Help me solve my headache puzzle.
July 4, 2016 9:35 AM   Subscribe

(YANAD/YANMD, I promise to ask my doctor, etc.) I've been getting headaches for years that don't seem to match up with anything I can find. I will ask my doctor next time I go in, but I'm curious if anyone else has experience with something similiar.

I get plenty of regular tension headaches; these are definitely different. Here's what I've pieced together:

- They're always on the right side of my head.
- It feels like someone is stabbing me in the eyeball and knuckling me at the base of the skull at the same time. Bad enough that I press my palm into eye, even though it doesn't help. Not so bad that I can't lay still. I've seen videos of cluster headaches and mine aren't that bad. The stabbing is the main characteristic, though.
- Won't go away on their own or with Advil. Advil and Excedrin usually help - I take that and try to go to sleep.
- Afterwards I often end up with what I call a "headache hangover" where my head feels like it wants to hurt but doesn't quite get there.
- About 75% happen either first thing in the morning or wake me up in the middle of the night.
- No associated nausea; mild sensitivity to light/sound only when they're REALLY bad.
- Haven't seen any association to stress level, sleep (or lack of it), food, my cycle, etc.
- Frequency ranges from a few a week to several weeks without one, or anywhere in between.

I've been getting these for 10+ years, but when you mention "headaches that are bad but don't throb" to a doctor their eyes tend to glaze over and they tell you to try to reduce your stress levels, so I generally don't bother. I will ask when I go in for my next physical, though. In the meantime, I'd love to know if the description rings a bell with anyone.
posted by CrazyGabby to Health & Fitness (32 answers total) 4 users marked this as a favorite
They sound like the migraines my mother gets. She experiences pain, light sensitivity, some nausea and fatigue but not auras or other migraine symptoms. There are many different medications- painkillers and prophylactics- that are available to treat migraines. She's tried a few of them and is currently on a prophylactic that seems to keep them at bay or keeps them at the "headache hangover/ghost headache" stage. You can memail me if you'd like to know specifics after you've talked to a doctor and they say if your headaches are actually migraines.
posted by mymbleth at 9:49 AM on July 4, 2016 [3 favorites]

This sounds a lot like migraines. It also sounds like your doctor isn't taking them seriously. You should see a neurologist, because if they are migraines, there are medications that might help.

I suspect that you're getting written off because you're a woman, so you need to really emphasize that this is an issue that you need treated.

I had serious migraines for 10+ years, and going to the doctors was often a frustrating experience because they weren't typical. I didn't have a visual aura very often at all, and I didn't have sensitivity to light and sound. I did have nausea sometimes, and post-migraine fugue. I also couldn't find any triggers, another typical migraine symptom.

Because they weren't typical, some doctors thought they were just regular headaches, despite the fact that they were seriously impacting my quality of life. This is one reason you need to see a specialist. Sometimes mgiraines are atypical. Or there may be something else going on that your primary care doctor isn't equipped to handle.
posted by Kutsuwamushi at 10:05 AM on July 4, 2016 [5 favorites]

These do sound like migraine. It's not unheard of to have pain in the back of the head. I get Botox now for chronic migraine (LIFE-CHANGING), and several of the shots are there.

I see a fantastic headache specialist now and my life is a billion times better than it was before. Recommended!
posted by Miss Scarlet with the Candlestick in the Lounge at 10:27 AM on July 4, 2016 [2 favorites]

Agree that they sound like migraines. Similar to what I get.

Go to a headache clinic or neurologist. I now get Botox shots for prophylaxis and have a prescription for Maxalt MLT and Sumavel Dose-Pro, either one of which I take when a headache breaks through. The Sumavel works within 10 minutes. The Maxalt, maybe 30 minutes.

Don't wait any longer. Your life can be SO much better if you get treatment!
posted by mmf at 10:39 AM on July 4, 2016 [1 favorite]

Many doctors don't understand migraines, which is unfortunate. But some will prescribe you medication for migraines, if you describe a textbook migraine issue. I learned to manage my own with hydration and OTC medications.

