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Suggest Treatment For Persistent Headaches And Nausea

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Posted on Mon, 29 Sep 2014
Question: I have been experiencing a persistent headache for over 6 weeks, with over 20 migraines and 3 trips to the ER. The pain is causing me to be very nauseous, so I am not eating well or keeping fluids in. At my last ER visit (14 days ago), my GFR was @ 54% and my electrolytes were just over the normal limit. I had labs redrawn last week, no one has called, so I'm assuming they were fine or at the very least not worse. Since Wed. the headaches have been manageable, but the nausea debilitating and everything smells like smoke, increasing the nausea. I'm am also experiencing a lot of dizziness and intermittent blurry vision. As well as severe arm/hand pain, the skin on my hands has been looking like it is being sucked in.
I generally have a mildly high pulse (around 100) and a normal BP, but with this pain my BP has been in the 160s over 130s, pulse between 130-150. Due to the BP/pulse I just keep getting sent to the ER, leaving me unable to work with my doctor/get answers. I have had a full cardiac workup, and an EKG every time I went to the ER, and everything has been fine. CT was clean. Brain MRI=6mm lesion on pituitary gland (recommended imaging specific to pituitary). Neck MRI=tiny bulge @ C5/C6. While I hate this headache, the nausea is more of a concern, because I'm not keeping food down and am unable to sleep. Which in the past has been my biggest trigger to mixed episodes. The snowball effect is killing me!
Yesterday I started having pains in my arms and hands that brought me to tears, a hot bath was all that helped, but the pains came back within 2 hours. I haven't slept our eaten the past 72 hours, and I'm sure I am dehydrated, which I am assuming is causing the hand/arm pain, as they looked dried/tight/shriveled. Would my doctor be able to order in-home IV fluids? I have taken Reglan, scopolamine, and Zofran with no relief, I am allergic to Phenergran. I have seen two neuros (1 dx chronic migraine the other cervicogenic HA) and am awaiting admission to an inpatient HA program the 1st of October. Thank you for your time!

Also, my arms seem discolored, like I am very tan/slightly burnt. Last night it looked as though I had a rash, but it was just goose bumps that looked very red. Is there any chance that any of this could be a medication reaction? Since things have seemed much worse in the last few days and the only meds I took those days were Saphris, Scopolamine, and Adderall I would think one of those would have to be the culprit. The Saphris has been burning my mouth (I think that is a normal side effect), I'm pretty sure I didn't have it in my system on Thursday when things really started going down hill, as I had missed several doses, so I doubt it is that. I also don't think I put the Scopolamine on until after things were pretty bad. Which leaves Adderall. I hadn't taken it for several days, and then the 1st day back on it was Thursday. I have been on it for 12 years with no problems, so I don't know why it would start bothering me now. I think some of these symptoms are pretty similar to what I went through this time last year, which was eventually attributed to Lithium sensitivity, at the time I had just started residential treatment and was taken off of Adderall (about the same time as Lithium), things got better, so we just assumed it was the Lithium. I started back on Adderall a few weeks after being discharged and haven't had problems since.
doctor
Answered by Dr. Shoaib Khan (1 hour later)
Brief Answer:
You need to learn more about your condition ma'am

Detailed Answer:
Hello ma'am and welcome.

Thank you for writing to us.

I have gone through your query with diligence and would like you to know that I am here to help. Your query is quite elaborate and I appreciate you providing me with all the necessary details. I would like you to know that I too have been battling migraines since childhood, and as my MRI's have returned normal the main factors we have to target are the triggering factors.

As accurately mentioned by you (when you spoke about medications being your possible factor), there is always a triggering factor present in every individual. Let me list the triggering factors most commonly observed in patients with migraines:

-Low blood sugar
-Long gaps between meals
-Blood pressure fluctuations
-High levels of stress
-Exposure to extreme climates (either too cold or too hot)
-Various medications
-Diet (certain types of food can also trigger migraines, and it is only best observed by the suffering individual themselves)
-ENT related abnormalities
-Brain structural changes (mostly due to abnormalities) [A pituitary gland lesion/tumor could easily be the cause for the migraines, please request your doctor to address the same]
and a few others.

