Specialists for tension headache?

[ChomDo]

Hi,

 

I have a history of back and neck related problems. I've seen many specialists and orthopedic doctors in Bangkok, but the morning headache is something that was never addressed in detail and now it's the main thing bothering me everyday. I would like to get some advice on doctors that might be best for this kind of tension headache caused (presumably) by neck problems?

 

So basically the issue is that every morning I wake up with a banging headache and dizziness (clearly also associated to neck tightness and crunching sounds when I move my head). Normally it would disappear in less than 20 min after getting up. If it doesn't I take a 1-2 muscle relaxants (Norgesic) or 1 000 mg of Paracetamol and it would usually go away.

 

I have read about all of this and done stretches and tried different pillows etc. but that doesn't seem to help.

 

I have two very distinct observations that clearly make my morning headache appear more often and stronger:

 

- If I sleep less than 6 hours I hardly have any headache when I get up, but if I sleep more than 8 hours I always have a banging head and dizziness.

 

- When I start to do daily exercise such as gym and swimming the morning headache clearly gets worse.  

 

Is this all normal for headaches caused by neck tension? So if I sleep only for a couple of hours and do no exercise I would feel better, but that doesn't sound like healthy lifestyle. And the doctors that were treating my neck and back especially told me to exercise a lot, so I'm confused what I should do now.

 

Thanks!

 

  

[ChomDo]

Just refreshing the post, because it's too far down the list now for anyone to notice it.

 

Any replies would be appreciated.

[Sheryl]

Please specify what your history of neck/spine problems is exactly.

 

And is the headache on one side?

 

I ask because it could be a headache due to nerve impingement from the cervical spine and not a tension HA at all, in which case would need to be treat the underlying cause.

 

Is your BP normal?

 

And as far as you know, do you grind your teeth in your sleep? (A dentist would be able to tell) - morning headaches due to tooth grinding will respond the use of a night guard.

 

And have you ever had a sleep study? Morning HAs can be related to sleep apnea.

 

 

[ChomDo]

Thanks for your reply Sheryl,

 

To answer your questions quickly first:

 

- The headache is not only on one side. It's more of the kind of general tension and dizziness. Lets say that if I walk up the steps or tie my shoe laces it will give me a pounding effect in the head and dizzy feeling for a few seconds. Normally it would disappear in about 20 min. If I sleep long it might last a lot longer after getting up.

 

- My BP is usually normal at around 120/70.

 

- I haven't had a sleep study done, but my wife has observed my breathing at night and noticed nothing abnormal (I don't sleep well though, probably wake up at least 10 times per night). Neither have we noticed any teeth grinding.

 

The history of my problems below:

 

I have quite a curved spine (S shape) and have had back problems since I was about 20 years old (I'm 35 now). Started with continuous pain in the middle of the spine and under the left shoulder blade about 15 years ago (no injuries related to this). It was MRId a couple of times and they found only slight bulging of a disk there. After that I started getting more problems on the left side of my lower back (right above the hip). Both sitting and walking have been causing pain since. That was also MRId a few years ago and they didn't find anything enough to explain the pain I was feeling. So after meeting with many doctors and physiotherapists, I still didn't have much help for my problems. For about 5 yeas now I've been having problems with my neck (pain, stiffness and lots of crunching sounds). As all my other symptoms, the problems are on the left side. Then in 2015 I suddenly got an insane pain in my left arm. It was nearly like I had to just hold my arm up and scream. It was really intense and felt like my bones are breaking inside the arm. I thought it was the disk pushing the nerve but finally the specialist in Samitivej told me it was a trapped nerve not the disk. It took a few weeks to get better (during which I was prescribed codeine and Rivotril). According to all my symptoms from the past years the doctor suggested I might have Fibromyalgia. I believed it at first, but after reading more about it, I just didn't recognize myself from the description. That was two years ago and since then I've just tried to live with the back and neck problems (as many doctors told me to do). The specialist who treated my neck last time especially encouraged me to exercise a lot, but it's just contradicting because I clearly have more head tension and dizziness when I exercise daily (even from just swimming).  

 

Now that this is bothering me quite a lot again, I'm just trying to figure out if I should go see a doctor again or just let it be and try to live with it. I'm not sure if it's just the discomfort or could the morning headache and dizziness actually be harmful in the long run? Also, I would like to exercise a lot like I was advised to do but it seems to be making the symptoms worse.

