Question: Hi, I am a 30 years old unmarried woman. I have had a history of all kinds of headaches since I was 15 and studying in schools.Presently I frequently feel mild tension/vascular headache, some time low grade fever (99F) and fatique across the body while working (esp on stressful days) that goes away only with paracetamol. I was advised by a doctor to take PCM as soon as I feel like getting a headache as it helps circulate blood in my head. He had also prescribed some daily medicine (that I don't remember) in order to avoid headache situation. I took that medicine for 3 months five years ago. It had depression as one of the side effects. Past History of headaches: My headache was more associated with the stress attached to studies, the non-stop ones I used do despite killer headaches. (I have been excellent in my studies all through; I am an Engineer and MBA from IIM). I thought headaches were normal as I didn't remember a time when I studied without it. I had unconsciously developed techniques of studying during headache like pinching gums, neck or cheeks so that pain and pressure transfered to that part from head. I don't remember writing a single engineering semester exam without excruciating pain in my head. It happened only during exams and I felt it the most while trying to study. Once I remember it came with an aura - dizziness for 3 days and then headache for a week. It felt like burning sensation in my scalp and as if my head was going to explode if I tried to study or look at computer screen. It didn't bother me much in regular chores. Sumatriptan helped a little but then I was advised to stop the medicine. Having known my condition I got extremely worried abt MBA at IIM Bangalore which is one of the most rigorous program. Then I visited a neuro specialist in Command Hospital. He suggested PCM and some daily medicine. This helped but now I have to take PCM every other day which is not healthy either. Now, this headache has reduced my efficiency and gets me stressed out in no time. I feel drowsy the who day with reduced efficiency. I find it hard to focus on my work and sometime resort to my older ways of pinching gums and cheeks. I generally sleep pretty well. I have always been a very deep sleeper with no interruptions thru the night (touchwood), so sleep is not an issue. Kindly suggest what is it about the frequent headaches, fatique and the need to take PCM almost every other day. How do I get rid of it. Thanks,XXXX

Dear Dr. XXXXXXX Thanks for your response. I would like to add that my present symptoms are quite in silent form. (vascular headache triggered by stress). I feel a clear tension / pull in my head, frequent yawning suggesting insufficient oxygen supply in head , lightheaded & fatigue but not always a sense of physical pain. I recognize an impending headache with an increase in my yawning frequency. It feels like stress has seeped into my entire body and needs to be squeezed out. Focusing on work feels like a lot of pressure on head. It goes away only with PCM. Relaxation and rest doesn't help much. It reduces my efficiency and requires more sleep. This pattern started since 2006 when I started working and is markedly different from the pattern I faced during school / college days. During school / college days, there was very dramatic change in stress levels peaking during exam times when most of the headaches (physical pain) were experienced. It was accompanied by aura sometimes and needed medication or pinching on gums & cheeks. Now, since I started working in 2005 (except IIM days in 2008-10), the headache pattern changed following the change in stress pattern which was more spread out across days. There are minor peaks in stress during deadlines only. The headaches now are mild and more in silent form but very frequent requiring me to take PCM very frequently. I sometime suspect silent headaches when there is no physical pain but extreme fatigue, excessive yawning and mile body ache. At times It feels extremely difficult to wake up in the morning and it doesn't feel fresh even after getting 7-8 hours of good sleep. It goes on for days at a stretch. Can it be silent migraine? I havent taken Sumatriptan since 2004. With this information, would you hold on to your earlier prescription? If yes, how should I take it (once daily)? Are there any side effects like depression? Is there any alternative medicine / methods available to deal with the situation? Thanks, XXXX

Thank you very much Dr XXXXXXX I will follow your prescription and get back after a month. I would have visited you in Hyderabad itself but I left Hyd just a year ago. I will get back to you on internet itself. Unfortunately, it is very hard for me to work on my stress levels considering the kind of work I am doing in a state like UP (voluntarily though). You may know Dr. P Nagabhushan XXXXXXX famous Pediatric Neurologist in Hyderabad whom we have engaged in UP / Bihar to help in Encephalitis cases in children. I am working with UP govt. on development issues. It's important that I am able to give my 200% and not get bogged down by migraine sort of stuff. Thank you for your recommendation. I will get back to you as suggested. Regards, XXXX