HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

Suggest Treatment For Anxiety Along With Headache

Posted on Thu, 16 Apr 2015

Question: I have been having tremendous anxiety along with headaches for about three weeks, partially due , I believe, to my stopping of drinking about six months ago. I had allot of withdrawal symptoms, including severe anxiety when I first stopped(which I never had while I was drinking alcohol), and then it went away, and now it is back with vengeance(I had a bad case of bronchitis and the stomach flu which may have triggered the reappearance of the anxiety). I had an Brain MRI, and the neurologist said the findings were basically normal. Findings: There is no demonstrable extra-axial hemorrhage, fluid collection or mass effect. Sulci and basal cisterns are normal in appearance. The gyral pattern is normal. There is normal gray/white matter differentiation. Ventricles are normal in size and configuration and midline in position. Incidental note is made of a cavum septum pellucidum and cavum vergae. There is no evidence of intra-axial hemorrhage, edema, mass effect or acute ischemia. A few small discrete T2 and FLAIR hyperintense foci are noted within the subcortical white matter of the left frontal lobe and subcortical and deep white matter of the right parietal lobe measuring 3 mm and less in size, The cerebellum, and brainstem are unremarkable. Normal flow-void is present within visualized intracerebral vessels. Visualized sinuses are clear. Impression: Few small subcortical and deep white matter signal abnormalities of questionable etiology and clinical significance. I really would like to get your impression of the MRI report, and whether or not you believe it is contributing to my anxiety/ headache condition. I am currently taking Clonidine, to reduce BP and anxiety, and I am considering going back on Seroquel(which helped with the anxiety the first time around I took Librium the other day when the symptoms were really prevalent(these are all prescribed medications) I am very edgy and brain fogged( I also have a candida overgrowth condition, which causes a variety of symptoms like brain fog). Please advise, as I am going through I very rough time right now.

Answered by Dr. Olsi Taka (1 hour later)

Brief Answer:
MRI report findings not contributing to anxiety or headache.

Detailed Answer:
I read your question carefully and I am sorry about the distress you seem to be in.

Regarding that MRI report I agree with your neurologist that it is to be considered normal. Some signal changes are often found on MRI due to normal aging of the brain, as a rule of thumb for every decade there is one such area of signal change and after the age of 50 their number increases even more rapidly with age.
If there were many of them one should pay attention to small vessel disease, meaning narrowing of small blood vessels related usually to diabetes, high blood pressure, smoking, high cholesterol, obesity, and try to address those symptoms. In your case though the lesions are just a few according to the report and it can be considered normal.
They are not the cause of your anxiety and headache anyway.

As for your treatment I wouldn't be that eager to go on Seroquel again, while it might seem beneficial due to its sedative effects, but it's not commonly used for anxiety. Librium which you mentioned is more appropriate but should be limited to short periods of time due to potential for dependance and tolerance. If treatment is thought to be needed for longer periods of several months, an antidepressant (they are also excellent anti anxiety medication) might be appropriate.

I remain at your disposal for further questions.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Olsi Taka (1 hour later)

Doctor,

Thanks for your response. I have one more question to ask about the MRI. I had a really bad experience with the meds that my doctor initially prescribed for me for this recent bout of anxiety. I was already on 50 mg of Clonidine twice a day(for about three days prior), when she added 50 mg of Vistaril twice a day to my protocol. The first night, after taking the 2nd Visitaril capsule, I became vey dizzy and confused, and I ended up falling , and my wife found me awake on my back on the bathroom floor(I may have passed out for a short period of time, and possibly XXXXXXX my head, although I don't think so-but it is possible). Also, at the time I had been battling allot of really loose diarrhea as a result of the stomach flu, which made me quite dehydrated. My question is, could I have done any damage(i.e loss of oxygen, possible concussion, stroke etc.) to my brain as a result of that incident, and would that have shown up in the MRI, which I got about a week later(and as you know the MRI has been deemed as coming back basically normal. Also, I am feeling VERY weak right now, almost like I am going to faint, and so my 2nd question is, knowing that my Brain MRI came back OK-is this extreme weakness, and BRAIN FOG(almost feeling like I am going to pass out) coming from my some type of brain issue, or is it more related to the medication , and or the anxiety that I am experiencing(or is it possibly from something else). Finally, this anxiety is making it difficult to perform normal day to day tasks-I would like your thoughts on that. I am heading out now to the doctor to discuss my condition, and try to get the correct medical protocol going forward. Thanks-I await your response.

