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What Causes Unilateral Pain In The Head?
Question: Headache/Migraine
I have been increasing cluster like headaches, most of the pain is behind my right eye and my right temple. I have been a long term sufferer of migraines, since age 6, and no formal diagnosis has ever been made, just treatment; general practitioners, pediatricians, neurologists have been seen in the past. What I am dealing with is nothing like a migraine. I will get intense pain for 15-40 minutes and it is a roller coaster of up and down pain for 12 hour period. My migraines significantly reduced to only 1 or 2 a year at age 30, but the last 6 months these awful headaches have come into my life.
My diet is good, been with a nutritionist for several years. I do consume caffeine rather heavily, coffee and 2-3 energy drinks per day. I do drink water and sparkling water in between. No recreational drugs, maybe a beer once a week. I do take tramadol daily for my knee pain. Stress level is pretty low, nothing like it was years ago.
Not sure if related but my periods are very heavy and last weeks, but that has been going on for about 2 years now.
I have been increasing cluster like headaches, most of the pain is behind my right eye and my right temple. I have been a long term sufferer of migraines, since age 6, and no formal diagnosis has ever been made, just treatment; general practitioners, pediatricians, neurologists have been seen in the past. What I am dealing with is nothing like a migraine. I will get intense pain for 15-40 minutes and it is a roller coaster of up and down pain for 12 hour period. My migraines significantly reduced to only 1 or 2 a year at age 30, but the last 6 months these awful headaches have come into my life.
My diet is good, been with a nutritionist for several years. I do consume caffeine rather heavily, coffee and 2-3 energy drinks per day. I do drink water and sparkling water in between. No recreational drugs, maybe a beer once a week. I do take tramadol daily for my knee pain. Stress level is pretty low, nothing like it was years ago.
Not sure if related but my periods are very heavy and last weeks, but that has been going on for about 2 years now.
Brief Answer:
Atypical headache, cluster and hemicrania continua to be considered
Detailed Answer:
I read your question carefully and I understand your concern.
It is true that those pain attacks are not migraine like. In terms of location and duration these pain attacks you describe do correspond to cluster headache. However what they seem to be lacking (or you do not mention) are the autonomic features which typically are part of cluster headache like lacrimation, eye redness, nasal congestion and discharge, droopy eyelid. At least one of these features are necessary for the diagnosis of cluster. Their lack does put the cluster headache diagnosis in question.
If you have persisting pain even between those acute attacks hemicranias continua should also be considered. It often does coexist in migraine patients. However it too does usually have those autonomous symptoms I mentioned before.
The fact that it is an atypical headache though doesn't mean it shouldn't be treated. First measure you should take is avoid those big quantities of caffeine and energy drinks. No matter which type of headache, all primary headache have one thing in common, they may be exacerbated or triggered by the use of caffeine and energy drinks. So that is a necessary measure.
If that is not enough then prophylactic treatment should be considered. First I would do an indomethacine test for the possibility of hemicranias continua. That is because that type of headache responds very well to indomethacine, unlike any other drug, so its response is used also as a diagnostic test. It is started by 50 mg twice a day for 3 days, then three times a day if not successful. If not effective I would suggest preventive treatment with a calcium channel blocker like verapamil. The rationale for using that treatment is that it is used both for migraine and cluster headache prevention.
I remain at your disposal for other questions.
Atypical headache, cluster and hemicrania continua to be considered
Detailed Answer:
I read your question carefully and I understand your concern.
It is true that those pain attacks are not migraine like. In terms of location and duration these pain attacks you describe do correspond to cluster headache. However what they seem to be lacking (or you do not mention) are the autonomic features which typically are part of cluster headache like lacrimation, eye redness, nasal congestion and discharge, droopy eyelid. At least one of these features are necessary for the diagnosis of cluster. Their lack does put the cluster headache diagnosis in question.
If you have persisting pain even between those acute attacks hemicranias continua should also be considered. It often does coexist in migraine patients. However it too does usually have those autonomous symptoms I mentioned before.
The fact that it is an atypical headache though doesn't mean it shouldn't be treated. First measure you should take is avoid those big quantities of caffeine and energy drinks. No matter which type of headache, all primary headache have one thing in common, they may be exacerbated or triggered by the use of caffeine and energy drinks. So that is a necessary measure.
If that is not enough then prophylactic treatment should be considered. First I would do an indomethacine test for the possibility of hemicranias continua. That is because that type of headache responds very well to indomethacine, unlike any other drug, so its response is used also as a diagnostic test. It is started by 50 mg twice a day for 3 days, then three times a day if not successful. If not effective I would suggest preventive treatment with a calcium channel blocker like verapamil. The rationale for using that treatment is that it is used both for migraine and cluster headache prevention.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
yes I do have watery eyes and congestion. My eye lid is not really droopy but hard to say because if I put pressure over the eye it takes the pain down a notch. I figured the caffeine intake would be mentioned. Should I gradually reduce or cut it out cold turkey? I think my husband will prefer the gradual reduction. I was on verapamil years ago for migraines when my stress level was high and I was working graveyard, good to know that drug can be used again.
Brief Answer:
Read below
Detailed Answer:
Thank you for the additional information.
Since there are some autonomic signs (they do not necessarily have to be all there) then cluster or hemicranias continua are much more likely. They are similar in features of the acute pain, but cluster is usually pain free between episodes while in hemicranias continua there is some persisting pain. So if there is persisting pain between the episodes I would do the indomethacine test I mentioned before for hemicranias continua. If effective indomethacine is also the preventive treatment.
Otherwise as I said verapamil would be the preventive treatment I would try.
As for caffeine since you have been taking it in high quantities a gradual reduction would be better.
Let me know if I can further assist you.
Read below
Detailed Answer:
Thank you for the additional information.
Since there are some autonomic signs (they do not necessarily have to be all there) then cluster or hemicranias continua are much more likely. They are similar in features of the acute pain, but cluster is usually pain free between episodes while in hemicranias continua there is some persisting pain. So if there is persisting pain between the episodes I would do the indomethacine test I mentioned before for hemicranias continua. If effective indomethacine is also the preventive treatment.
Otherwise as I said verapamil would be the preventive treatment I would try.
As for caffeine since you have been taking it in high quantities a gradual reduction would be better.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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