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Suggest Treatment For Left-sided Dull Temple And Sinus Pain Causing Neck Stiffness
Question: I have had a dull ache in my left temple which can last up to 15 days a month. The pain sometimes travels into my left sinus and results in stiffness in my nec
An MRI of my brain and a sinus CT scan were clear. So i was diagnosed with migranes. However imitrex and over-the-counter pain meds have not solved this ache
An MRI of my brain and a sinus CT scan were clear. So i was diagnosed with migranes. However imitrex and over-the-counter pain meds have not solved this ache
Brief Answer:
A trial of Indomethacin can be considered
Detailed Answer:
I read your question carefully and I understand your concern.
First it is very good news that you have had brain MRI and sinus CT as it confirms that there is no life threatening condition at the root of your symptoms.
I am a little perplexed about the diagnosis of migraine, at least I don't think it's classic migraine as migraine usually appears at a much earlier age (it seems yours is a recent manifestation). Also by definition migraine attacks last up to 72 hours, so pain lasting 15 days doesn't fit well into that description.
I wonder also whether there are any other symptoms like eye watering or redness, congested nose, eyelid drooping, nausea, vomiting. Also some more info on the characteristics of the pain (pressure, tightness, pulsating etc), intensity migh be of help.
One condition I might suggest to be considered is hemicrania continua, a chronic unilateral headache, continuous with episodes of exacerbation. If those eye or nasal symptoms I mentioned above are present they support the diagnosis. While there is no test to confirm the diagnosis its characteristic is that it is well controlled very well by a specific anti inflammatory pain killer which is Indomethacin. So even when the diagnosis is not clear (because your headache doesn't fulfill all criteria) in a continuously unilateral headache a two week trial with Indomethacin is often done, since no other cause has been identified.
Other causes might be tension type headache, a primary headache, (primary meaning no cause can be found), which is exacerbated by stress and anxiety. It usually responds to painkillers though. Also neck issues can cause neck pain irradiating into the head, but usually is somewhat eased by over the counter pain killers
I remain at your disposal for further questions.
A trial of Indomethacin can be considered
Detailed Answer:
I read your question carefully and I understand your concern.
First it is very good news that you have had brain MRI and sinus CT as it confirms that there is no life threatening condition at the root of your symptoms.
I am a little perplexed about the diagnosis of migraine, at least I don't think it's classic migraine as migraine usually appears at a much earlier age (it seems yours is a recent manifestation). Also by definition migraine attacks last up to 72 hours, so pain lasting 15 days doesn't fit well into that description.
I wonder also whether there are any other symptoms like eye watering or redness, congested nose, eyelid drooping, nausea, vomiting. Also some more info on the characteristics of the pain (pressure, tightness, pulsating etc), intensity migh be of help.
One condition I might suggest to be considered is hemicrania continua, a chronic unilateral headache, continuous with episodes of exacerbation. If those eye or nasal symptoms I mentioned above are present they support the diagnosis. While there is no test to confirm the diagnosis its characteristic is that it is well controlled very well by a specific anti inflammatory pain killer which is Indomethacin. So even when the diagnosis is not clear (because your headache doesn't fulfill all criteria) in a continuously unilateral headache a two week trial with Indomethacin is often done, since no other cause has been identified.
Other causes might be tension type headache, a primary headache, (primary meaning no cause can be found), which is exacerbated by stress and anxiety. It usually responds to painkillers though. Also neck issues can cause neck pain irradiating into the head, but usually is somewhat eased by over the counter pain killers
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
No eye watering. Antibiotics made no difference. Also chiropractic and nutritional counseling haven't made a difference
Brief Answer:
Read below.
Detailed Answer:
Thank you for that additional info. To be honest I didn't expect antibiotics, nutritional counseling or chiropractic to be of much help.
As I said it is difficult to fit your headache into a precise category, it doesn't fulfill the criteria for any specific headache type. At this point my suggestion about an Indomethacine trial remains.
If that fails I wonder whether regular preventive treatment was considered by your doctors when the diagnosis of migraine was made. There are many medications used to reduce frequency and intensity of headache episodes. I would suggest preventive treatment with amitriptyline which is a first line prophylactic medication efficacious in many different types of headache including migraine.
I hope to have been of help.
Read below.
Detailed Answer:
Thank you for that additional info. To be honest I didn't expect antibiotics, nutritional counseling or chiropractic to be of much help.
As I said it is difficult to fit your headache into a precise category, it doesn't fulfill the criteria for any specific headache type. At this point my suggestion about an Indomethacine trial remains.
If that fails I wonder whether regular preventive treatment was considered by your doctors when the diagnosis of migraine was made. There are many medications used to reduce frequency and intensity of headache episodes. I would suggest preventive treatment with amitriptyline which is a first line prophylactic medication efficacious in many different types of headache including migraine.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Do i need a prescription for indomethacin? I don't know if amitryptaline is good for me since im already on antidepressants
Brief Answer:
Read below.
Detailed Answer:
So you are already on an antidepressant, well then no, you can't add amitriptylin as it is an antidepressant as well. There are other migraine prevention treatments available (beta blockers, calcium channel blockers, antiepileptics), but as I said your description doesn't fit in with migraine criteria. However you should discuss them with your doctors, if they are convinced about that diagnosis (if migraine present for a long time it can take a chronic appearance) prevention with one of those drugs (all prescription ones) should be considered.
As for Indomethacin it is a prescription drug in the UK so you will have to take it with your doctor as well. As I said the reason I am advising it is more as a therapeutic test for the possibility of hemicrania continua, for migraine, tension type headache or cervical related headache it shouldn't have any more benefit that antiinflammatory over the counter pain killers which you must already have tried (like Ibuprofen).
Read below.
Detailed Answer:
So you are already on an antidepressant, well then no, you can't add amitriptylin as it is an antidepressant as well. There are other migraine prevention treatments available (beta blockers, calcium channel blockers, antiepileptics), but as I said your description doesn't fit in with migraine criteria. However you should discuss them with your doctors, if they are convinced about that diagnosis (if migraine present for a long time it can take a chronic appearance) prevention with one of those drugs (all prescription ones) should be considered.
As for Indomethacin it is a prescription drug in the UK so you will have to take it with your doctor as well. As I said the reason I am advising it is more as a therapeutic test for the possibility of hemicrania continua, for migraine, tension type headache or cervical related headache it shouldn't have any more benefit that antiinflammatory over the counter pain killers which you must already have tried (like Ibuprofen).
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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