Hemicrania continua

17 December 2020

Pupils Constricted During a Headache Attack?

Have you ever noticed a change in the size of your pupils during a migraine attack?

To be fair, this is probably the last thing you’re thinking about. But maybe someone else has noticed. Dilated pupils – that is, larger pupils, caught the attention of this writer as a significant migraine symptom – Eye Pupils Dilated during Migraines- Is that Normal? The condition in which pupils dilate unusually is called mydriasis.

But according to most research, and a recent study, the opposite is more likely to be true – constricted pupils (this condition would be called miosis). This has been observed in conditions such as hemicrania continua and cluster headache.

A recent study published in the European Journal of Ophthalmology investigated constricted pupils in migraine. The study of 24 patients and their 48 eyes showed that migraine patients did tend to have significantly constricted pupils during attacks. There was no significant difference between the two eyes – in other words, patients with a headache on one side of the head had similar constriction in both eyes, not just on the painful side.

Apart from being an interesting symptom to keep an eye on (oops! sorry!), it will also open up future study into how muscles and nerves around the eye respond to migraine attacks – or how they are involved in the web of causes and effects.

If your pupils are constricted during migraine, you can probably simply think of it as another strange migraine symptom. However, certain medications – namely opioids and other narcotics, may also cause constriction. If you’re regularly taking one of these medications during a migraine attack, you might want to talk to your doctor about other long term solutions to avoid and treat migraine pain.

Read the study abstract here: Effect of migraine attack on pupil size, accommodation and ocular aberrations

2 July 2018

Causes of Daily Headaches

James Information 1

Some daily headaches start all of a sudden. Others are just headaches that gradually become more frequent. The causes of daily headaches are sometimes obvious, and other times completely unknown.

Although some people are diagnosed with chronic daily headaches, the term is very general and could refer to a variety of conditions. If you haven’t received a specific diagnosis, talk to a specialist.

Now, let’s look at some examples of causes of daily headaches:

Various Secondary Headaches

There are a whole range of secondary headaches that can be a daily problem – too many to list here. But think of pain from a tumour, a recent trauma to the head or neck, aneurysm, and cervicogenic headache.

Causes: Too numerous to mention.

Many of these headaches are serious enough that you should get to a doctor right away. But how can you tell?

If you have headaches that are getting worse day by day, or if you’re experiencing changes in headache symptoms, or if you’re getting headaches after an event you can remember (such as an accident or illness), see your doctor right away. She can help you narrow things down, and get you the treatment you need.

Chronic Migraine

Most daily headaches are actually a form of chronic migraine. So why does migraine become chronic?

Causes: Genetics may be the #1 reason. Other reasons include poor treatment (using the wrong medications, or too many over the counter medications, for example), depression, obesity, or sleep disorders.

Often the cause is unknown, but migraine symptoms could also be the result of an underlying disease, or a recent physical trauma. Again, when symptoms change, see a doctor as soon as possible.

Chronic Tension-Type Headache

Some daily headaches may actually be a combination of migraine and tension-type headache.

Causes: Tension-type headaches may become chronic for similar reasons that migraine becomes chronic. But the reason often remains unknown.

In spite of its name, we now know that tension-type headaches are not simply caused by tension. The actual cause may lie deep in the brain.

New Daily-Persistent Headache (NDPH)

With NDPH, patients know the exact day when the headache began. This is not a gradual-onset type of headache.

Causes: Usually the cause is unknown. However, patients often report that the headaches started with a flu-like illness. Sometimes the start of the headache is corrolated with a stressful life event, or a surgery. Read more here: What Triggers New Daily Persistent Headache?

Hemicrania Continua

Hemicrania continua is a rare one-sided headache that is usually treated with indomethacin. Hemicrania continua is often misdiagnosed.

Causes: Unknown

Chronic Cluster Headache

Like migraine and tension-type headache, cluster headache can become chronic.

