Please help solve my husband's headaches
February 9, 2015 5:10 PM   Subscribe

My husband has been getting near-daily headaches for about three weeks now. How can he make them stop?

My husband rarely gets headaches, but starting on January 19, he's been getting a headache nearly every day. The first two weeks were the worst. The symptoms are as follows:

- The headache occurs on the right side of his head, above the eyebrow.
- The pain is dull, not throbbing. The pain gets sharp if the headache is allowed to peak, but that's only in the worst-case scenario.
- The headache generally comes on at 2pm.
- Without medication, the headache generally disappears after 4-5 hours.
- The headaches also come on weekends, but later in the day.

He saw a doctor after one week of headaches. She diagnosed him with migraines and prescribed Maxalt (rizatriptan). She also tested him for a UTI (?!), which he tested negative for. Husband says the Maxalt helps, but two Extra-Strength Tylenol works even better.

Husband and I have been trying to figure out what's causing his headaches, but without much luck. We initially thought it was caused by the dark chocolate (86%) he started eating the same day as the headaches started, but he stopped eating it after four days, and the headaches did not budge. He's tried eliminating caffeine and stopped eating processed deli meats for lunch. Once he started taking medicine in earnest after about a week-and-a-half of headaches, the headaches seem less consistent, but have not disappeared completely. He's been a bit more stressed at work lately than usual. He drinks water, gets about 7 hours of sleep a night.

Does anybody have any suggestions on what he can do to quash this nasty cycle? Are there other headache triggers we should watch out for?
posted by Rora to Health & Fitness (33 answers total) 2 users marked this as a favorite
When I get headaches above my eyebrow, one-sided, it's been sinus difficulties. Has he tried taking Real No Shit Sudafed?
posted by KathrynT at 5:14 PM on February 9, 2015 [6 favorites]

Sinus-y at all? There has been a virus going around the midwestern U.S. with this symptom. Supposedly. I've been having headaches every day the past couple of weeks, that feel sinus-y, when usually I never have headaches. This is the best explanation we have been able to come up with so far.

They are what I would describe as moderate/annoying, not really incapacitating. Word on the street is that symptoms vary, though. "Word on the street" is probably just about as reliable as it sounds.
posted by flug at 5:15 PM on February 9, 2015

If the headache kicks in reliably at 2PM, he might try taking the tylenol at 1:30 to see if he can get ahead of it.
posted by Blue Jello Elf at 5:20 PM on February 9, 2015 [5 favorites]

When I can point to the pain, it's almost always a sinus headache. Usually I get them when the barometric pressure shifts - a bad storm can lay me out for days. Seconding Sudafed or Tylenol Sinus. I also get relief from tenting a towel over my head over the sink and steaming my face off.
posted by Mchelly at 5:21 PM on February 9, 2015 [3 favorites]

I have also recently been having recurring headaches above the eyebrow area that I could not initially figure out the cause of. When I started using some natural tears type eye drops because I have also been having itchy dry eyes from the cold/dry winter air, I immediately noticed that my headaches went away. So, that might be something easy to try?
posted by fourpotatoes at 5:23 PM on February 9, 2015 [1 favorite]

Yup, another vote for sinus. Mine get so bad I can't move my head around because the movement makes everything even worse. I get the most relief from sinus irrigation (I like the SinuCleanse squeeze bottle for ease of use - watch some YouTube videos for instructions) and Mucinex/Guaifenesin to help what's stuck up there drain out. It often will occur when I have no nasal congestion, so the absence of that isn't enough to rule out upper sinus congestion.
posted by quince at 5:26 PM on February 9, 2015 [1 favorite]

Computer use caused a localized, regular headache for me. A particular combination of keyboard and monitor positioning.
posted by tofu_crouton at 5:29 PM on February 9, 2015 [1 favorite]

Hmm.. he might have cluster headaches. The "always happens at the same time of day" and "only on right side around the eye" are the things that's leaning me in this direction. Note that there isn't a cure for these, if that's what he ends up having. There are treatments and it can go dormant for weeks or years, but they can come back.

I'd eliminate eyestrain (from computers/screens), check to see if he needs glasses or an updated vision prescription, and try the suggestions for sinus headaches that people are making here first. If none of that helps, go see a neurologist. Clusters are rare, so you might need to ping more then more neurologist.
posted by royalsong at 5:36 PM on February 9, 2015 [1 favorite]

I get migraines, so does my whole family, and this doesn't really sound like them (yes I know about atypical, they're what I get, and also IANAD).

In your position I'd be getting my doctor to refer me to a neurologist/head-pain-specialist. Oops, and an eye exam.
posted by feckless fecal fear mongering at 5:37 PM on February 9, 2015 [3 favorites]

Maybe visit the eye doctor.
posted by synecdoche at 5:41 PM on February 9, 2015

I get atypical cluster headaches and this describes them pretty exactly. (Atypical because they last more than 20-40 minutes). Bright lights, being dehydrated and excitement/ stress/ not eating bring them on. Its super common to get them at the end of a long day when you relax- bam headaache.

