CHRONIC TENSION HEADACHE

By Tamsin Wilson Thursday, January 03, 2008

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Hello there

I was wondering if anyone could advise me.... I was diagnosed by a Neurologist 5 months ago with Chronic Tension Headache. So far he has prescribed me 3 preventative drugs that are not helping me at all. They are not painkillers and so I am still dealing with the pain every day whilst waiting for weeks for each drug in turn to work and so far they haven't been.

I am really getting depressed and cry most days because of the pain and frustration. My neurologist refuses to give me prescription painkillers because of the risk of rebound medication headaches.

To give a bit of history about this, for many years I used to have tension headaches once or twice a week which were treatable with over the counter painkillers. However 5 months ago I came down with a virus infection and was put on anti biotics. All the virus symptoms went apart from this constant painful achey severe pressure-like headache which has stayed with me every day all day for the past 5 months. I cant use over the counter painkillers any more because they dont help the headache at all and I have had painkiller rebound headache ruled out as I have not taken painkillers since this started. I have also ruled out other illness's.

I wanted to find out if anyone else has this problem (that is not related to medication rebound headache) with not being able to use regular over the counter painkillers anymore because they dont work?

Also, have other people experienced trying a few different preventative drugs that have not worked? So far I have tried Amitriptyline, Gabapentin and am now trying Duloxetine. I am getting scared that I am resistant to treatment.....

What drug treatment is best for Chronic Tension Headache?

Anyone else diagnosed with NEW DAILY PERSISTENT HEADACHE?

Comments (20) | Add comment

GWP

1/ 3/08 3:28pm

I have daily pain, too. Have you asked about a muscle relaxer? A lot of my pain starts in my neck, scalp, and the base of my skull. Muscle relaxers help.

I've been on Zanaflex and Flexeril. I'm now taking Skelaxin at the first sign of neck/head pain. I'm supposed to take it when my pain is between 1 and 3 (scale of 10). When it gets above that, I'm to treat it like a migraine with Anaprox (high dose ibuprophen) and Imitrex, a migraine-specific drug.

I can only use the Anaprox/Imitrex treatment 3 days a week. I can use the Skelaxin up to 3 times a day, every day. The Anaprox and Imitrex can cause rebound, but the Skelaxin doesn't.

All these muscle relaxers can be taken every day, whether you're in pain or not. I took Flexeril for several years, but had to stop because of dizziness.

Unfortunately, there's no way to tell which preventive will work, other than trying various ones out and seeing what happens. And as you're discovering, you have to give each med time to see if it will work. I think of it as an auditioning process.

What does your doctor say about what he'll recommend if this med doesn't work out?

If you don't think your current doctor is on the ball, it may be time to see a headache/migraine specialist.

Gretchen in Mississippi

Tamsin Wilson

1/ 4/08 11:11am

Hey there

Thanks a lot for replying! its kinda comforting to know there are lots of other people out there too. Your email was really helpful and I will look into muscle relaxants like you suggest.

Sounds like you suffer badly too, I hope things pick up for you. My worry is that I will be like this for years and that scares me so much as I have been unable to work since this started and am burning through my savings as it is!

I think your right its time to find a new doctor, I actually really dislike the guy I see he is so rude and dismissive and has the WORST bed side manner ever! What is your doc like?

Tamsin

GWP

1/ 4/08 1:57pm

I like my local neurologist very much. I've been seeing him for 10 or 15 years, and he's stuck with me, even when I've been very frustrating to treat.

At my request, he referred me to Dr. Jan Lewis Brandes in Nashville about a month ago. My local doc was about out of ideas. I'm going to continue to see my local neurologist while I'm seeing Dr. Brandes. He wants to keep an eye on me, and my primary care doctor wants me to have a local neurologist in case trouble comes up.

Dr. Brandes is the one who put me on the Skelaxin/Anaprox/Imitrex regimen. Before I saw her, I considered pain between 1 and 5 (on the 10-point scale) to be "background noise," to be ignored as much as possible. Dr. Brandes instructed me to take the Skelaxin when the pain is between 1 and 3, and take Anaprox and Imitrex when the pain gets between 4 and 6. But I can only do the Anaprox/Imitrex three times a week.