 

       

[Sheryl]

Pain worsening with exercise is typical of fibromylagia...as is of course pain for which any other physical cause cannot be found, which I gather is the case for you.

 

You might fin dit worthwhile to consult a specialist in fibromylagia to see whether they think this is what you have:

Assoc. Prof. Dr. Pradit Prateepavanich at Siriraj Hospital pain clinic, he specializes in myofascial pain and is the author of what I think is the only Thai language textbook on fibromyalgia

 

http://www.siphhospital.com/th/splash

 

 

Otherwise if you want specifically specialists in headache:

 

1. Headache clinic at Bangkok Hospital    https://www.bangkokhospital.com/index.php/en/center-of-excellence/brain/brainclonic-5

 

2. Prof. Anan Srikiathachorn BNH Hospital Wednesdays 5-6 PM only. he is an Assoc Professor at Chulalonghorn (leading medical school) and heads up their headache clinic. https://www.bnhhospital.com/find-doctor/search-result/?dname=Anan Srikiatkhachorn

 

3. Assoc. Prof Nijasri Charnnarong Modays & Fridays Bumrungrad 4- 6 PM Same affiliation as Dr Anan above  https://www.bumrungrad.com/doctors/Nijasri-Charnnarong

 

 

[ChomDo]

Thanks again for your reply.

 

Actually when I exercise I feel great. I only notice that the next morning my headache will be worse. Maybe this is normal for my condition then. Also, I wonder is it common for Fibromyalgia to have no symptoms in the morning if I sleep less than 6 hours? There seems to be a huge difference between 6 and 8 hours of sleep. With 6 hours of sleep no headache and feeling fresh, but with 8 hours of sleep banging head, dizzy and sleepy.

 

I guess it would be a good idea to see a specialist in Fibromyalgia or headaches in general as you suggested. Of course I would only go to see the Fibromyalgia doctor if I'm sure that's what I have. It's just that right now the only symptom that affects my daily routines is the headache, so I would like to focus on treating that.

 

Just a few additional questions below:

 

- Can a neck tension relieve massage help for my morning headache? I have a neck massager machine but it has no effect. 

 

- What would be the correct/common kind of medication for these type of headaches? Of course I'm only talking about a preventive medication because I have the headache every single morning so I can't take pills juts when the symptoms occur.

 

Thanks!

[wgdanson]

Very interesting program on BBC Radio.https://www.bbc.co.uk/sounds/play/b00d0f3p

[Sheryl]

1 hour ago, ChomDo said:

Thanks again for your reply.

 

Actually when I exercise I feel great. I only notice that the next morning my headache will be worse. Maybe this is normal for my condition then. Also, I wonder is it common for Fibromyalgia to have no symptoms in the morning if I sleep less than 6 hours? There seems to be a huge difference between 6 and 8 hours of sleep. With 6 hours of sleep no headache and feeling fresh, but with 8 hours of sleep banging head, dizzy and sleepy.

 

I guess it would be a good idea to see a specialist in Fibromyalgia or headaches in general as you suggested. Of course I would only go to see the Fibromyalgia doctor if I'm sure that's what I have. It's just that right now the only symptom that affects my daily routines is the headache, so I would like to focus on treating that.

 

Just a few additional questions below:

 

- Can a neck tension relieve massage help for my morning headache? I have a neck massager machine but it has no effect. 

 

- What would be the correct/common kind of medication for these type of headaches? Of course I'm only talking about a preventive medication because I have the headache every single morning so I can't take pills juts when the symptoms occur.

 

Thanks!

It all depends on what is causing these headaches. Seems you have already tried massage without relief.

 

A sleep study will likely be advised.  that your wife does nto notice you having apnea does nto mean anything. She is presumably not awake the entire night watching your respiration. The combination of frequent awakening and morning headache are suggestive of a sleep disorder. If you have significant sleep apnea then CPAP rather than  medication might be the answer.

[ChomDo]

Well sure that's true I could still do a sleep study, but as I said when I have the morning headaches at the same time my neck is clearly having a lot of problems. Like these past few weeks my neck is also soar (mostly on the left side as usual), making a lot of crunching and clicking sounds when I move my head and for example when I twist my head fully to the left side I can feel a sharp pain from the left side of my neck all the way down to the middle of my back (kind of to left shoulder blade). I guess this all suggests that when my neck gets worse the headaches get worse too. If it's related to a sleep disorder then it would be quite a coincidence that headaches come at the same time with neck problems. 