Causes: Largely unknown. Factors may be similar to migraine, when it comes to why cluster becomes chronic.

Conclusion

There are other types of daily headache, but that covers the majority. In most cases, it probably won’t be immediately obvious why you start getting daily headaches.

Causes of daily headaches, if known, can be a big step toward proper treatment. If you do have some idea why your headaches have gotten worse or why they started, talk to your doctor.

Although daily headaches can increase at the same time as stress in your life, the stress is probably not the cause. It’s easy to think that the headaches are “normal” when you’re going through stress, and that they’ll get “better” when the stress goes away.

However, this can keep you from investigating what the real cause is. So be very careful before you blame daily headaches on “stress”. Lots of people under hugely stressful events are headache-free.

1 March 2016

Diagnosing Head Pain Behind Ear

James Information 0

There are so many causes of this type of pain, that diagnosing simple head pain behind ear may not be so easy. But there actually are some common causes and good treatments.

Hi,

Recently, I’ve been experiencing sudden, sharp head pain behind my ear. It comes without warning, and makes me wince at best – it’s very painful! Any idea what may be going on?

Sometimes this type of pain may be sudden and temporary. Other times, it grows slowly and gets worse.

For a pain that’s getting worse, it’s entirely possible that there is an ear problem, such as an ear infection. Even though the problem may come from the ear, the pain may be perceived as being “behind the ear”.

An example common in children is mastoiditis, which may also cause redness of the ear or behind the ear.

For a pain that’s getting worse, always right around the ear, it may be wise to check with an ear, nose and throat specialist (an otolaryngologist, if you want to get technical).

A number of bones, muscles, and other structures right around the ear may cause problems. There may be a strained neck, or the degeneration of arthritis.

There are neurological headache conditions which may cause head pain behind the ear. Hemicrania continua is a one sided headache, which could localize around the ear (see pain locations in Hemicrania continua: a clinical study of 39 patients with diagnostic implications).

Glossopharyngeal neuralgia is a rare condition which may cause severe though temporary pain in and around the ear. This pain is often provoked by swallowing, coughing, or even talking. It last from a few seconds to a minute or two.

Primary stabbing headache is another possibility. Commonly known as ice-pick headache, it causes sharp, temporary pain even though there is no underlying disease of the nerves or structures nearby the pain location. The stabs of pain only last a few seconds.

Diagnosing Head Pain Behind the Ear If you’re experiencing head pain behind the ear, keep track of how often it happens, how long it lasts, how severe the pain is, and any other symptoms that you may be experiencing.

Do take this pain seriously. There are many possible causes, some more serious than others, but your doctor can help you narrow them down. First, she’ll probably look for organic and structural problems that could be causing the pain. Certain tests may help rule out infections as well.

Sometimes the diagnosis will be based on your symptoms alone, in the absence of evidence of other problems. Treatments will be based on this diagnosis.

It’s difficult to take medication for a headache that only lasts a few seconds. However, some conditions have responded well using indomethacin (a common non-steroidal anti-inflammatory drug) as a preventative.

If you’re not finding answers, consider a neurologist and/or otolaryngologist, and possibly a physiotherapist if the problem seems to be structural. It can take time to find a proper diagnosis for head pain behind the ear, but there are good answers and good treatments for many related conditions.

Sources/References/Further Information:

20 August 2015

Are we ruling out hemicrania continua too soon?

James Information, Medications, Tips 3

You’ve had a headache for weeks – then months – it may get better or worse, but it rarely (if ever) goes away completely.

It’s a one-sided headache, and some strange symptoms go along with it. Flushing or sweating in the face, congestion, watery eyes, feeling restless. A sensitivity to light or noise.

Are we missing hemicrania continua? Part of the problem is that sometimes the symptoms play tricks on you. They may look a lot like migraine symptoms. Or they may not look like hemicrania continua (HC) symptoms – for example, a key diagnostic criteria, that HC is pain on one side of the head, seems to be almost always but not always the reality.