Caffeine is your friend: swig a few extra strength Excedein with a coke or sugary coffee when you feel them coming on.

Honestly though I'd go back to a different doctor if they suddenly came on in an adult with no history of headaches. The one you have doesn't seem very headache knowledgeable. Just in case. And have him check his blood pressure throughout the day.
posted by fshgrl at 5:42 PM on February 9, 2015 [2 favorites]

How many days a week has he been taking the Tylenol? More than twice a week can cause rebound headaches. I've had trouble with them when taking acetaminophen too many days in a row, so that first the headache is caused by something else, and then it's caused by the treatment for the headache.
posted by artistic verisimilitude at 5:44 PM on February 9, 2015 [7 favorites]

I'll throw out poor posture. I have forward head posture and get regular headaches as a result. Tension headaches above the eyebrow are often rooted in neck strain. Sitting at a computer, looking down at a smartphone, slouching on a couch, driving with your head pushed forward, propping you head up to read in bed, or sleeping on too high a pillow all can lead to forward head posture and the accompanying headaches.
posted by cecic at 5:52 PM on February 9, 2015 [3 favorites]

I second trying real-no-shit-sudafed. I get migraines and sinus headaches, and this sounds more like my sinus headaches than migraine. Of course, this is armchair advice, but unless you have contra-indications real-no-shit-sudafed is a pretty easy thing to try.

The consistent timing is more migraine-like, but I also get this with my sinus headaches. I suspect i has something to do with my sleeping schedule or something else (perhaps the way I'm sitting aggravates it)?
posted by Kutsuwamushi at 5:52 PM on February 9, 2015

How much does he weigh? Is he at a healthy weight? What is his salt intake? Does he have high blood pressure? Has it been cold where you are?
posted by Nevin at 5:57 PM on February 9, 2015

If he has high blood pressure, he shouldn't take Sudafed.
posted by Obscure Reference at 5:59 PM on February 9, 2015

The pain is dull, not throbbing. The pain gets sharp if the headache is allowed to peak, but that's only in the worst-case scenario.

That's not typical for cluster headaches, mine usually throb, but it's not impossible if it's what they call a ghost headache btw. The think that distinguishes cluster headaches for me is that they stop without you having to go to sleep. They dont spend much time winding down either, they just... end. Most of mine are about 30-50 minutes but the less severe ones drag on.
posted by fshgrl at 5:59 PM on February 9, 2015

Could be a low-level sinus infection that he's otherwise not noticing, exacerbated by exposure to an allergen he's only getting exposed to at work, a cleaning chemical or dusty carpets or something. That could account for why it's worse on weekdays. He could see if Benadryl helps at all. Also if it is sinus, Advil often helps more than Tylenol.

(Obvious contingent those being safe with whatever he's already taking.)

Caffeine can help control migraines or sinus headaches in some situations. The key migraine medication for me, when I was getting them daily and couldn't beat them, was one that had a muscle relaxant as well as the migraine medicine. I tend to tense up my jaw and neck when stressed or in pain, and that was definitely making the headaches worse.
posted by Eyebrows McGee at 6:04 PM on February 9, 2015 [1 favorite]

I get very similar headaches above and behind my left eye, and I would second cecic's posture/neck strain suggestion. I have been to my doctor a couple of times for these types of headaches, and he's sent me to massage and physio for dealing with upper back/neck issues, which lead to the headaches.. He also suggested I get a countered pillow, which has definitely helped.
posted by just_ducky at 6:25 PM on February 9, 2015 [1 favorite]

Agree, new doctor time. I take Maxalt for migraines but it's not recommended to take it every day. Tylenol as well, taken daily, can cause rebound headaches. I would ask to be checked for sinus problems and then head off to a headache clinic specialist.
posted by mmf at 6:32 PM on February 9, 2015 [1 favorite]

Husband says the Maxalt helps, but two Extra-Strength Tylenol works even better.
IANAD, but I think this would be surprising if his headaches are migraines. For migraine sufferers, the opposite is often true - that OTC painkillers do very little, and specialised medications are needed.

I think sinus inflammation (either due to infection or allergy) fits with most of the facts as described - particularly the sudden onset with no previous history, and the persistent headaches. Not sure about the afternoon onset, though. Regular nasal irrigation (twice a day) with a neti pot or similar can make a big difference for inflammation, but if it's really infected then my understanding is you really need antibiotics.

However, I think it is time to go back to the doctor - maybe a different doctor. I think that if he is getting almost daily migraines for 3 weeks with no prior migraine history, that itself would warrant further investigation - but I suspect a different diagnosis and treatment is still on the cards.

I was also interested to discover that 500mg of Tylenol is "Extra Strength", whereas 500mg of Panadol (the Australian version) is standard strength!
posted by Cheese Monster at 6:45 PM on February 9, 2015 [3 favorites]

The most likely diagnosis for your husband's headaches was migraines - your description is nearly textbook. That's why the doctor treated him for migraines.

