Am I dying or what?
February 8, 2012 3:47 PM   Subscribe

How do you know when to seek medical attention for persistent headaches?

I've had a headache for the last two weeks (at least).

At first I thought I must be dehydrated due to the dry winter air, so I made sure to drink extra water. The headaches did not go away.

Then I thought it must be because I'm drinking more caffeine then usual, so I went back down to my usual one cup a day (from, like, maybe two cups per or a cup and a couple diet cokes). The headaches did not go away, even after waiting a week or so for any residual caffeine withdrawal effects to die down.

Then I thought it must be because I'm not getting enough sleep, so I made sure to get eight hours a night if at all possible. The headaches did not go away.

Now it's been a few weeks, and I'm starting to get worried. It's a "front of the head" sort of headache. Most of the time it's relatively mild, but other times it can be difficult to gather my thoughts. A few times I've been in so much pain I felt nauseated. Sometimes I feel a little tongue-tied, but I'm not aphasic or anything as far as I know. I don't see auras and am not oversensitive to light or sound. It tends to kick in during the afternoon (hence why at first I thought it was caffeine related). Advil helps, but it feels wrong to just take an advil every day for weeks on end.

I'm fairly sure this is being caused by stress. I'm at the end of a particularly burnout-inducing job that has involved 14 hour days sitting at a desk under fluorescent lights with no breaks, almost no ability to get up and walk around, in a bullpen office where I tend to be on a hair-trigger due to unpleasant coworkers. So, y'know, chronic headaches would be par for the course.

The only reason I'm concerned about it is that, after said job is over next week, I'm going on vacation to Istanbul. I don't really want to have an aneurism on a 10 hour trans-atlantic flight, or suddenly start having scary neuro problems in Turkey. Also, I don't have health insurance. (Yes, after I get back from my vacation, if this is still a thing, I plan to see a doctor anyhow.)

I'm not allergic to anything, not prone to migraines, don't have any substance abuse problems, etc etc etc. I'm a pretty healthy person, on the whole. The headache has been going on long enough that it's probably not menstrual cycle related.

Tell me, mefites: am I gonna live?
posted by Sara C. to Health & Fitness (27 answers total) 3 users marked this as a favorite
Best answer: You'll probably live. However. This is your head and there's no realm wherein "persistent two week long headache with no immediate underlying cause" is normal. You absolutely should get this checked out before it becomes a potentially *worse* problem either on a trans-Atlantic flight or in a foreign country.

I understand how much the "no insurance" part of this sucks. Oh, boy. It sucks so hard. Still. It's your head. You probably want to keep it. Make an appointment with your PCP if you have one, or go to an urgent care if you don't. A lot of clinics have sliding scales for patients without insurance - check around in your area and see if you can find one. Regardless of your own religious affiliation, a lot of Catholic hospitals have reduced fees and/or payment plans for patients based on income level. I've gone to one for minor infections when I didn't have insurance and got excellent care.
posted by sonika at 3:51 PM on February 8, 2012 [1 favorite]

The fluorescents, honestly, have a bigger impact than you think. When I quit my "normal" office-based job I saw a MASSIVE decrease in the kinds of headaches you're describing. And I was getting the kinds of migraines that actually make you turn funny colors (grey, in my case) on top of the "regular" headaches...

I chalk it up to shitty office environment and stress. If you were going to pop an aneurysm, it probably would have happened by now -- those typically sneak up on you, they aren't persistent forever and then pow!

As a fellow headache sufferer, I feel for you, but I think it's probably cumulative stress and bad office environment taking its toll.

Now -- if they're persisting after you have a nice relaxing vacation -- THEN I might worry. But for the moment, just try to maintain the schedule/lifestyle improvements you've made in terms of hydration and sleep, and carry on. Also -- and I know it sounds crazy, but I know people this has helped -- you might want to cut out or cut down on gluten-y things. I have friends who went misdiagnosed with gluten allergies/celiac/etc for AGES because their symptoms were all over the place, not gastrointestinal. So watch your diet, too, not just your caffeine intake. Good luck!
posted by at 3:53 PM on February 8, 2012

Could it be possible that you need glasses? I had a headache in my forehead (directly surrounding my optic nerves) for four months and what solved it was new prescription glasses. I finally figured it out because it would be fine when I woke up but get steadily worse into the afternoon as my eyes wore out trying to focus.
posted by stellaluna at 3:56 PM on February 8, 2012 [6 favorites]

Have you checked your blood pressure lately? Daily headaches are almost always a symptom of high blood pressure. It's free to go get checked at almost any pharmacy with a machine.