Advil never did anything for my headaches, but excedrin (acetaminophen + asprin + caffeine) helped if taken first thing. Ibuprofen also helps, and that's mostly what I take these days. I've had cyclobenzaprine prescribed for a tension headache that accompanied flu, and that worked but also knocked me out.

How is your hydration? Staying on top of that has been a preventative. There are some things I've mostly avoided in quantity because I noticed that they affected hydration: caffeine, sugar and sugar substitutes (mostly in drinks). Caffeine is a big one for tension.
posted by zennie at 10:39 AM on July 4, 2016

Have you checked for association with chocolate?
posted by bq at 10:41 AM on July 4, 2016

Yeah, sounds like migraines to me. Mine are always focused on the back of my skull. See a specialist if your GP doesn't take you seriously (and maybe get a new GP). For me, my GP prescribed a migraine abortive first--you take it when one starts. After a few years, something changed and they started coming way too often, so I got a preventive to take every day. She also suggested taking riboflavin (400 mg) and magnesium (500 mg). Now I'm 99.9% headache-free.

However, if they're mostly morning headaches, your doctor might also want you to get a sleep study. Morning headaches can be a sign of sleep apnea, for one thing (and yes, it's possible to not be overweight, not audibly snore, and not gasp for air but still have sleep apnea).

Good luck and hang in there till you get help! Headaches suck.
posted by wintersweet at 10:42 AM on July 4, 2016 [1 favorite]

Response by poster: So it *can* be a migraine without throbbing? That's the main thing that was throwing me.
posted by CrazyGabby at 10:46 AM on July 4, 2016 [1 favorite]

(Correction: 250-500 mg riboflavin, 400 mg magnesium -- check with a doctor before trying it)

I would not describe my migraines as throbbing. It just HURTS. Sometimes it hurts, and fades, and hurts again later, but...
posted by wintersweet at 10:49 AM on July 4, 2016 [1 favorite]

I was also very confused by my recurring headaches, because they didn't fit with the descriptions everybody seemed to give of what migraines were like. But I think there are just different types of migraines.

My biggest trigger is dehydration. Try drinking, like, twice the amount of water you normally drink for a couple of weeks, and see if it makes any difference.
posted by showbiz_liz at 11:05 AM on July 4, 2016 [1 favorite]

So it *can* be a migraine without throbbing? That's the main thing that was throwing me.

Here's a thing that can blow your mind: according to my new headache specialist, it can be migraine without a headache. New research is looking into whether colic in babies might be an early manifestation of migraine disease.

I've had a headache for over twenty years. You will get your best, most supportive and understanding treatment if you can get to a doctor whose specialty is headache. These are the professionals who understand that there are a lot more headache patterns than the most typical migraine pattern, and they have the most experience and resources for treating them, including botox, nerve blocks, and a wide variety of medications that are not migraine-specific.
posted by not that girl at 11:06 AM on July 4, 2016 [11 favorites]

My migraines rarely throb, per se, more like a stabbing pain when I change position.

+1 to a specialist if you can get to one, I just never did because reasons.
posted by zennie at 11:08 AM on July 4, 2016 [1 favorite]

I've had migraines without headaches, though I usually have a headache.

Get a migraine prescription. And even if you don't think you have light sensitivity, get some migraine sunglasses. I swear those sunglasses changed my life.
posted by If only I had a penguin... at 11:12 AM on July 4, 2016 [2 favorites]

For me, sensitivity to sound is a symptom of magnesium deficiency. It can come on suddenly for various reasons and it can be resolved by eating magnesium rich foods, which I typically crave when it occurs. So it easily comes and goes.

My headaches sometimes respond well to foods that are high in certain nutrients. Natural peanut butter is one such food.
posted by Michele in California at 11:12 AM on July 4, 2016

Best answer: So it *can* be a migraine without throbbing?

Absolutely. Migraines can vary a lot between people. Mine rarely throbbed; they were just intense pain, like someone was pressing something sharp into my skull from the inside. I would do the same palm thing you describe.

But even if it's not migraine, it might be some other kind of headache that is treatable. It doesn't need to to have the name "migraine" in order to be worth taking seriously.