Answered by Dr. Olsi Taka (25 minutes later)

Brief Answer:
Read below.

Detailed Answer:
If that possible loss of consciousness and fall episode had caused any stroke, concussion etc it would have been visible on the MRI, so do not worry on that regard, it had no consequences.

The extreme weakness, I don't think it is due to any brain issue, the MRI is the most sensitive test for the brain so it definitely excludes that possibility. The most probable cause would be anxiety in my opinion.
However some routine blood tests are recommended to exclude other common causes of weakness. Perhaps you have done them already, but in case you haven't I would recommend tests such as: complete blood count, blood glucose, liver and kidney function tests, electrolytes, thyroid function, vitamin B12.

As for the management of anxiety, since it's been already six months and the symptoms persist, as I said before I would consider starting an antidepressant of the SSRI group (citalopram, paroxetine, sertraline. Because their action can take a few weeks to take place, during the first few weeks they could be accompanied by a benzodiazepine (alprazolam, clonazepam, librium) (which are effective but shouldn't be used for long) and then be taken alone. You should talk to your doctor about that option.

I hope to have been of help.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Olsi Taka (7 hours later)

I had some blood work done a couple of days ago, and it came in pretty much within the range in most categories, with the exception of the following three tests.

1) My ICL was (H) at 109 mmo1/L with the range being 98-107

2) MY 1ALKPHOSi was (H) at 164 U/L with the range being 45-117 *

3) MY 1ALT was (H) at 104 U/L with the range being 12-78 *

* these two scores have been consistently higher than normal, especially when I was drinking, and also they could be higher because I have been taking an anti fungal prescription called Diflucan, which the doctors say could be somewhat toxic on my liver. Overall, they weren't overly concerned with the blood work results.

I got a prescribed shot of Ativan today, and it did make me feel better-so it sounds like the root of most of my severe discomfort is coming from this wide range of anxiety symptoms that I am experiencing. I await to hear your comments on the blood work as well as the anxiety. Thanks in advance.

Answered by Dr. Olsi Taka (5 hours later)

Brief Answer:
Read below

Detailed Answer:
While liver failure could result in weakness and fogging, I agree that if those result were high in the past as well and other liver tests are normal they aren't a cause for increased concern. I am not 100% sure what ICL means, I guess different acronyms might be used in different countries, I think it is chloride level judging by the reference range, if that is the case it's not a cause for concern.

Yes, if Ativan (lorazepam), a benzodiazepine, made you feel better that confirms anxiety to be the probable cause. Regarding its management my opinion remains the same, benzodiazepines are good for short term relief but should be careful for abuse potential, while for longer term treatment antidepressants might be considered.

Above answer was peer-reviewed by : Dr. Pradeep Vitta

Follow up: Dr. Olsi Taka (12 hours later)

Again, I just want to ask you if you feel that my anxiety(which I know demonstrates itself in many ways) can be the cause of the feeling of faintness, of which I have been experiencing for the last two days. Secondly, I was wondering why the severe anxiety that I experienced for about 4 months after I stopped drinking, has come back after being dormant for about two months. I am still having withdrawal anxiety symptoms.

Also, I would like to thank you-your feedback has been very helpful in this difficult time.

Answered by Dr. Olsi Taka (27 minutes later)

Brief Answer:
Read below.

Detailed Answer:
Yes, I do believe that the feeling of faintness is related to anxiety. I am sorrry if I didn't specify that. I already considered that probable before but wanted to know if you had done the tests to be sure there was no other reason, now that you said to have had the blood work a couple of days ago I feel even more confident that anxiety is the cause.

As for why has it returned, I don't have a clear cut explanation for that. Anxiety is often a chronic issue. It is possible that you have always been an anxiety prone person. Many people with anxiety have an accompanying history of alcohol abuse, because alcohol relieves anxiety and they were driven towards drinking to relieve those anxiety symptoms. So alcohol just masked the already underlying anxiety issue. That could be your case as well.

I hope you will get better soon.

Above answer was peer-reviewed by : Dr. Prasad