Have you had your eyes checked lately? You may not realize that your eyes are strained and that can also cause headaches.
posted by HeyAllie at 3:57 PM on February 8, 2012

Does it get better over the weekend when you get better sleep and are away from the stressful office?

The "so painful you are nauseated" aspect of this would have me thinking doctor, myself.
posted by LobsterMitten at 4:05 PM on February 8, 2012 [1 favorite]

Yes, definitely get your blood pressure checked. I've just been through this - including nausea - and tried everything, speculated on every possible thing that could be wrong - neck, back, cafeine, chemicals in my house, menstruation, tumours, allergies, rest, etc etc. A routine blood pressure check showed what the problem was and now I'm on medication which has definitely helped with headaches.
posted by honey-barbara at 4:12 PM on February 8, 2012

Response by poster: Gluten: I've been carbing it up my whole life to no ill effect. However, I work on a TV show and the end of the job = the end of this season of the show. There's been a lot of celebrating in the form of cupcakes, epic dessert table at catering, the Wafels & Dinges truck coming for a visit, and the like. I've definitely been eating more sugary refined crap lately.

Eyes: Hm, good point. Definitely scheduling an eye checkup when I get back from my vacation.

Blood Pressure: Another good point. I had mine taken over the holidays and it was 130 over 80, which is borderline. I've been trying to cut the sodium ever since, though it's hard because my work* means that I eat a lot of takeout and processed foods.

*I'm aware that my job has a lot of these sorts of low-stakes health hazards (stress, bad eating, eyestrain). It's outside the scope of this question, but I'm working on some long terms solutions to this.
posted by Sara C. at 4:13 PM on February 8, 2012

I would get checked out by an eye doctor or your GP. It could be something fairly innocuous, like grinding your teeth. For me, it was eyestrain. I used to get headaches often, and my eye doctor recommended trying to take 10-15 min breaks from looking at my computer screen every 2 hours, so now I take a walk in the afternoon (besides my usual lunch break). I've also heard others taking 2 minute breaks every 15-30 min or so. The doctor also suggested I find hobbies to do in the evening that didn't involve looking at screens and close up work (I've started to cook more). This has helped me immensely. It was a pretty easy adjustment to make -- maybe you could try it?
posted by bluefly at 4:15 PM on February 8, 2012

If you've been taking Advil every day, switch to a different pain reliever to lessen the impact of rebound headaches.
posted by Sweetie Darling at 4:19 PM on February 8, 2012 [3 favorites]

It's possible that you're having rebound headaches.

As to when you should see a doctor about headaches, well, one reasonable answer is "when you're worried by them." Of course, unless the headaches are symptoms of something very scary (brain tumor etc.) there's rarely a lot the doctors can do. FWIW (which may not be much) my sister had persistent recurrent headache that sounds a lot like what you have and found that she could treat it with half a Seldane (terfenadine--an antihistamine) once a day. It might be worth a try.
posted by yoink at 4:20 PM on February 8, 2012

Do you have a new computer, or new computer monitor? Check the refresh rate. It can make a huge difference.
posted by NotMyselfRightNow at 4:54 PM on February 8, 2012

About a week ago.
posted by thelonius at 5:06 PM on February 8, 2012

Best answer: Likely a combination of stress and staring at a computer screen. I got something similar when I took a computer science class in college: after regularly putting in several long hours troubleshooting my sloppy student code, I kept getting totally bizarre might-be-a-tumor headaches. Does it go away when you leave work?