I read your reply to Teri. Don't be afraid of a NPDH diagnosis. Even though it might be tough, it can be treated. And you don't have to have aura (the visual stuff) or nausea to be having a migraine attack. I don't think I've ever had aura, and I only rarely get nauseated. And even if I get queasy, I almost never throw up. I can take Phenergan, an anti-nausea drug, when I feel nauseated. But the pain is definitely migraine. It can be triggered by pain in my neck, scalp, and the base of my skull.

I understand the frustration of not being able to work. I had to give up a successful law practice because of my head. Have you looked into disability?

Hang in there!

Gretchen in Mississippi

Tamsin Wilson

1/ 8/08 12:02pm

Hey there

How's it going with you?

Yes I am on what's called incompacity benefit here in England but its next to nothing £60 per week. I am having to use my savings to cover doctor's costs as I am not insured and am out of work currently.

I'm sorry to hear you had to give up your law practice, do you work at all now?

I hope to return to at least part-time work if I can be given some form of pain killers for at least 2 days per week. I just need for this to be over ASAP as my family are beginning to think I am a chronically depressed despite me explaining what it is. My mum is taking me to see a healer this thursday to see if it helps any!

Tamsin

Nancy Harris Bonk, Health Guide

1/ 3/08 3:52pm

Hello, and welcome to MyMigraineConnection.com!

Tension-Type Headache (TTH) can be broken down in to three types: Infrequent Episodic Type TTH, Frequent Episodic Type TTH and Chronic TTh. Chronic TTH occurs when we experience more than 15 episodes per month for three or more months. For detailed information on Tension-Type Headache, click HERE.

When prescriped preventive medications, our bodies sometimes take almost three months to adjust to the correct dose. Being on 3 different medications in 5 months, hasn't given you the opportunity to see which of these medications will work to reduce your head pain. Do you see what I mean?

Some medications that have been used for TTH include muscle relaxants, Botox, and antidepressants, like amitriptyline. Complementary therapies like physical therapy, massage, and biofeedback are often used to help treat TTH.

You may need to find another doctor who can help you with your head pain. A Migraine specialist is an expert in Migraine disease and headache disorders who will properly diagnose and treat you. Click HERE to see our list of patient recommend speicalists.

Thank you for creating a SharePost. SharePosts are a form of blogging, and there are many things you can do with them. You can share an experience, suggest something that's helped you, use SharePosts as a Migraine and headache journal, and many other things.

We also have a discussion forum that you may want to check out. Especially if you have questions or are looking for information, you may find the interaction on the forum to be quite helpful. To get to the forum, just look for the orange box marked "Manage" and click on the Migraine Forums link. Because our forums are maintained by a third party, you'll need to register for the forum. You can use the same information you used to create your community log-in if you like. If you want to go directly to the forum, you can click HERE.

Along with your personal "My Home" page and the discussion forum, you'll find links to a great deal of helpful information on the main page of our site, MyMigraineConnection.com

If you have any questions, please feel free to post them to the forum or send me a message through my profile.

Welcome again,

Nancy Bonk
MyMigraineConnection.com Expert

PS: If you receive this message from more than one of us, please excuse the overlap. Thanks!

Tamsin Wilson

1/ 4/08 11:15am

Hi Nancy

Thankyou loads for your reply.

Yes I think your right, I probably haven't been on these preventative drugs for long enough and I do need to find a headache specialist as I really dislike the Neurologist I am seeing!

Thanks again

Tamsin

Teri Robert, Health Guide

1/ 4/08 2:30am

Miffy,

Once medication overuse headache has been ruled out, I don't understand why your doctor won't prescribe something for pain for you to try a couple of days a week. Prescription pain meds can cause rebound too, but most doctors will prescribe something for a couple of days a week to try to give you at least some relief.

Three preventive medications in five months? If you were taking each of them separately, they may not have had time to work. It can take up to three months to give them a fair trial.