[Sheryl]

Only thing I can suggest on that is to see a spinal specialist but you indicate you have already done so and nothing was found that would account for it.

 

if you want to try again, excellent spine specialist is:

 

Prof. Wicharn Yingsakmongkol

https://www.bnhhospital.com/find-doctor/search-result/?dname=wicharn

also at Bangkok Christian hospital once a week

https://www.bch.in.th/find-doctor/doctor-profile/?smid=4555

[ChomDo]

Thank you Sheryl. Yes I've had MRI's on my neck, upper back and lower back. Each spot had some slight bulging of a disk on the left side, but according to the doctors not enough to explain pain. That was one reason that the specialist in Samitivej suggested that I have Fibromyalgia. 

 

What I never understood about that diagnosis is that I've understood that people with Fibromyalgia experience morning headaches without any physical reason (I mean that their mind makes them feel pain). but in my case I have a soar stiff neck that makes a lot of crunching and clicking sounds, so it seems obvious that there is something really wrong there and not taht my brain is just sending pain signals for no clear reason. Does that make sense? Maybe I've misunderstood something.    

[Sheryl]

It is though that  fibromyalgia  is due to either hyperactivity/sensisitivity of sensory nerves or something in the manner the brain processes nerve impulses. In either case there is a physical reason. Physical and mental  are actually not independent .categories, mental states are inextricably linked to   physiological processes

 

Muscle stiffness is also a feature of the disease and could explain what you describe in your neck.

 

Fibromylagia is a diagnosis of exclusion. If I were you I would go ahead and see Dr. Wicharn first because  I have known him to identify problems such as bone spurs missed by other doctors.

 

If he finds nothing then I'd have a sleep study.

 

If that also turned up nothing (or if treating any sleep disorder failed to relive things) then I'd see the previously mentioned fibromylagia expert.
 

[ChomDo]

Thanks again for your advice! I'll proceed with one of your suggestions and see if I can get any solution on how to treat my condition.

[Sheryl]

One other thing just occurred to me given the association eith sleeping longer and the headaches: could be due to hypoglycemia. You can find out by testing your blood glucose when you first get up.

 

If so a high protein snack just before going to bed may help. Preferably with some fat content as that slows digestion. If you tend to get up in the middle of the night keep a glass of milk or soy milk by the bed and drink it. Avoid sweets/processed carbs at night as they can cause rebound drop in blood sugar after insuln spike.

 

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

 

 

 

 

[stud858]

I take tramadol for constant head pressure.  It works well,  but I'd only recommend it if you are on the border of insanity with pain, because once you start is hard to come off it.

Dangerous but powerful stuff.  

 

 

[ChomDo]

17 hours ago, Sheryl said:

One other thing just occurred to me given the association eith sleeping longer and the headaches: could be due to hypoglycemia. You can find out by testing your blood glucose when you first get up.

 

If so a high protein snack just before going to bed may help. Preferably with some fat content as that slows digestion. If you tend to get up in the middle of the night keep a glass of milk or soy milk by the bed and drink it. Avoid sweets/processed carbs at night as they can cause rebound drop in blood sugar after insuln spike.

 

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

 

 

 

 

OK I'll read about that. I do usually wake up very hungry (I guess this is quite normal) so I tend to have a bowl of oats (porridge with milk and raisins) about an hour before going to bed. 

[ChomDo]

17 hours ago, stud858 said:

I take tramadol for constant head pressure.  It works well,  but I'd only recommend it if you are on the border of insanity with pain, because once you start is hard to come off it.

Dangerous but powerful stuff.  

 

 

I've been taking Tramadol occasionally for my back and neck pains. I know it's a dangerous medicine to take too often because it makes me feel "good" all day. If my morning headache doesn't disappear, I usually would just take 2 tablets of Norgesic or 1000 mg of Paracetamol. Both seem to work, but I try not to have to take those more than once a week. 

[Sheryl]

4 hours ago, ChomDo said:

OK I'll read about that. I do usually wake up very hungry (I guess this is quite normal) so I tend to have a bowl of oats (porridge with milk and raisins) about an hour before going to bed. 

Combination of headache and feeling very hungry in awakening could indeed point to hypoglycemia.

 

What do you eat and drink i nthe evenings?  Alcohol in particular will lower your blood sugar.

 

You might try a more substantial high protein meal close to bedtime and avoid sugars (including alcohol) at night and see if that helps.