Also, is there a lot of noise in your office? You may not be consciously bothered by it, but it can contribute to the stress. Simply Noise is a godsend.
posted by Metroid Baby at 5:32 PM on February 8, 2012

Headaches are not normal. Chronic headaches should be checked out by a doc. Especially new onset chronic migraines.
posted by brevator at 5:50 PM on February 8, 2012

Err, I meant new onset chronic headaches, not migraines. My bad.
posted by brevator at 5:52 PM on February 8, 2012

Best answer: This happened to me about 10 years ago. I had great medical care at the time, got scanned, had chats & tests with a neurologist, etc. They never figured out what the cause was, and I'm still alive & kicking. (Headaches are mysterious phenomena of the sort technoscience is poorly designed to understand, says Oliver Sacks in an oddly lovely book on the topic.) After a while my GP happened to also get headaches, so she started doing some serious research. What she passed on to me:

(i) rebound headaches are indeed a much stronger, more common effect than is generally publicized. She had me go cold turkey for three weeks to see what happened. It did help, but not enough. Don't feel obliged to try this on your vacation.

(ii) clinical evidence says the best treatment is acupuncture. (I've never heard this anywhere else, but I pass it on for what it's worth. It does make some sense -- the neurologist I talked to had a theory about brain electrical activity.) The bad news is acupuncture isn't usually covered by insurance. The good news is you don't have insurance, so you don't care!

(iii) second-best, which is super-cheap: tricyclic antidepressants, in very low doses. E.g. 25 mg amitriptyline, taken at bedtime every night.

By the way, another thing science doesn't really understand too well is the alleged distinction between migraines and other kinds of headaches. Nothing you've said rules out migraine. So if feasible (maybe not on your job or on holiday), you might try avoiding tyramine. It's found in an annoying number of my favorite foods, but I find I can get by if I steer away from:
-aged hard cheeses (stuff like supermarket cheddar is fine)
-aged red wine (stuff like supermarket merlot is fine)
-cured meat like salami (also avoid msg)
I eat all this stuff sometimes, because it's worth it. Except walnuts. The payoff ratio for walnuts is just too steep.

Bottom line: I'm not a doctor and I don't know whether your risk having a brain tumor is bigger than your risk of getting hit by a bus in Istanbul. But given the headache-factors of your job (junk food, stress, hours), I'd lay good odds that you are not about to drop dead.
posted by feral_goldfish at 6:01 PM on February 8, 2012

Dittoing rebound headaches. Ibuprofen is particularly pernicious for creating this phenomenon. Naproxen is a good alternative.
posted by altopower at 6:31 PM on February 8, 2012

How about a sinus headache? Your sinuses are in the front of your head. That's where I hurt, when I'm having an allergy/sinus flare-up.

I would try taking a hard-core decongestant to see if that helps. Are you running a fever? (Have you checked?)

Similarly, if you can cadge a few OTC allergy pills (Claritin or Allegra), it's worth taking them for a few days to see if that helps.

You mention they happen late in the day. I have an "I'm stressed out and working hard" expression where I kind of scrunch my entire face towards the bridge of my nose. This gives me a terrible headache if I do it long enough.

If you make a goofy-ass face, open your eyes and your mouth as wide as you can, does that make it feel any better?

Two weeks of chronic mystery headaches definitely warrants a trip to the doctor. Sorry.
posted by ErikaB at 7:22 PM on February 8, 2012

Best answer: Have you considered getting a massage? You can usually find a place that will be pretty affordable with a first-time customer discount. When I get stress-related headaches that go on and on, it's because I carry that stress in my neck and shoulders. I've learned to pay attention to it throughout the day now, and if my shoulders are creeping toward my ears I take a deep breath and relax them back down. But a massage can do wonders to ease up the ongoing muscle tension that contributes to those stress headaches.

But honestly, if a headache is ever bad enough to cause nausea (and it's not an obvious migraine symptom that you've had before), you should probably go to the doctor, like now.
posted by vytae at 7:38 PM on February 8, 2012

MedlinePlus from the National Library of Medicine (part of the National Institutes of Health) says:
Take the following symptoms seriously. If you cannot see your health care provider right away, go to the emergency room or call 911 if:
  • This is the first headache you have ever had in your life and it interferes with your daily activities
  • Your headache comes on suddenly and is explosive or violent
  • You would describe your headache as "your worst ever," even if you regularly get headaches
  • You also have slurred speech, a change in vision, problems moving your arms or legs, loss of balance, confusion, or memory loss with your headache
  • Your headache gets worse over a 24-hour period
  • You also have fever, stiff neck, nausea, and vomiting with your headache
  • Your headache occurs with a head injury
  • Your headache is severe and just in one eye, with redness in that eye
  • You are over age 50 and your headaches just began, especially if you also have vision problems and pain while chewing
  • You have cancer and develop a new headache
See your health care provider soon if:
  • Your headaches wake you up from sleep
  • A headache lasts more than a few days
  • Headaches are worse in the morning
  • You have a history of headaches but they have changed in pattern or intensity
  • You have headaches often, and there is no known cause
Emphasis added. I probably wouldn't go to the ER for this, and, yes, you are probably going to live, but you should really see a physician. It's not something to mess around with.
posted by grouse at 8:38 PM on February 8, 2012

