I'm posting here about some help for my wife. She has had daily severe headaches for over three months now. The symptoms started with cold-like symptoms and three days later came neck pain with the headaches. She's been diagnosed at different times with viral meningitis, neck strain, postviral headache, postviral syndrome, and migraines. She doesn't have auras and has only had nausea twice during a headache but could have been coincidental (one time was at the same time her blood sugar bottomed out). She has quite a bit of dizziness, lightheadedness and ear/jaw pain when the headache is the most severe and it starts/gets worse with exertion.
A back x-ray and an MRI were both negative. Bloods and urine in the very beginning showed an asymptomatic UTI and an EBV positive indicative of previous infection but nothing else. Ibuprofen, naproxen, acetaminophen, sulindac, fioricet, phenergan and imitrex all failed to do anything more than take the very edge off the pain or knock her out so she could sleep through it. She's currently taking tramadol 50 mg which is giving her a bit better relief but gets breakthrough pain. Prednisone didn't help and nortriptyline not only didn't help but made her aggressive/manic and have blackouts. She doesn't have TMJ or ear problems.
A neuro put her on topamax almost a month ago (now at 125 mg split dose daily) and it hasn't helped at all. An APRN-C that deals with a lot of pain management was recommended to us for a second opinion as the neuro seemed pretty uninterested in looking for a cause of the headaches. We like the APRN-C a lot. She ordered the MRI and the back x-ray, told her to stop the nortriptyline and prescribed the tramadol. The visit today delved into other possible causes of the headaches. Her BP has always been on the high side of normal but since the headaches started it's been as high as 163/102 and the lowest was around 145/95. She prescribed metoprolol 25mg 2x/day and is doing an overnight pulse ox test to check for sleep apnea. They'll meet again in two weeks to see where we're at.
I guess what I'm asking here is if, from experience, someone can suggest anything to consider. Her biggest complaint is the pain getting worse with exertion and says that if the doctors can't make the pain go away completely then she just wants to be able to exert herself without additional pain. She works a very physical job and was off for 2 1/2 months due to the headaches. She isn't handling the extra pain or the frustration about it well and isn't dealing with the everyday stress of the job as well as she used to. She alternately claims she isn't depressed and says "who wouldn't be depressed having this headache every day?!?" I have fibro so I can totally relate but it's so frustrating to see your loved on in pain and not to be able to do anything about it. *sigh* Any input?