So please make sure all factors are ruled out and only then go ahead with any treatment. Adequately addressing the causative factor is the most important treatment approach when it comes to treating migraines.

As for the pain in your arms and legs, there could be various causes for this according to me:

-Could very well be the dehydration as suspected by you, as dehydration causes slight muscle atrophy that can cause the pain; a warm bath helps in mildly hydrating the muscles thus reducing pain
-The bulge seen in your spine (C5/C6) could also easily result in pain similar to yours
-Side effect of medications
-Nutrient deficiencies
-Check on serum calcium, vitamin D, uric acid, RA factor, etc. These values need to be checked in middle aged women experiencing pain to rule out certain conditions commonly seen in middle and elderly women.
and a few others.

As for the IV fluids, they can be administered at home ma'am, but it would safer in the hospital as it helps in reducing chances of infection of the site of administration and so on. But yes, we can administer them at home as well.

If you feel and can so closely relate to Adderall, it is something we can consider and exclude from your treatment chart, so do not forget to speak to your prescribing doctor about it and find a substitute for the same with lesser undesired effects. Although you have reported not having any such experiences since you recently restarted the medication it is still better we try to substitute this medication, but the decision would be best left to your prescribing doctor.

I hope you find my response helpful. Please feel free to write back to me for any further clarifications, I would be more than happy to help you ma'am.

Best wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Shoaib Khan

General & Family Physician

Practicing since :2009

Answered : 9409 Questions

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Suggest Treatment For Persistent Headaches And Nausea

Brief Answer: You need to learn more about your condition ma'am Detailed Answer: Hello ma'am and welcome. Thank you for writing to us. I have gone through your query with diligence and would like you to know that I am here to help. Your query is quite elaborate and I appreciate you providing me with all the necessary details. I would like you to know that I too have been battling migraines since childhood, and as my MRI's have returned normal the main factors we have to target are the triggering factors. As accurately mentioned by you (when you spoke about medications being your possible factor), there is always a triggering factor present in every individual. Let me list the triggering factors most commonly observed in patients with migraines: -Low blood sugar -Long gaps between meals -Blood pressure fluctuations -High levels of stress -Exposure to extreme climates (either too cold or too hot) -Various medications -Diet (certain types of food can also trigger migraines, and it is only best observed by the suffering individual themselves) -ENT related abnormalities -Brain structural changes (mostly due to abnormalities) [A pituitary gland lesion/tumor could easily be the cause for the migraines, please request your doctor to address the same] and a few others. So please make sure all factors are ruled out and only then go ahead with any treatment. Adequately addressing the causative factor is the most important treatment approach when it comes to treating migraines. As for the pain in your arms and legs, there could be various causes for this according to me: -Could very well be the dehydration as suspected by you, as dehydration causes slight muscle atrophy that can cause the pain; a warm bath helps in mildly hydrating the muscles thus reducing pain -The bulge seen in your spine (C5/C6) could also easily result in pain similar to yours -Side effect of medications -Nutrient deficiencies -Check on serum calcium, vitamin D, uric acid, RA factor, etc. These values need to be checked in middle aged women experiencing pain to rule out certain conditions commonly seen in middle and elderly women. and a few others. As for the IV fluids, they can be administered at home ma'am, but it would safer in the hospital as it helps in reducing chances of infection of the site of administration and so on. But yes, we can administer them at home as well. If you feel and can so closely relate to Adderall, it is something we can consider and exclude from your treatment chart, so do not forget to speak to your prescribing doctor about it and find a substitute for the same with lesser undesired effects. Although you have reported not having any such experiences since you recently restarted the medication it is still better we try to substitute this medication, but the decision would be best left to your prescribing doctor. I hope you find my response helpful. Please feel free to write back to me for any further clarifications, I would be more than happy to help you ma'am. Best wishes.