If you have a headache specialist in your area you really should go.
posted by Kutsuwamushi at 11:17 AM on July 4, 2016

I have migraines and cluster headaches. Mine are never as bad as the videos either, although I did typically lose the ability or desire to talk. Yours do sound like cluster headaches but the defining characteristic of a cluster headache is that it ends, mine typically went pop in less than 45 minutes.

I've had migraines since I was a small child of all kinds and while the suggestions to see a doctor are well meaning I've found they can't do much. They'll make sure you don't have a tumor then go "eh". Excedrin migraine or Botox and good sunglasses work about as well as anything. You have to figure out your triggers yourself and avoid them.

One less known trigger is constipation, not peeing enough or indigestion. If you're getting migraines almost every day or on a schedule look into that.
posted by fshgrl at 11:24 AM on July 4, 2016

Best answer: Pain on one side of the head, hangover afterwards, you're describing a quite classic migraine. The one side thing is apparently the big difference between migraine and tension headache (although a tension headache can cause a migraine sometimes, that's a fun combination). No throbbing or other symptoms necessary, although they are possible of course.

With your frequency it's worth finding a good doctor to help you out. There is a lot that can be done but there's also often a lot of trial and error, so it's worth working with a good doc that understands headaches rather than some random GP that shrugs you off. Just tell them straight up that you get frequent migraines and go from there. Describe the symptoms and impact on your life of course. They can question you more if they think migraine doesn't fit for some reason. But don't start with something as easily ignore-able as 'just a headache' when you clearly have something more.
posted by shelleycat at 12:09 PM on July 4, 2016

I vote migraines. The stabbing in the eyeball and "headache hangover" sound similar to what my migraines often feel like. I tried to take "normal" painkillers against them, but they won't help. Try to get a subscription for a triptan! Rizatriptan (aka Maxalt) helps me a lot. Usually the headache will be gone in 30 to 60 minutes.

Seconding finding a good doctor who takes your headaches seriously.
posted by amf at 12:13 PM on July 4, 2016

Nthing migraines without throbbing are definitely a thing. Mine also don't respond well to painkillers, though I have found that a combination of ibuprofen AND paracetemol, lying in a darkish room and covering my eyes and the back of my neck with a cold damp cloth, if done as soon as the symptoms show themselves, can greatly reduce the duration. I was prescribed triptans but haven't yet liked to try them as the side effects sounded unpleasant.

You say you have ruled out a connection to your cycle, but it might be worth another look - I have had these headaches for at least 10 years, possibly much longer (they've slowly been getting worse) and it is only the last 18 months or so I made the connection with my menstrual cycle, and I have been pretty rigorous for most of my adult life in recording menstrual cycles and associated symptoms. For me, it seems the migraines are related to the drop in oestrogen before my period - not the fact that it drops, but how big the drop is, hence the severity between migraines varying a lot. Having said that, I have only rarely had two close together, so YMMV.
posted by kumonoi at 12:18 PM on July 4, 2016

Best answer: Yeah, these could totally be migraines, even without the throbbing.

Migraines are weird - they present with different symptoms for different people, they are triggered by different things for different people, and they are helped by different things for different people. This is a case where YMMseriouslyV. For example, my triggers are chocolate, alcohol, and caffeine, which are totally "standard" triggers for migraines, and bananas, which no one I've talked to has ever heard of before as a trigger.

For me, the most useful thing I did while I was having migraines was keep a record of my pain. In my case, I would print out a calendar for the month and use a red pen to make a line horizontally across each day for pain. A dotted red line was minor pain and a thick red line was lots of pain. Towards the left of the square for the day was the morning and towards the right was the night. It wasn't super specific, obviously (I wasn't rating my pain on a scale of one to ten every half hour all day), but it was quick and easy, and it was also super easy to compare against previous days/months at a glance. It was also easy to spot patterns ("Hrm, I always get a headache in the mid-afternoon - that's interesting.").

