Severe Headaches

[xiado]

I know a woman in Chiang Mai who frequently has severe headaches. She visits clinics where doctors bombard her with all kind of painkillers. It is unclear what the cause is, maybe it has to do with her menstruation, maybe it's also partly a mental problem.

Although she's not stupid at all, she's had no formal education in her country of birth which is Myanmar. In Chiang Mai she works, like many other people from Myanmar for a small salary, the kind of money which never fails to amaze me.

I would like to help her. I wonder : are there any doctors in Chiang Mai who could have a thorough view on her situation and who can be recommended ?

[Drew Aitch]

Hi Xiado

I can fully sympathise with anyone who gets regular headaches. I had migraines as a child, and plenty of them. The doc said i would probably grow out of them, and i did for the best part with maybe just the odd one reoccurring every few years. However, migraines were replaced by the most awful dull to sharp headaches that always appear in the same place. I've had an average of 2 a week for decades, and no analysis has been able to identify any pattern or root course. They always appear around the right eye entire eye area and expand to the back of the neck on the same side.

3 to 4 500mg of paracetamol used to work, as did the same amount of co-proxomol and other over-the-shelf pain killers, but for the past couple of years these proved next to useless and i just had to wait them out. Constant headaches can make anyone short tempered, debilitated, fed-up, and unproductive, to say the least.

HERE'S THE GOOD NEWS

About 8 months ago, a chemist got me to try 2 different tablets, and up until this day, i still get the headaches, but they are gone anywhere between 45 minutes to an hour with this combination of medication. They might work for your friend too. I take one of each every time the onset of a headache kicks in.

One tablet is called Ponstan 500 ( non-steroidal anti-inflammatory) I believe there are generics too.

The other is called Mydocalm (a muscle relaxant)

Both of the above can be bought over the counter, and they have been a miracle cure for me. Hope they work as well for others who suffer from headaches where pain killers are no longer working.

As with all medications (even those over the counter), it is always wise to consult a medical professional before trying something new.

Good luck

Aitch

[Mario2008]

They are not a cure, only a relief from the symptoms. Prolonged use often leads to dependency, so that if you don't take the medication anymore you will get the symptoms back because the body is used to having painkillers.

It is always better to try and find a cause, as the OP seems to suggest.

[Mahseer]

Cafergot is another tablet that may be of help but would recommend visiting the young neurologist at Chiang Mai Ram first and try and get a correct diagnoses. I can't recall his name but if it's of any help he is from Phetchabun and he's there most mornings. I paid 400baht for the consultation but do what you can to just get a prescription and buy elsewhere as it's common knowledge that CMR mark up on meds is heavy.

Good luck.

[eek]

xiado, is she taking the pill (contraceptive pill)? Im predisposed to severe headaches and migraines. I have to be careful with any medication, and in particular the pill. Last year the pill that i was on aggravated my migraine to such an extent that i ended up being taking to accident and emergency. If she has a history of headaches/migraines any medication that she is taking may trigger episodes...the pill is the usual bad culprit. If you know her well enough (or get a female friend to ask her if possible), ask what medication she is taking aside from the pain medication, including any contraceptive pills.

Edited January 25, 2010 by eek

[PMNL]

Does the pain come just before/ around her period?

What is the character of the headache? Throbbing at one side of her head?

If she has all the symptoms, the most likely diagnosis would be migraine.

Does she has any neurological problem? blurred vision? double vision?vomit when severe pain/projectile vomitting?

If so, it is serious and should be evaluated bythe neurologist/neuro-surgeon.

I would recommend that you take her to any local clinic/hospital to seek professional medical advise before starting any medication.

[NancyL]

Here's another obscure cause for migraine headaches -- having a fairly common congentital heart defect called an patent foramen ovale, a small hole between the upper chambers of the heart. According to Wikipedia, up to 25% of the population can have this defect and those people are twice as likely to suffer from migranes (the "classic" ones with visual auras prior to onset). I know several people who had migranes, had doctors that found they have PFOs, had them fixed and the headaches disappeared. It's a fairly common cardiac procedure that can be done non-invasively now.

I would imagine this surgery could be done in Chiang Mai. Certainly it can be done in Bangkok.

[Mario2008]

If OP wishes, this thread can be moved to the health forum.

[xiado]

Thanks all posters for all the useful advice !

Eek : no, she's not taking the pill.

