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Suggest Treatment For Constant Headache
Question: I am having constant head ache for the last four weeks.No dental problems ,E.N.T problems and and no problems with the eyes. I had the brain scan also. Last week I have consulted a Neuroligist and he has diagnosied as
Vascular Head aches. He has prescribed the following medicines. Tab Naproxen 500 mg 1-0-1 for 2 days.
Tab Clonazepam 0.25 mg 0-0-1 for 10 days and then 0.50 mg 0-0-1 for 1 month. I have been taking the above medicines since 30.11.2016. NO RELIEF. And I have always the pain. I am also taking Sebelium 10mg 0-0-1 for the last 2 weeks.
I am taking medicines for B.P, Cholosterol,and Blood Sugar. All these are under control. At night I am taking stinoct 6.25
Vascular Head aches. He has prescribed the following medicines. Tab Naproxen 500 mg 1-0-1 for 2 days.
Tab Clonazepam 0.25 mg 0-0-1 for 10 days and then 0.50 mg 0-0-1 for 1 month. I have been taking the above medicines since 30.11.2016. NO RELIEF. And I have always the pain. I am also taking Sebelium 10mg 0-0-1 for the last 2 weeks.
I am taking medicines for B.P, Cholosterol,and Blood Sugar. All these are under control. At night I am taking stinoct 6.25
Brief Answer:
Read below
Detailed Answer:
I read your question carefully and I understand your concern.
I am not sure I agree with that definition of vascular headache. That is not a term which is used in modern medicine, there is no such diagnosis in the classification of headaches. So it can signify several things like migraine, tension headache, cluster headache, stroke or vascular malformations headache etc. My assumption is that the neurologist felt that while you have a primary headache (a headache without an identifiable cause like migraine or tension type headache) your headache didn't completely satisfy the criteria for any of those.
There are several medication which can be used for prevention of primary headaches. Sibelium is one such possibility. However if it is seen not to be effective other options should be tried. I think the next best option would be an antidepressant, they are commonly used for headache prevention. Usually the most studied and proven is amitriptyline, it is one possibility. However given your age perhaps I would give a try to the newer antidepressants which have fewer potential for side effects like citalopram. It is not effective in as many patients as amitriptyline but it does work in many, I have used it to good success in many elderly patients. So you should discuss the use of an antidepressant with your doctor.
I do not agree much with the use of Clonazepam honestly, it is not used that much for that purpose and it can create dependence. It must have been prescribe thinking there is a contribution of anxiety to your headache, but it is not a long term solution and if you start an antidepressant it should help with anxiety as well anyway.
I remain at your disposal for other questions.
Read below
Detailed Answer:
I read your question carefully and I understand your concern.
I am not sure I agree with that definition of vascular headache. That is not a term which is used in modern medicine, there is no such diagnosis in the classification of headaches. So it can signify several things like migraine, tension headache, cluster headache, stroke or vascular malformations headache etc. My assumption is that the neurologist felt that while you have a primary headache (a headache without an identifiable cause like migraine or tension type headache) your headache didn't completely satisfy the criteria for any of those.
There are several medication which can be used for prevention of primary headaches. Sibelium is one such possibility. However if it is seen not to be effective other options should be tried. I think the next best option would be an antidepressant, they are commonly used for headache prevention. Usually the most studied and proven is amitriptyline, it is one possibility. However given your age perhaps I would give a try to the newer antidepressants which have fewer potential for side effects like citalopram. It is not effective in as many patients as amitriptyline but it does work in many, I have used it to good success in many elderly patients. So you should discuss the use of an antidepressant with your doctor.
I do not agree much with the use of Clonazepam honestly, it is not used that much for that purpose and it can create dependence. It must have been prescribe thinking there is a contribution of anxiety to your headache, but it is not a long term solution and if you start an antidepressant it should help with anxiety as well anyway.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Many thanks for your immediate response. As I will be going out of XXXXXXX for few days until the end of this month, to get immediate ,some relief ,can i use the medicine Citalopram , and start immediately the same. I will be seeing my Neurologist, only after my return. Please advise the dosage etc. .
