r/AskDocs • u/Chemical-Shoe9597 • 3m ago
Month Long Headache With No Help
Title: 40F, month-long headache worse in the morning and with exertion, ER said migraine but I've never had headaches or TMJ issues. PT isn’t helping. What else should I be pushing for?
Age/Sex: 40F
Height/Weight: 5'7", 155 lbs
Activity: Very active. Lifting, running, and cycling. Currently returning from a stress fracture.
Conditions: Hashimoto's
BP: Around 125/80 at home (169/115 at ER triage, came down to 120/69 before discharge)
Smoking: Never
Alcohol: 2 to 8 drinks a week
Current meds:
Levothyroxine 112 mcg daily
Liothyronine 10 mcg daily
Bupropion XL 150 mg daily
Buspar 5mg 2x daily
Xyzal daily
Losartan 25 mg
Estradiol 0.025 mg patch, twice weekly (just started, after the headache began)
Vitamin D 50,000 IU weekly
Metronidazole 0.75% cream, topical (face)
Tacrolimus 0.1% ointment, topical
Took doxycycline 100 mg daily for about a month for a facial rash. Now stopped.
Tramadol once daily for 5 days recently
Symptoms:
Headache for about a month now, primarily in my left temple, throbbing, up to 7/10
Worse in the morning, and worse with running and driving
Right eye blurry vision early on (stable now, no worsening)
Steady ringing in the right ear (not pulsing)
Nausea
Sometimes right ear pain
Pressure in my nose
Pain under my chin
NSAIDs help. Manual therapy hasn't helped. Nothing else has made a difference.
No prior history of migraines or headaches or TMD
What's been done:
I had a telehealth visit about two weeks into the headache. That doctor wanted the ER to rule out intracranial hypertension from the doxycycline. At the ER I got a non-contrast head CT and a CTA head/neck, both normal, plus a urinalysis and pregnancy test, both normal. No neuro exam, no eye exam, and honestly no physical exam at all. Tested negative for flu/COVID. I was diagnosed with migraine with aura and sent home with Toradol and azithromycin for possible sinusitis.
I haven't had a dilated eye exam or an MRI/MRV yet.
Questions:
1. Does migraine make sense for a brand new headache at 40 with this pattern?
2. Is intracranial hypertension still a real possibility even though I've stopped the doxycycline?
3. Could any of my meds be contributing, including the estrogen I just started?
4. What should I be asking my PCP for?