“Painful headaches?”
Hello, I have been having headaches that feel kinda pressure. I have also found that I'm more bothered by light than usual, seeing the bright light gives me pain in my head. I have been a little disoriented and a little bit dizzy do you have any idea what's wrong with me?
Female | 14 years old
Complaint duration: 10 days
3 Answers
Based on your signs, most like you’re suffering from migraine, one of the most common disease worldwide and major cause of disability. Migraine is understood as a disorder of sensory processing in susceptible people, and the pain reflects trigeminovascular pathway activation and sensitisation. The timeline of a migraine episode includes Premonitory symptoms, the AURA headache and Postdromal phase. However, before making the diagnosis of migraine, it’s important to rule out secondary headache disorders initially. Consider secondary headache disorder if the headache changes in character or frequency. Medication overuse headache often coexists with chronic migraine and needs to be addressed. Disorders of the cervical vertebrae, should be excluded, as well as the PFO of the heart. Migraine without aura is classified as Primary “recurrent headache disorder manifesting in attacks lasting 4-72 hours. Typically, characteristics of the headache are UNILATERAL location, PULSATING quality, moderate to severe intensity, aggravation by routine physical activity and association with NAUSEA and/or PHOTOPHOBIA or Phonophobia (l believe, this is your case).
Treatment:
-Soluble Aspirin 1gram+Brufen 400mg.
-Elemental Magnesium 600mg once daily orally, Riboflavin 200mg, twice daily.
-Ice packs around the forehead or back of skull, heat packs over the tense muscles of the neck and shoulders, and rest in dark room.
Migraine prophylaxis:
-Propranolol 20 mg orally at night, uptitrate weekly by 20 mg each time to 80 mg twice a day, continue for 8-12 weeks, or
-Candesartan 4-8 mg daily, uptitrate by 4-8 mg weekly to 24-32 mg (mornig dosing if hypertension, nighttime dosing if normotensive). Or
-Pizotifen 0.5mg orally at night, uptitrate to 1.5-3mg. Or
-Amitriptyline 10 mg orally at night, uptitrate weekly by 10-50 mg.
Second-line medications:
T-apiramate 25 mg orally daily, uptitrate weekly by 25-100 mg twice a day.
Treatment:
-Soluble Aspirin 1gram+Brufen 400mg.
-Elemental Magnesium 600mg once daily orally, Riboflavin 200mg, twice daily.
-Ice packs around the forehead or back of skull, heat packs over the tense muscles of the neck and shoulders, and rest in dark room.
Migraine prophylaxis:
-Propranolol 20 mg orally at night, uptitrate weekly by 20 mg each time to 80 mg twice a day, continue for 8-12 weeks, or
-Candesartan 4-8 mg daily, uptitrate by 4-8 mg weekly to 24-32 mg (mornig dosing if hypertension, nighttime dosing if normotensive). Or
-Pizotifen 0.5mg orally at night, uptitrate to 1.5-3mg. Or
-Amitriptyline 10 mg orally at night, uptitrate weekly by 10-50 mg.
Second-line medications:
T-apiramate 25 mg orally daily, uptitrate weekly by 25-100 mg twice a day.
Could be migraine but may need an eye check to check retina
This is migraine. Make sure you are well hydrated and sleep well, take some Panadol and ibuprofen when it happens, also check your eyesight as low eyesight is a trigger.
