hearing loss (NO)

1)Duration of headache: Usually 3-5 days. Recently - PERMANENT

2)Location of headache: difficult to get a reliable answer from her - seems to be ALL OVER spreading from the center, but I cannot be certain that this is reliable data

3)Intensity: often 10 without medication. ("I would be better off dead" has occasionally been uttered). This spring she has been unable to go to work on many days. Right now she is unable to function at all without maximum recommended dosages of pain-killers. I alternate her between NSAIDs and Acetaminophen to try to mitigate the high usage, but it is way more than I am happy with.

4) Type of headache: THROBBING: "sounds like someone is scrubbing in my head" - I have ascertained that the scrubbing is synchronous with her pulse.

5)nausea or vomiting: YES, especially vomiting.

6) photophobia, phonophobia: NO. As far as I can tell, no effect at all.

7) aggravating factors like missing meal, chocolate, coffee, sunlight: NONE

8) releiving factors like sleep, dark room, pain killers. NONE

9) amount of pain killers and duration: She never takes pain killers without consulting me. I try to alternate between NSAIDS and Acetaminophen so there is at least 12 hours between a repeat dose of the same drug family. OTC generic Acetaminophen 2 x 325mg (very very occasionally 1 prescription Hydrocodone in the evening instead) alternating with 2 OTC Naproxen (or less often OTC ibuprofen). She probably uses more Naproxen than anything else because they seem to work the best and last longer, but she never gets near the maximum recommended daily dosage. We are both very weary of over-use of drugs - she is definitely not over-using them.
She has tried Maxalt in the past and has a current prescription for Sumatriptan, both of which are less effective than OTC pain killers.
OTHER MEDS: She is on a permanent daily regimen of (a.m.) 25mg Losartan (her BP is fine with this dosage) and (p.m.) 25mg Amitriptyline, (prescribed by Neurologist), 1mg Clonazepam (maybe the headaches are caused by anxiety?) and 500mg Methocarbamol (maybe the headaches are caused by neck tension due to posture/anxiety?). The latter two could well just be the historical result of trial and error by her doctor to find a cause. Although, she does have a tendency to jump to negative conclusions and get worked up about trivial things, she shows no real signs of depression/anxiety other than those indicated by her physical conditions or being, understandably, fed up with the pain.

10) associated features like redness of eye, nasal congestion: YES. ITCHY EYES AND EARS (but I have never noticed redness) AND NASAL CONGESTION. She is always complaining about PHLEGM IN HER THROAT. She snores like an elephant and has a CPAP.

Headache for more than 15 days?: normal period is less than a week, but this Spring has been worse and she appears to be en-route for a 15 day duration right now.

More than 3 months?: She has had this issue for several years and it is getting
progressively worse each year, especially in the spring.

Pain killer for more than 15 days?: NO but as things are progressing right now this current episode might be the first time. The normal duration would be less than a week.

for more than 3 months?: She has been taking pain killers for this for several years but, until this episode, never in high doses and not for a prolonged period. I worked for a pharmaceutical company, so I am very wary of drug over-use and my wife, who is Filipino, is culturally very wary of taking a lot of drugs. You can be sure that this is not being aggravated by over-use of pain killers. I am familiar with the rebound headache effect.

Seasonal variations in headache may be seen in migraine also with aggravating in cold weather....
She is always worse in the Spring and is very much affected by swings from hot to cold AND vice versa. She NEVER has persistent headaches even with no meds (except Losartan) when we are in the Philippines, but there, of course, as well as there being only allergens for which she likely has resistance built up during childhood, there are also no severe temperature swings - it is always hot!

I will advise you to consult a neurologist:
Yes going to different neurologist that specializes in headaches is on my list as a next step, providing we can be satisfied that the evidence of a more critical condition is not indicated by her symptoms. I was only favoring an allergist first because it is a more straightforward set of tests, even if only to eliminate that as the cause or an aggravating contributor.

Thank you for your response. I hope my answers will give you more confidence in your opinion.

Regards

XXXX
952 201 6901