But there is another concern that neurologist Dr. Randolph W. Evans has. In his recent article Migraine Mimics, he suggests that some doctors may not be using the typical HC treatment properly.

HC is one headache condition that is diagnosed by treatment. It always responds to indomethacin. When the patient takes indomethacin, the headaches go away, and the diagnosis of hemicrania continua is confirmed.

But there is a catch. How much indomethacin should the patient take, and for how long? Could it be that some doctors are not raising the dosage high enough?

Dr. Evans mentions one case in which a woman had tried indomethacin for five months – surely a long enough trial. The problem was, the dosage was too low.

Missing a diagnosis by a few milligrams is pretty frustrating, especially considering that it’s not unusual for a patient to go through several doctors and wait 5-10 years for a proper diagnosis.

Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID), and doctors are right to start on a low dose. Side effects can include abdominal pain, nausea, and diarrhea to name a few.

Dr. Evans suggests that doses as low as 25-50mg a day can be effective for some patients. Some patients may go up to a high dose, but be able to taper off down to about 60mg.

One specific suggestion is to try going from 75mg to 150mg to 225mg, trying each dosage for 5 days. Patients will often split the daily dose throughout the day.

Although the usual recommendation is to try up to 225mg (for example, 75mg 3x daily), there are some reports of patients responding to 300mg/day.

Because indomethacin can help us get a clear diagnosis, even if the patient can’t continue taking it, doctors should be cautioned not to stop raising the dose too soon. If the patient is able to get rid of the headache, but can’t tolerate the medication, there are other options to try.

Hemicrania continua is so often misdiagnosed, it may be more common than we think. This may be a simple way to catch cases and provide better treatment.

18 May 2015

Headache and Watery Eyes

James Information 0

There are actually a number of disorders that may lead to headache and watery eyes. Although sinus infections are blamed more often than not, a chronic sinus infection (sinusitis) is actually a more unusual cause of watery eyes.

Headache and Watery Eyes? First, it’s commonly known that migraine attacks can lead to congestion and watery eyes. This from Johns Hopkins Medicine:

Migraine pain can be felt in the face, where it may be mistaken for sinus headache â€“ or the neck, where it may be mistaken for arthritis or muscle spasm. Complicating a migraine the diagnosis of migraine is that the headaches may be accompanied by other “sinus-like” symptoms, including watering eyes, nasal congestion, and a sense of facial pressure. Most patients who think they have sinus headache in fact have migraines.

But watery eyes, also known as lacrimation (lachrymation) or epiphora can go along with headaches for a number of reasons.

Sometimes, something like the common cold can trigger both migraine attacks and watery eyes. It helps to make a note of when headache symptoms and lacrimation starts – do both always happen at the same time?

Migraine attacks may last for a few hours to two or three days. Other headache and watery eyes conditions may have different timetables.

Cluster headache attacks often lead to congestion and water eyes as well. These attacks are typically shorter than migraine attacks, lasting from a few minutes to two or three hours. The pain is severe, and attacks may come every day or even hit several times a day.

Paroxysmal hemicrania attacks may be even shorter, but also lead to headache and watery eyes. Attacks are treated with indomethacin.

There are other headaches that may last only a few seconds, but look similar. Hemicrania continua headaches may look similar to paroxysmal hemicrania, except that the headache doesn’t go away.

There also may be attacks of facial pain which lead to watery eyes.

This is by no means a complete list of what can cause headache and watery eyes. There are other issues, not as focused around headache, which can lead to lacrimation, such as hay fever and pink eye.

If your headache symptoms have changed, or you’re noticing new symptoms, it is wise to see a doctor as soon as possible. Tell your doctor when the symptoms began, if they symptoms affect both eyes or just one, and if/how headache and watery eyes go together (do they always strike at the same time? Do your eyes water as the headache goes away?). Your doctor should be able to help you narrow down the possible diagnosis and get you the treatment you need.