Since you mentioned this starting, did your doctor conside that this might be new daily persistent headache (NDPH)? You can find some information in our article New Daily Persistent Headache - The Basics.

Keeping in mind that neurologists aren't necessarily Migraine specialists, you might want to think about a second opinion.

For prevention, the same medications are used for headache and Migraine prevention. There are over 100 of them, and you can find them listed in Migraine preventive medications: too many options to give up! . There isn't really any one best preventive medication. I can tell you that when I developed chronic tension-type headaches on top of my Migaines, Zonegran took care of them.

Welcome to MyMigraineConnection!

Teri

Tamsin Wilson

1/ 4/08 11:24am

Hi there

Thank you for your reply it really helps. I am looking into another doctor as we speak.

I looked into New Daily Persistent Headache myself as it seemed to fit with my symptoms but it scares me even more if it is that as in your article it says people tend not to respond to treatment...

Is it possible to have both mild migraine and Chronic Tension Type headaches? You

see I am not sure if I am having mild migraines every day as it feels like my head is going to explode with this heavy painfull pressure like achey pain. I dont have nausea or problems with sight though..what do you think?

Teri Robert, Health Guide

1/ 4/08 4:59pm

Miffy,

You're very welcome! Glad to be of help.

Yes, you can have both CTTH and Migraines, but you would have both a tension-type headache and a Migraine at the exact same time. One thing that can happe is that a TTH can trigger a Migraine.

One way some people can tell the difference between a headache and a Migraine is to sit down and put their heads between their knees. If activity like that makes it worse, it's more likely to be a Migraine.

Please give some thought to checking out our forum too for additional discussion.

Teri

Tamsin Wilson

1/ 8/08 12:03pm

How do you access the forum? I thought these blog things were the forum!?

MaxJerz

1/ 5/08 3:47pm

Hi Miffy, it looks like you've gotten some great feedback here already.

I just wanted to add that I was diagnosed with chronic daily headache (CDH) about five years ago, and I truly do have head pain every day. Over the last two months or so, the daily headaches are now daily migraines. So I can understand your frustration with daily pain!

I've tried five preventives since March - Topamax, nortriptyline, cyproheptadine, gabapentin, verapamil. I had awful reactions to two of them (cyproheptadine and verapamil); two of them were ineffective (Topamax and gabapentin); I'm still one one of them (nortriptyline) seeing if a different dosage will work.

I'm telling you all of this because I know how frustrating it is to keep dealing with the daily pain while trying to find a preventive that works. OTC painkillers haven't worked for me for probably five years. (Occasionally ibuprofen will take the edge off, but I only take that out of desperation if I've already reached my triptan limit for the week.)

It takes a lot of courage and perseverance to keep trying different meds while coping with the daily pain. Have you tried any complementary therapies, like biofeedback, acupuncture or meditation? These may help you cope with daily pain.

Keep hanging in there, Miffy. One day you will be very glad you didn't give up!

Tamsin Wilson

1/ 7/08 2:44pm

Hi there

Thanks for your email it was really informative and helpful. You mentioned that you have been having chronic daily headaches for 5 years. Do you have chronic migraine every day or chronic tension type headaches every day?

Yes I've tried acupuncture and massage, both were really nice and relaxing but didn't touch the headache at all.

Do you take prescription pain killers then? The neurologist I am seeing wont prescribe me any but I am hoping the new headache specialist I am planning to see will do.

Can I ask how your constant headache came about?

It's so weird eh that over the counter painkillers wont work anymore. Do you have a view on this?

Tamsin

Tamsin Wilson

1/ 7/08 2:45pm

Hi there

Yes I've tried acupuncture and massage, both were really nice and relaxing but didn't touch the headache at all.

Do you take prescription pain killers then? The neurologist I am seeing wont prescribe me any but I am hoping the new headache specialist I am planning to see will do.

Can I ask how your constant headache came about?

It's so weird eh that over the counter painkillers wont work anymore. Do you have a view on this?