[ChomDo]

2 hours ago, Sheryl said:

Combination of headache and feeling very hungry in awakening could indeed point to hypoglycemia.

 

What do you eat and drink i nthe evenings?  Alcohol in particular will lower your blood sugar.

 

You might try a more substantial high protein meal close to bedtime and avoid sugars (including alcohol) at night and see if that helps.

In the evening I mainly eat porridge or a regular meal. I eat very healthy and I stopped drinking alcohol many years ago. I've always had a fast metabolism (at least I get hungry very often/ have to eat frequently) and never gained wait, so I guess naturally I'm quite hungry when I get up. Usually when I eat a bowl of porridge some time before bed, I don't feel that hungry when I get up but still have the banging head.

 

Anyway, I will try what you suggested. I could for sure add some protein to my evening meals. I've been trying to eat porridge before bed time because I read that it's the best thing you can eat for the night.

[stud858]

1 hour ago, ChomDo said:

In the evening I mainly eat porridge or a regular meal. I eat very healthy and I stopped drinking alcohol many years ago. I've always had a fast metabolism (at least I get hungry very often/ have to eat frequently) and never gained wait, so I guess naturally I'm quite hungry when I get up. Usually when I eat a bowl of porridge some time before bed, I don't feel that hungry when I get up but still have the banging head.

 

Anyway, I will try what you suggested. I could for sure add some protein to my evening meals. I've been trying to eat porridge before bed time because I read that it's the best thing you can eat for the night.

I've come to the conclusion by trying,  that removing carb foods such as bread pasta cereals helps with my ailments a lot.

I recommend a deep ketosis diet and fasting. There is an associated difficulty with ketosis but with discipline it gets easier. 

[ChomDo]

11 hours ago, stud858 said:

I've come to the conclusion by trying,  that removing carb foods such as bread pasta cereals helps with my ailments a lot.

I recommend a deep ketosis diet and fasting. There is an associated difficulty with ketosis but with discipline it gets easier. 

Thanks for the hint Stud. I could look into that too. I do eat very healthy and I've been fit all my life. I'm not sure if going on a low carb diet would be good for me since I wouldn't want to lose any weight. I have tried to cut most sugars off my diet and the carbs I do eat are mainly from oats, rice and pasta.

 

Anyway, I would like to emphasize that at least it seems very clear that my symptoms are caused by my neck. Of course there could be other factors, but like I said earlier it would seem like quite a coincidence that my neck is soar, stiff, crunchy and squeaky at the same time as I get most of the morning headaches. At least that makes it seem like the headache is directly related to the neck symptoms.

[stud858]

I think the strongest of people I know use the power of distraction very well.

A guy I know looks so unwell,  yet he works a hard day. He keeps his mind ticking over. You could kick him in the nuts and he wouldn't feel a thing. 

I use music a lot for distraction. Good headphones and psy trance. Quite the opposite of the meditation technique of  focusing on discomforts. I tried that but found the power of distraction better for me. 

Which works for you?

Ignoring the pain until it fades or focusing on it until it fades?

[ChomDo]

17 hours ago, stud858 said:

I think the strongest of people I know use the power of distraction very well.

A guy I know looks so unwell,  yet he works a hard day. He keeps his mind ticking over. You could kick him in the nuts and he wouldn't feel a thing. 

I use music a lot for distraction. Good headphones and psy trance. Quite the opposite of the meditation technique of  focusing on discomforts. I tried that but found the power of distraction better for me. 

Which works for you?

Ignoring the pain until it fades or focusing on it until it fades?

Sure, that works well too. Two years ago when I had a trapped nerve in my neck and my arm felt like the bones are breaking inside, I used to lie on the yoga mat and listen to music for relaxation. I guess meditation would be great too, but still didn't put the effort into it (would like to in the future tho). 

[faraday]

On the subject of relaxation for, in this instance headache, my wife has had many similar symptoms.

 

Apart from getting an MRI done to rule out any gross pathological changes, she uses Lavender oil to help her relax. It helps her a little, & I find it great for relaxation.

 

Botannic Essence in BKK, sell alot of good quality oils.

[stud858]

There is another distracting thing that works well for me. It's a bit bizzare. 

You can listen to a podcast called sleep with me. On YouTube.

A guy talks absolute nonsense to bore you into relaxation.

I find it interesting but in a boring sort of way. Give it a try.