Best answer: When I had headaches like this, it was eyestrain from holding my laptop too close. When my sister-in-law had headaches from a brain tumor, they were almost completely unlike the headaches you're describing. Try to schedule a meeting with a GP, start using a neti pot in case it's sinuses, maybe pick up a pair of drugstore reading glasses?
posted by KathrynT at 9:32 PM on February 8, 2012

Best answer: ErikaB mentioned it above, but "Front of head" may be sinus pressure, depending on where it hurts.

Look at the first diagram on this Sinus Wikipedia article and if it's in those areas, try a pseudoephedrine-based decongestant.

If it's happening a certain time of day, there are several factors that could be at play here:

Food-related - have you been eating the same thing for lunch around the same time? Do you only eat when starving, and what do you eat then? Is it blood-sugar related?

Environment - This is where the lighting situation, or pressure changes, or even being in this environment for too long comes into play. Is it really dry where you work? When I lived in Arizona, I'd get sinus headaches from the pressure changes almost every afternoon during monsoon season.

Good luck!
posted by bookdragoness at 6:49 AM on February 9, 2012

Response by poster: Thanks, everyone, for all your advice.

I'm glad to hear that I likely have no special risk of sudden neurological distress on my trip!

After reading through all these responses, thinking about my workplace environment and typical work day, I'm definitely thinking this is stress related. Especially since, today, I was fine up until I had yet another stressful exchange with coworkers that involved various kinds of miscommunication and bus-throwing-under. Then suddenly my headache was back! With a side order of jaw clenching and tooth grinding! What a surprise!

My guess is that a week in Istanbul will even things out. If not, I'm going in for a full workup when I get home, regardless of the chunk it takes out of my savings. Regardless of anything, I'm off to an urgent care center as soon as possible.
posted by Sara C. at 11:27 AM on February 9, 2012

Well, if you are bruxing due to stress, that can most definitely be a contributing factor.

(As an aside, I brux so badly that not only are my molars completely free of cusps, but they are also riddled with stress fractures. And, yes, I get some major headaches.)

Also, seconding the massage. I tend to carry all my stress in my shoulders and neck, to the point some friends who will toss out the occasional shoulder rub while I fix their computer (generally) have come up with some amusing nicknames/comparisons.
posted by Samizdata at 10:58 PM on February 9, 2012

Oh, just remembered, you also might want to have a sleep study done.

I am an apnic, and it amazed me to find out what it was like (after my initial titration study) to not have the general low grade background headache I had lived with for so many years that I had almost stopped noticing it.
posted by Samizdata at 10:59 PM on February 9, 2012

I just wanted to second that it could be sinus headaches, too. I had all [however many we have] sinuses all clogged up, and it was a constant headache, but I never knew it was the sinuses until I had an MRI because there was no outward signs of congestion/rhinitis.
posted by Pax at 12:58 PM on February 13, 2012

Response by poster: The headaches stopped! By the time I left for Istanbul, they had pretty much started to wind down (so just a few days after my job ended.) I think I had one or two while there, though they were easily chalked up to caffeine withdrawal since the morning beverage of choice is tea rather than coffee. Anytime I felt a headache coming on, I'd find a cappuccino and things would level out pretty quickly.

Now that I'm back, the headaches haven't returned. I'm still thinking about getting checked out by my GP, but I'm fairly sure they were caused by one of the many non-life-threatening things mentioned by folks in this thread: constant exposure to fluroescent light, stress, teeth grinding, stuff like that.

I'm also hoping to bring down my coffee consumption to the point that I stop getting caffeine withdrawal headaches if I don't have my morning cup like clockwork.

Thanks for all your advice, folks.
posted by Sara C. at 1:58 PM on March 10, 2012 [1 favorite]

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