Hi doctor, I have had the headache issue for more than 12 years now and seems to be getting worse. The onset of this headache starts with like a pressure getting built up in my head, like stress for no reason and all of a sudden and then the headache starts at the back of the head and within minutes it gets severe. If I have to describe the location, it is above the base of the skull and below the top of the skull. The pain is so severe that I have to take a pain killer else it will not subside. There are no other symptoms like vomiting, dizziness, nausea, speech imbalance nothing. The pain is pulsating or throbbing and it increases with any movement or applying pressure. This headache also comes on while having alcohol and on a very rare occasion at the time of ejaculation while having sex with my partner (once in a blue moon scenario). I got my cervical spine CT scan done and the reports were normal. The onset of headache has to do something with the time as well, for example, if today it has started in the evening then for the next few days it will happen around the same time. If I think a lot or involved in any discussion (intense or involves me getting anxious or excited) it triggers. It also gets triggered sometimes, if I am washing dishes or cooking food which requires a bit of focus. I do not know what the pattern is but all I know is it is ruining my quality of life. The frequency of these headaches are very frequent and consuming pain killers has started to affect my digestive system. I want to get rid of this problem. Please suggest.
Hi. Your headache most likely is migraine since it has been going on for the last 12 years. Another less likely possibility is occipital neuralgia. One thing that is not clear from your description is whether the pain is localized to one side or occurs on either side. Nevertheless, I would recommend the following: 1. MRI of the brain to rule out structural abnormalities that could be causing the headache. 2. Start on tablet Topiramate 25 mg twice a day and build up to 50 mg twice a day. 3. Maintain a headache diary- note the time, duration and character of pain in a diary each time you have pain. 4. Consider tablet Pregabalin 75 mg twice a day if Topiramate is not effective. Migraine or occipital neuralgia. Migraine or occipital neuralgia.