I was advised to take Clonazepam and reduce Stilnox ,from 10 mg to 5 mg.
I have been continuously taking only stinoct 6.25 mg, which is available in XXXXXXX
I live in Geneva-Switzerland and come down to XXXXXXX for some family visit and am leaving back for Geneva in the first week of January 2017. Sinace I always consult your team for any urgency, I need your kind advise.
I was advised to take Clonazepam and reduce Stilnox ,from 10 mg to 5 mg.
I have been continuously taking only stinoct 6.25 mg, which is available in XXXXXXX
I live in Geneva-Switzerland and come down to XXXXXXX for some family visit and am leaving back for Geneva in the first week of January 2017. Sinace I always consult your team for any urgency, I need your kind advise.
Brief Answer:
Read below.
Detailed Answer:
Hello again!
Medication like citalopram, sibelium (or any other headache prevention medication for that matter) are not used for immediate relief. Their purpose is to prevent headaches, to reduce their frequency and intensity in time. They all need at least a few weeks for their effect to come into play. So I wouldn't start it with that aim. If you are to start it the initial dosage for citalopram is 10 mg daily in the morning.
For immediate relief medication like Ibuprofen or Naproxen are usually the first step. If not effective then combinations of paracetamol with caffeine or with codeine may be tried.
Let me know if I can further assist you.
Read below.
Detailed Answer:
Hello again!
Medication like citalopram, sibelium (or any other headache prevention medication for that matter) are not used for immediate relief. Their purpose is to prevent headaches, to reduce their frequency and intensity in time. They all need at least a few weeks for their effect to come into play. So I wouldn't start it with that aim. If you are to start it the initial dosage for citalopram is 10 mg daily in the morning.
For immediate relief medication like Ibuprofen or Naproxen are usually the first step. If not effective then combinations of paracetamol with caffeine or with codeine may be tried.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Good morning Doctor
Many thanks for your quick advise.
I have uploaded a copy of the Brain Scan Report done on on 12.11.2016 for your
reference. I have also uploaded a list of medicines,I take,regularly.
As per your advise I will start taking Citalopram 10 mg 1-0-0 immediately. I have already taken Naproxen 500 Mg 1-0-1 for 2 days as advised by the Neuro.
My son-in-law is a General Medicine Doctor in XXXXXXX Asia Hospital-Bangalore, and I will seek his advise and take the other medications as per your advise.
Thanks and regards
Many thanks for your quick advise.
I have uploaded a copy of the Brain Scan Report done on on 12.11.2016 for your
reference. I have also uploaded a list of medicines,I take,regularly.
As per your advise I will start taking Citalopram 10 mg 1-0-0 immediately. I have already taken Naproxen 500 Mg 1-0-1 for 2 days as advised by the Neuro.
My son-in-law is a General Medicine Doctor in XXXXXXX Asia Hospital-Bangalore, and I will seek his advise and take the other medications as per your advise.
Thanks and regards
Brief Answer:
Read below.
Detailed Answer:
Thank you for the CT report (I had already reviewed the medication list). It looks completely normal. However if headaches persist in time then a MRI might be considered as well. Also I assume you have had some routine blood tests to screen for inflammatory and infectious changes.
Naproxen can be taken again to alleviate the pain, but preferably not frequently as it may cause side effects with prolonged use such as high blood pressure or gastric ulcers.
Wishing you good health.
Read below.
Detailed Answer:
Thank you for the CT report (I had already reviewed the medication list). It looks completely normal. However if headaches persist in time then a MRI might be considered as well. Also I assume you have had some routine blood tests to screen for inflammatory and infectious changes.
Naproxen can be taken again to alleviate the pain, but preferably not frequently as it may cause side effects with prolonged use such as high blood pressure or gastric ulcers.
Wishing you good health.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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