Tamsin

MaxJerz

1/ 7/08 11:56pm

Hi Miffy. My chronic daily headaches used to be just that, headaches. I had migraines about 3-4 times per month. Recently (the past month or so) these have become chronic migraines, instead of headaches, with a severe migraine once a week.

I do not currently take any prescription painkillers. I have been working with both my neuro and my new headache specialist to find a preventive medication (or combination of medications) that works. I also just got a prescription for Imitrex to use as an abortive, no more than twice per week.

I won't lie, it's been very difficult to cope with the pain and migraine symptoms. Until about a month ago, I couldn't do much for my daily pain but try to get through it, rest when I could. I developed a lot of "tools" for my "toolbox" of tricks for when I'm in pain. I haven't pursued the painkiller route for a number of reasons, the number one being that I usually have a strong reaction to narcotics.

It's hard to say how my constant headache came about. I think it was a combination of factors - some of it was medication overuse headache (MOH), some of it was because I was left untreated for so long. From personal experience, the longer I leave my pain untreated, the worse it gets.

There's a good overview of MOH HERE.

- MJ

Tamsin Wilson

1/ 8/08 11:56am

Hey there

Thanks for reply

I'm sorry your suffering so much too, I hope you find the right preventative one soon.

Yeah I've had medication overuse headache ruled out, but have yet to have new daily persistent headache ruled out. I have an appointment with a new specialist headache doctor next week so fingers crossed I get hold of some proper prescription pain killers : )

I really need to get some help because I am beginning to be a real burden to my family and friends. I hate that this consumes my life but its so hard for it not to be when you have a pain that is constant its like an itch you cant scratch...

It's hard isn't it when loved one's who you try and explain it to again and again still think your either chronically depressed or deliberately avoiding life!

Tamsin

MaxJerz

1/ 8/08 12:34pm

I can definitely relate. I often feel guilty for how little I help out with chores or errands. DBF does understand, but I still feel bad leaving him with all the work to do.

It sounds like your symptoms may indeed be NDPH - obviously, I'm not a doctor, so I don't know for sure. My CDH developed gradually: frequent headaches which eventually became chronic. MOH was likely part of it a few years ago, but this past year it hasn't been. So maybe I would have become chronic even without the painkillers. It's hard to tell.

I do hope you find something soon. Being in pain every day is awful, and almost impossible to explain to someone who's never experienced it.

Heart MJ

MaxJerz

1/ 8/08 12:34pm

Oh, and good luck with your new specialist! Let us know how it goes.

MyHeadHurts

1/ 8/08 12:10am

A reason many neurologist tend not to give pain killers to Neuro patients is because they (pain pills) can mask the signs and symptoms of neurological degeneration. it may be happening and nobody would even know it because theywould they you are 'loopy' on pain pills.

Im really concerned about your doctor. He doesnt seem to be giving you proper care or attention that fit your health needs. I have daily (chronic) tension headaches. look up neurologists, or specialists in your area, or ones that are affiliated w/the hospital that you frequent most.

Remember pain pills are just a bandaid. Just an opinion, see a specialist [infectious disease..not as scary as it sounds], and they will figure it out [most likely]. BUT you should still find a new neurologist!!!

Tamsin Wilson

1/ 8/08 12:10pm

Hi there

Thanks for your reply, I'm always curious to hear from other people who have chronic tension type headaches 24/7 as most people suffer from migraine mostly. How did you come to be diagnosed and how long have you been unwell?

I am seeing a headache specialist next week so hopefully he will be more help. What treatments work for you by the way?

Tamsin

Shel

2/ 6/09 6:24am

It was wonderful to find this website. I was diagnosed yesterday with NDPH and, just like many of you, it was a long road to this diagnosis: MRI, artery biopsy, spinal tap, steroids, weekly blood tests, etc. I finally went to Mayo Clinic - who came up with the NDPH diagnosis in mere days. I have to go back there next week to discuss treatment and all your comments on different medications is so informative and helpful to me. I will read this site faithfully and hope that we all find some relief.

CHRONIC TENSION HEADACHE

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