Then I'd start recording in blue pen other things I was changing - meds, cutting out triggers, exercising, etc. It made it super easy over the course of a few months to see "No, that med really doesn't help at all, I should stop taking it" or "Yes, being really good about hydration is helping, I should keep that in!" It is really hard to accurately recall pain over time (i.e., how does your headache last week compare to your headache today), at least in my experience, so having the record of what I was feeling at the time really helped.

It was also great to bring in to my doctors for them to see what was working or what wasn't, and gave my theories some instant credibility. Nthing finding a good doctor who won't blow you off and who will sit down with you and your pain record and help you try to figure out the best options for you.

For me, meds didn't work - triptans actually made my migraines worse (that's another place where my migraines were weird) - so it was all about lifestyle changes, including avoiding triggers, drinking more water, regular eating times, better light when working, better posture, more exercise, etc. But I am pretty much 99.99% migraine free now - I can't remember the last time I had one, and that's after several years of near-daily "have to go to bed now" migraines.

Maybe for you, meds will work, and that's awesome. But the takeaways for me were:
1. Keep records so you can see what's working and what isn't
2. Don't despair if the "textbook" meds/other things don't work to help - there are lots of other options out there, including cobbling together a bunch of small but cumulatively life-changing little things

Good luck!
posted by bananacabana at 12:19 PM on July 4, 2016 [5 favorites]

Further to not that girls point. I get migraines with without a headache of any sort. My own symptoms are eyesight disturbances & sore eyes. Turns out my migraines are caused by to idiopathic Intercranial hypertension (high pressure in the cerebral fluid).

Go find a doctor who will take you seriously. Let them know this has been going on 10 years. Push to see a neurologist. Be polite but firm until they actually take you seriously. bananacabana's idea to keep records to take with you & present to the doctors of just how often these headaches occur etc is also a great idea. I had to push until I found a doctor who took me seriously, OK he took me too seriously & went straight to brain tumor but at least I got the tests I needed done super fast after that & a treatment plan in place once they worked out what it was.
posted by wwax at 12:33 PM on July 4, 2016 [1 favorite]

Yeah they suspect I'm having vestibular migraines without headache - I don't have full answers yet. I do get headaches a lot, but when I'm at my worst with nausea and vertigo and light sensitivity and unable to move I don't have a headache.

So yes, see your doctor and see a migraine specialist. I also noticed a correlation with chocolate increasing my dizziness. I don't eat wheat or dairy (but I hope to try dairy at some point but I think wheat/gluten triggered something because the last times I ate it I was SO sick.)

Keep a food/sleep/medication/headache/hormone journal starting now. Don't forget about things like artificial sweeteners, too.
posted by Crystalinne at 12:42 PM on July 4, 2016

Keep track of changes in barometric pressure when you get one of these headaches. That's my trigger.
posted by amro at 1:29 PM on July 4, 2016 [2 favorites]

Migraines for sure, find a neurologist that specializes in migraines because no one else will really care or take you seriously. Definitely start the sort of journal crystalinne mentions above but some other categories to include are weather and potential environmental irritants (allergy stuff, no matter what time of year). You can check stuff like that on some weather websites, it will tell you what pollens or molds are high in your area on a day to day basis.
posted by poffin boffin at 1:31 PM on July 4, 2016 [1 favorite]

Migraine! Migraines come in all different varieties- being one-sided is a big clue though. (You can even get migraine aura symptoms without the headache, that's how much they vary.)
posted by Coaticass at 1:51 PM on July 4, 2016

You have migraines. When I first started getting them, my pediatrician sent me for an MRI to rule out anything awful, since they started suddenly. Since you have had these for years without anything else happening you probably don't need to worry but, a good brain scan couldn't hurt.

Start documenting possible triggers and address them. Your pain is severe enough that you should qualify for medication.

The simplest definition of a migraine is that it is a severe headache that last for more than a day. Every migraine is different. Just because you don't have all the symptoms does not mean that you do not have a migraine.
posted by myselfasme at 3:15 PM on July 4, 2016

Just to clarify cluster headaches are also one sided and centered around the eye. So lots of bad info on this thread about that "definitely" being a migraine.