PMNL : Yes, she told me that she sometimes vomits during these pain attacks. What could this mean in your opinion ?

[Drew Aitch]

It is always better to try and find a cause, as the OP seems to suggest.

Sadly, headaches are sometimes as difficult to detect as certain back complaints and other latent ills, meaning that all the diagnostic tests and treatments may never result in a long term fix. My advice on headaches is the same as it is on any medical condition and that is; NEVER take advice from people who have not experienced whatever it is you're suffering from. Well meaning they might be, but not really the sorts of folks that anyone should be following directions from. Especially avoid those; 'A friend of mine use to blah blah blah blah', or worse still, 'A friend's friend tried ....'.

Aitch

[xen]

Xiado,

If she is vomiting when she experiences headache then it will be migraine. There are quite a few different types of migraine and causes. I suffer from a one of the least common types generally called week-end migraines when it is usual i will get a migraine on a week-end when i begin to relax after a stressful working week. I went to a specialist who perscribed caffagot which is a high caffine dosage and my migraines respond to them altho a lot of people with migraines don't. It can be bought over the counter here in Thailand.

Also i have a yeast intolerance which can also trigger migraines - beer, yeast extract spreads and bread all increase the incidence of migraine for me so it may be she needs to keep a dairy and work out what triggers her migraines. It can be yeast from bread, beer or other common trigers are chocolate, oranges, etc.

Another very common trigger is MSG which, as you know , is in almost every Thai meal. I have read on other posts that some TV members doubt the negative effects of MSG but you could get her to restrain from using MSG (it won't hurt her if she does not use it) and see if that helps.

Hope this helps but i would also advise she sees a migraine specialist as well .

[philliphn]

It is key to get a correct diagnosis! Without this it is impossible to treat.

It could be a brain tumor, highblood pressure, narrowing arteries. These are just a few possibilities..................

[philliphn]

It is key to get a correct diagnosis! Without this it is impossible to treat.

It could be a brain tumor, highblood pressure, narrowing arteries. These are just a few possibilities..................

[xiado]

Xiado,

Hope this helps but i would also advise she sees a migraine specialist as well .

Do you know a migraine specialist in Chiang Mai ?

[xen]

I don't know of any but perhaps a Chaing Mai member may be able to help. Also what philliphn said is right, there are many other possibilities to the cause of migraines.

[noise]

Xiado,

Hope this helps but i would also advise she sees a migraine specialist as well .

Do you know a migraine specialist in Chiang Mai ?

Dr Piset at Sripat: a head ache specialist (layman term). Seems to regularly get special training in the U.S. on head aches. Treated my MIL. Typical doctor; started off being brusque by our standards, uncommunicative at first. But once I started tactfully questioning him, showed a modicum of knowledge about medical terms, and returning on every visit, he opened up and started explaining the rationale for what he was doing.

Call Sripat and you can make an appointment for evenings or weekends when it is not so crowded (that is what we do).

[BlueSmurf]

Headaches can be terrible as i found out 7 years ago..I was worried i had a tumour and put off going the the doctor but when I went he suggerted I hada head x-ray..I had blocked sinuses.Relief or what but the headaches included blinding eye pain.i could not go out in the daylight or watch tv..A course of anti=biotics sortd it and to this day when I get a cold I'am very careful .If I feel any pain back on the pills. my point is get a x=ray..Good luck Dave

[ManilaLover]

Hello,

I suggest consult a doctor at Munkala Chinese Clinic at Ratsjamanka street (the other end of soi 2 that starts at Johns Place at Moonmuang)

Very good doctors there, they often have a better vision on the situation of the patient that regular doctors who just send you away with a large bag of drugs that make you even feel worse and often not cure the problem.

Very good stories from Munkala.

Phone 053-278494

[PMNL]

Thanks all posters for all the useful advice !

Eek : no, she's not taking the pill.

PMNL : Yes, she told me that she sometimes vomits during these pain attacks. What could this mean in your opinion ?

It could be migraine as the other poster said but it could be something more serious than that such as intracranial mass/brain tumor.

You need to get the doctor to exam and see if she has any neurological defect e.g. double vsion, abnormal eye movement, if there is not it is most likely to be migraine in my opinion.

[Chicog]

I would think she'll need a scan (MRI, CAT, PET, can't remember which is which) to rule out things like aneurism and tumour.

After that it's anybody's guess. Most of the quacks here will just prescribe her a big bag of coloured sweets and send her on her way.

