Severe Headaches with Vertigo and Insomnia

[grillmaster]

I have always suffered with headaches, but in the last year they have gradually become so severe and constant that they are affecting my ability to function. It is rare to have a day that  my headache is dulled back enough that it is bearable. At times I suffer vertigo which can be brought on by standing, looking up, leaning over, or simply occur while I lay in bed with my eyes closed and turn over. Recently I have been experiencing insomnia. I have had my eyes checked and am told I need reading glasses (1.25) but that this should not cause the type of headaches and problems I am having. After my first child was born I had a spinal fluid leak, and 7 years ago I had surgery for (2) arachnoid cyst in the sacral region which had caused a spinal fluid blockage. So trust when I tell you I know what severe headaches are, and that is what I am dealing with on a nearly daily basis. Any advice or insight would be appreciated. Thanks in advance.

[grillmaster]

Thank You for taking the time to give me some insight. I have been hesitant to see a doctor in fear that the arachnoid cyst may be back and be the cause and therefore it would be called pre-exsisting, as I do still have electrical shocks down my legs from time to time and if I sit the wrong way even for short periods of time my bottom goes numb. But I do have a open window (4x1) where the bone was removed from my "turtle shell" and not replaced, so I assume this could easily explain those problems away. I feel a little better now that this could very well be something else going on that will not be labeled pre-exsisting, so I will be making a doctors appointment. I have had some hearing loss in the last 6 months (hard of hearing) so it could be related to an inner ear problem, and it could very well be and probably will end up being over use of over the counter headache meds. I often joke that I should own stock in the companies that make BC powders, tylenol, and ibuprofen as I would be a rich woman just from the money I invest in these companies. My husband tells me all the time that I am going to kill myself with these meds., however I don't know what choice I have had, even with the meds. I suffer constantly. Thank you again for taking the time to address my issues.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

It is difficult to provide you with much information regarding the headache based on your description. Headaches can be either primary (i.e., migraines, tension-type, cluster, etc) or secondary. Secondary causes of headache can be from a tumor, medication, vasculitis, neck problems, bleeds, clots, benign intracranial hypertension, or intracranial hypotension. This last type is the type you have experienced where there was a spinal fluid leak. These headaches are postural in nature meaning that they are worsened with standing up and improved with lying flat.

I agree that the vision is not the cause of your headaches. Given your prior history of spinal fluid leak and also with spinal fluid blockage, you really should be evaluated by a neurologist.  The vertigo (or dizziness) can be associated with migraines; however, it may be of a different etiology (e.g., inner ear which is postural like in your description). It is important to determine the type of headache you have. Each headache variant has its own treatment. Chronic headaches usually require an abortive medicine (i.e., a medicine to take at the onset of headache) and also a prophylactic medicine (i.e., a medicine to decrease the frequency of headaches). However, with frequent use of abortive medications including triptans, tylenol, advil, and others, medication overuse headaches can occur. This requires a specific treatment in which the over-used medications are slowly stopped and replaced with more long-acting medications.  

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.