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advice on daily headaches and possibly depression

I am 26years old woman and have had daily headaches since I was about 16. I often get migraines, about 1-2 every month or so, but in stressful periods of life, the daily headaches can transform into migraines 3-4 times a week, with heightened anxiety and panic to boot. On an average day I would say the headache pain is only 2/10 in the morning but will often escalate to 5-7/10 by the evening. I have been on a pill for over 8 years that stops my periods so I don't think the headaches are hormonal. I am over weight at 12stone 8 and only 5ft 2 - I try to lose weight as I am not happy with it but its sooo hard!
Finally doctors are actually listening to me and I've been put on 10mg amitriptyline daily. I've been on this a month now and I have noticed a very dry mouth and drowsiness but it has not really helped my daily headaches. Also, maybe just a coincidence, but my mood has been lower...recalling traumatic experiences I have had over the years resulting in a few episodes of anxiety which I have not suffered in a long time. I don't know whether to ask to up the dose, as I know this drug is an anti-depressant and that 10mg is a low dose( and this sees to be the drug for getting rid of CDH), but I am worried about making my mood even lower. Recalling one traumatic episode in particular has in the past made me want to hurt myself and has brought on thoughts of suicide...but I am so so tired about always having a headache. I get the impression doctors are getting bored of me mentioning headaches to them and that they will just up the dose to get me out and move on to the next patient. Comments like "what do you want me to do? If you want meds ill give you them, if not why are you here?" from one doctor I saw do not encourage me to 'pester' them with it again. Also I find it hard enough to lose weight already, and I believe tis drug can make you gain weight.
Any advise would be very gratefully received as I feel at a loss with what to do.
Sarah
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replied July 4th, 2013
Hi, and thanks for your query on eHealth forum!

Since you have a headache almost daily, what you have is in all probability not a simple migraine but a chronic daily headache (CDH). This can be the primary type—without any cause. One simple reason for daily headaches with nausea is compression of cervical spinal nerves. Another reason is TMJ, especially if the headache starts with chewing. The third reason could be severe acidity with or without GERD. The CDH could also be secondary to trauma, raised intracranial hypertension, high blood pressure, temporal arteritis etc. Hence all these need to be ruled out.

If the headache lasts for less than 4 hours then it could be a chronic cluster headache or a chronic paroxysmal hemicranias. If it lasts for more than 4 hours it could be chronic tension headache, chronic migraine or altered migraine or hemicranias continua. Indomethacin is the drug of choice in hemicranias continua. In fact the diagnosis is considered confirmed if a patient responds to Indomethacin. Consult a gynecologist and rule out hormone imbalance and low estrogen as the cause of your headaches. Since a confirmed diagnosis cannot be given on net please discuss these possibilities with your doctor once. Hope this helps. Take care!



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