I think what you need is a referral to a Neurologist.

[xiado]

Thanks again to all posters !

"noise" : Are you sure his name is "Dr. Piset" or does this have to do with the fact that he's a "special doctor", although the Thai word for a specialist is different, as far as I know ?

"PMNL" : She doesn't have double vision and the like.

She also told me that he pain attacks are less severe if she does exercises.

[tomahawk]

Don't know if this is helpful, but I also used to get severe headaches. Went to doctor, who told me it was probably from high blood pressure. Recommended I not eat at restaurants, which I used to do all the time. I also noticed headaches worse after eating. I started eating only home cooked meals without salt or MSG and headaches stopped. Blood pressure lower also, but due also to fact I lost 20 kilos , exercise regualrly and take medication. However, I would suggest maybe just having her limit intake of salt and MSG and see if that helps.

[Mahseer]

Xiado, get the young lady to a neurologist. I told you of one in CM Ram early on in this thread that you don't need a referral for and the consultation cost is minimal. Apologies for not recalling his name but 2 minutes on the phone will identify him. He is in the special clinic on floor 4. Make an appointment.

No need to reply.

[Puwa]

She may also want to visit an allergy clinic to see if a food is the problem. MSG is one possibility, and severe headaches are a common symptom of sensitivity to MSG. But the good news is that, with some determination, it is relatively easy to cut out of the diet.

[xiado]

Xiado, get the young lady to a neurologist. I told you of one in CM Ram early on in this thread that you don't need a referral for and the consultation cost is minimal. Apologies for not recalling his name but 2 minutes on the phone will identify him. He is in the special clinic on floor 4. Make an appointment.

No need to reply.

Sorry for replying, but actually I wanted another Thai Visa member to reply, named "noise".

Thanks anyway.

[chiangmaibruce]

Well this has been a quite interesting thread ... esp. as I also tend to get quite a number of them when staying in Thailand ... a few comments:

1. Quite a few workers get exposed to chemicals during the course of their work in Thailand (and of course nil protective clothing). You might want to ask this lady if she uses any liquids that smell, etc etc ... this might be cause

2. Interesting to see the mention of caffeine. I only learnt quite recently that coffee taken in conjunction with your normal analgesics (e.g. paracetamol, aspirin, etc) dramatically increase the speed at which they are absorbed and their effectiveness (in fact I think the figure of 47% comes to mind in terms of increased efficiency after 100 miligrams of caffeine ...anyway something like that)

3. I always put down my increased headache frequency in Thailand down to heat/humidity ... with dogs, chooks & tuk-tuks in 2nd place ... funny it was MSG!! after all this time. Will definitely trial this on my return

[Mahseer]

As one who suffers from migraine I was surprised that I wasn't more aware of the MSG link.

Thanks for mentioning folks.

[lukeskywalker]

I'm sure this is not the OPs answer but dehydration causes severe headaches. I learned this the hard way when I first moved to Thailand (Koh Samui where it is very hot and very humid), even mild dehydration can bring on a severe headache. (in my case at least).

the first thing I do when I feel a headache come on is down as much water as I can. Of course, I drink a lot of water during the day so that the headaches never have a chance (so I don't get dehydrated in the first place).

[noise]

Xiado, get the young lady to a neurologist. I told you of one in CM Ram early on in this thread that you don't need a referral for and the consultation cost is minimal. Apologies for not recalling his name but 2 minutes on the phone will identify him. He is in the special clinic on floor 4. Make an appointment.

No need to reply.

Sorry for replying, but actually I wanted another Thai Visa member to reply, named "noise".

Thanks anyway.

I got tied up and did not check this thread yesterday.

อ. ผิเศษ

His name, Ajarn (CMU teaching professor) Piset confused me at first, also. I thought his position was being described at first instead of being told his name.

His schedule from the latest print out I have is:

Mon - Fri 5 pm to 8 pm; Sat - Sun 9 am - 12 pm 9th floor, Sripat. Call center (appts): 053-946900-1 9th floor clinic: 053-946909-10

That is what it says, 7 days a week (on top of teaching) in the clinic, No wonder he starts off fairly brusque.

One thing to add: I have taken my MIL to private ortho clinics for her knee replacement and it was pretty primative by my standards. But Sripat has all the records on the computer and every time we go in to follow up with Dr./Ajarn Piset, he calls up and reviews the complete record going back close to a year.