The more important differences are that cluster headaches are usually daily, come around the same time, come on suddenly and stop fairly quickly within an hour, or a few hours. You can have a ghost headache associated with clusters and all the runny nose, weepy eye, pallor and nausea of a migraine too. And while it hurts I think the youtube videos are kind the extreme end.

It's probably a migraine but if you find yourself pushing the side of your head very hard into random objects at the same time every day almost unconsciously that's a definite clue it's not.
posted by fshgrl at 3:53 PM on July 4, 2016

A doctor who treats cluster headaches will treat migraines and there is some overlap between the weirder types of migraines. The recurring pattern of your headaches makes them sound like migraines and you will need to push hard for a specialist. You're getting them often enough to make it worth trialling a preventive medication to reduce the frequency as well as something to directly to treat them, and there are lots of options.

I recommend Living Well with Migraine Disease Headaches as a general patient advocate guide. It's older, but she explains the range of migraines and how to advocate with doctors (and others) who dismiss migraine pain which were the most valuable parts for me.
posted by dorothyisunderwood at 5:15 PM on July 4, 2016

I get migraines triggered by high tyramine levels in foods. There are things that guarantee migraine for me. Torula yeast on roasted almonds, stilton bleu cheese, brown beer, ripe banana, peanut butter, red wine fermented with one type of yeast. The list of these foods is long, as long as I don't eat two or more secondary level foods I am OK, and always, drink enough water. I went to a neurologist for these, the food pamphlet was right in the foyer, I was able to trace the sources for the two day migraine I just endured. They were much worse when I was vegetarian, lentils with brewers yeast, and buttered toast, bad news. People who take tricyclic anti depressants have to be on a low tyramine diet, I don't take these meds, but I used to have to write therapeutic diets for those folks. Good luck.
posted by Oyéah at 5:19 PM on July 4, 2016 [1 favorite]

Just another data point, but I also didn't realise I was having migraines because of atypical symptom presentation: I don't have particularly bad pain, usually, but do get light sensitivity, visual distortions, and nausea - and it is defintely more stabby than throbby when it hurts.

I found they diminished in frequency by about 80% when I started purposely drinking more water prior to going to the gym. I've never been a great drinker, and knew I was often slightly dehydrated due to the colour of my urine, but now I make the effort even though it doesn't come naturally. Obviously everyone's triggers are different but this is an easy one to check.
posted by AFII at 4:01 AM on July 5, 2016

Yes, definitely sounds like migraine. Describing pain with words like "throbbing" is an imprecise measurement at best (I've been asked if mine was "pulsing" or "throbbing." WTF? How can I distinguish between those objectively, and how on earth could medical literature possibly distinguish?), so if you get a doctor who's hung up on a term like that, switch doctors.

The problem with asking about migraines: you're going to get 100 different suggestions from 100 different people, each of whom eventually found something that worked for them. Most of these are not likely to work for you. Your doctor, unless a specialist in headaches specifically, is going to go through the same differentiated diagnosis that's in the literature, and then give you a list of things to do. If you can rule out food-related triggers, then great, problem solved! Trick is, you'll have to drop down to a diet of bananas and white rice, and then slowly add things back one at a time until you find something that does it. I could never bring myself to do that. I'd recommend starting with prophylactic medication for it--low doses of nortryptaline worked for me, with a triptan for acute flareups.

The good news is, this isn't necessarily a forever thing. I was having 1-3 serious migraine events a month for two years before I found a medication that worked, and took it for about two years. I dropped the nortryptaline almost seven years ago, and haven't had a real showstopper of a headache since then.
posted by Mayor West at 6:48 AM on July 5, 2016 [1 favorite]

Response by poster: This is super helpful - thank you. The lack of throbbing and nausea had me completely thrown but so many other characteristics do fit. I'll follow up with doctor-types. I found an app to track headaches so I'm going to try keeping notes on mine for a while and see if anything pops up as a trigger. (pleasedontbechocolate) ;-) Thanks, everyone!
posted by CrazyGabby at 7:47 AM on July 5, 2016

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