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Sunday, May 29, 2011

Severe Continuous Headache. Look for Trigeminal Nerve involvement

DIANA: Hi, for the past 2 1/2 weeks, I am experiencing major headaches about every other day. They are always right in the center of my head and don't go away unless I take a strong Ibuprofen dosage. And sometimes come back a few hours later. Sometimes I don't get them until night time, but I have woken up with them occasionally. I suffer from migraines off an on ,but typically that would be once every couple of months. Never this often. I'm also extremely exhausted all day long. I wake up tired, and I go to bed tired. Also experiencing a lot of anxiety, more so than normal which was triggered around the same time. I don't feel depressed so I don't think it's that, but I'm not sure. Not sure what triggered all of this, but I can't get over it. My doc did blood work on my thyroid, vit D, and one other thing (I can't remember) and it was all normal. She wanted me to take migraine medicine to stop the headaches but I wasn't comfortable taking it. Plus I wanted to find out why it was happening, not just take the pain away. I'm scared it may be a tumor or something similar. I'm 29 and have 2 small children.

Dr Shapira response: Diana,
I am sorry to hear you are having some much pain. Checking thyroid function is a good step, but it is important to look not just if you are in the normal range but where in the range are your numbers. Normal is a range for a population not an individual. If you are at the bottom of the normal range it could still be a problem.

I would suggest having a sleep study since your tiredness is a major problem.

I obviously cannot diagnose on the internet but frequently neuromuscular dentists use "spray and stretch techniques" that can quickly relieve the pain and diagnose a muscular orgin. I normally start with a consultation and can relieve most pain using those techniques, This helps to understand where the pain is coming from.

Other possible treatments to stop a continuous headache are SPG blocks that work well for autonomic pain and trigger point injections. Stopping the pain is usually easy but more importantly it lets us understand where it is coming from and learn more about the nature of the pain.

There is very little history to this pain, and I would like to know much more about the onset and any unusual events a week or two before it began.

An aqualizer oral appliance is also an inexpensive way to evaluate whether the pain is jaw related.

Most of my patients are fitted with a 24 hour diagnostic orthotic if it appears there is trigeminal nerve involvement in the headache. This is true for the majority of severe continuous headaches as well as headaches and migraines in general


















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posted by Dr Shapira at 12:30 AM

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