What is the treatment for severe headache?

Question

Hi doctor,

I have been suffering from severe headaches either on the right back side of the head or the center back of the head. Pain starts on the right side of the lower back. It radiates to the leg and foot (joint pain), comes up to the arm and shoulder, then goes to the other side of the body, left shoulder, and then leg and foot. It is like a pain attack that lasts for an hour or so. After that, I have muscle weakness and limb tingling, which might be the arm, leg, feet, or shoulder. I have also had,

Burning pain in fingers and toes all the time.
Ankles and wrists hurt most of the time.
Chronic headache.
Jaw cracking in the morning.
Muscle stiffness and tingling feeling on legs, arms, and shoulders.
Normal brain MRI, but there is a minor disc bulge on the cervical spine.

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

What is your occupation, and is there exposure to toxins or chemicals? How are your mood and sleep? Do you have laboratory tests for inflammation, such as ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein)? How is your blood sugar and complete blood count? Do you get nerve conduction tests? If the above tests have no results, please undergo these tests. Regarding symptomatic relief, you can take Pregabalin 75 mg at night and Amitriptyline in the morning, as tolerated. It would be great to update me or your attending physician regarding your response to treatment.

I hope this information will help you.

Thanks.

Answer 2

Hi,

Welcome back to icliniq.com.

I understand your concern.

Small fiber neuropathy is one differential. EMG (electromyography) NCV (nerve conduction velocity) cannot detect it. It presents with a burning sensation in the legs and feet but not a headache. Do you have a cervical MRI (magnetic resonance imaging)? The location at the back of the head is cervical nerve territory. Kindly do a cervical MRI. What is your occupation? What other medications are you taking? I will be exploring your mood symptoms. How have you been lately regarding your mood? Do you feel anxious all the time? How is sleep? I suggest you take Amitriptyline 25 mg once a day at night. It can alleviate pain by centrally acting mechanisms. Please do have a follow-up regarding the response to treatment.

I hope this information will help you.

Thanks.