Unless you let the doctor know that the headaches are continuing and the medication isn't doing the job, she has no way of knowing the problem is still ongoing. But new headaches are a problem that doctors take seriously and if treatment for migraines or sinus aren't working, they'll dig in for a more thorough workup.

Please get him back to see the doctor asap. You can try a new doctor, but unless you have other reasons for distrusting this one, I think you're already one step ahead here. I'd ask for a thorough workup now, though.
posted by aryma at 7:58 PM on February 9, 2015

IANYD/TINMA - I think he should return to the doctor.

This actually isn't totally textbook for migraine (yes, it's unilateral, but migraine typically has other features too), and it's not that common for a middle aged man to suddenly start getting daily migraines. People with significantly severe headache who don't usually get headache may warrant imaging studies.

Neurologists are the best for headaches but unfortunately often they are booked up and scheduling pretty far in advance. If he can easily go straight to a neurologist or get a referral, I think that would be a good idea. If not, an appointment with a different primary care for a second opinion.

(however, tangentially, in the original doc's defense, you can see UTI present with headache - it's strange, but I've definitely seen it in a young man before)
posted by treehorn+bunny at 8:26 PM on February 9, 2015 [5 favorites]

He may want to look into whether he has a trigger point with a Massage Therapist. Splenius Cervicis and Temporalis are two muscles that commonly refer pain behind the eye which feels like a headache.
posted by legendarygirlfriend at 8:30 PM on February 9, 2015

As a lifelong migraine sufferer this doesnt really sound like migraine. Others have suggested cluster which I dont know much about. I would investigate tension headaches. How are his neck and shoulder muscles? Does getting into the notch at the base of his skull with a thumb feel good or bring any relief? I also think its irresponsible for the doc to have disgnosed migraine after just a week AND tell him to take maxalt that often. I vote go to a neuro who specializes in headaches. The sudden onset is concerning. Also try 800mg of ibuprofen next time and see if that helps any better than acetaminophin. The have slightly different moas and advil is the only otc that helps my head pain
posted by misanthropicsarah at 8:40 PM on February 9, 2015 [2 favorites]

I would definitely push for a neurologist visit. His relief from Tylenol is atypical for migraines (decade long sufferer here). He may be having sinus stuff, bad posture, a variety of things...
posted by heathrowga at 8:41 PM on February 9, 2015 [2 favorites]

As someone who suffered from headaches daily for about a year (see my post history) I will just throw out the possibility of occipital nerve injury due to work. If your husband works a typical 9-5ish schedule it may be that 2pm is around when his neck muscles start to weaken and twitch against his occipital nerve, which results in pain right above the eyebrow.

Solutions would be mainly to try to reduce any work that causes shoulder and neck strain, which may mean taking frequent breaks and doing stretches. Meds won't really help heal things - you just kinda have to wait it out and use pain killers to soften the blow.
posted by joan_holloway at 8:45 PM on February 9, 2015 [2 favorites]

Go to a doctor, or better yet, a neurologist.
posted by pando11 at 11:02 PM on February 9, 2015

Nthing a sinus infection. OTC medicine for now, Sudafed is best. If that doesn't work, as a last resort have hubby go to the doctor to get some antibiotics. Only as a last resort! But if all else fails, get some antibiotics.

Sinus infections can be a real bitch. I've had one, off and on, for about two months. Very hard to get rid of.
posted by zardoz at 11:20 PM on February 9, 2015

Turning the brightness way down on every screen I use, taking frequent eye breaks when working with a screen and getting my work to take the bulbs out of the light directly above my desk has made a massive difference to the amount of headaches I'm getting. Could it be light/glare related?
posted by terretu at 12:15 AM on February 10, 2015

Similar to me. Thought it was migraines. Turned out to be sinuses. Pre-emptive doses of real Sudafed solved it (not everyday, but during a run of them).
posted by blue_wardrobe at 8:36 AM on February 10, 2015

I'm going to agree with the suggestion for a neurologist, but while you are waiting he should start keeping a headache diary.

There are a number of different forms (search google for headache diary for examples), but at minimum I would recommend tracking the following: sleep time and quality, all food and beverage intake, any medications taken, perceived stress level through the day, exercises, activities, weather, and if you have a headache that day. For the headache keep track of when it started, any preceding events (visual disturbances, strange smells), location, pain description, intensity, and duration. This could be helpful for finding any headache triggers that he may have.
posted by Broken Ankle at 9:03 AM on February 10, 2015 [2 favorites]

I wanted to second artistic verisimilitude's suggestion that they might be rebound headaches. That they're occurring in the early afternoon everyday in the same place sounds similar to the rebound headaches I had a couple of years ago. He should definitely follow up with the doctor, but in the mean time he might try taking a long (unpleasant) weekend without the Tylenol to try and reset the rebound cycle.
posted by twoporedomain at 11:10 AM on February 10, 2015

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