February 19, 2009 in Features

Dr. Gott: Head pain needs diagnosis

Peter H. Gott, M.D.
 

Dear Dr. Gott: I hope you can help me. I am an 80-year-old widow, living alone, not overweight and I am active. I still mow my own lawn and have a garden and orchard. I grow veggies, berries, grapes, several types of tree fruits and walnuts. I have many other hobbies that keep me busy during the winter months. My faith is also very important to me. My only medication is thyroid hormone replacement, which I have been taking for more than 60 years.

My problem is that for the past 40 years, when I go to bed, I awaken between 2 a.m. and 4 a.m. because of a pounding pulse and pain on the right side of my head that extends down through the back of my neck. The pain is very intense. A few years ago, I found that taking an aspirin with caffeine stops the pain within half an hour. I still cannot get back to sleep, but I figure it’s better to lie awake pain-free than to lie awake with a horrible headache. I never get headaches during the day.

I have lost track of the number of chiropractors and doctors I have seen and tests I have had done. One physician thought it might be something in my room or house. I have a big house with four bedrooms and have tried each bed and about 12 different pillows. I even went to visit some relatives in California but still had the same problem in three different locations while visiting. All the tests I have had, including a few days in a sleep clinic, have been normal.

My only relief came last spring, when I tried a new supplement that contained butterbur, ginger and riboflavin. I had three glorious months without a headache, but just as suddenly as they stopped, they returned. I still occasionally retry the supplement, but with no effect.

Dear Reader: Your situation is incredibly difficult. Upon first reading, I thought perhaps sleep apnea was the problem, but I then saw that you had already been tested.

You may wish to repeat certain tests, because 40 years have brought substantial change in their accuracy and sensitivity. Tests that didn’t exist 40, 30 or even 20 years ago may now be available.

You have already indicated you underwent a sleep study, but if it was more than five or 10 years ago, you may wish to have another. The brain monitoring associated with many of these studies has improved drastically.

You may also benefit from a Holter-monitor study because of the pounding pulse. That recording will be interpreted by a cardiologist, who may be able to detect any abnormal cardiac rhythms.

Another option is to start keeping a journal of your activities. This should include mealtimes (what time and what foods were consumed), showers (and products used), exercise and more. This could point out triggers, such as an allergy to a laundry detergent, perfume, shampoo or food. It could even show a relation to the time you last ate and when you woke up.


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