Case Summary  |  Posttraumatic chronic daily headache

In July, 2004 I was hit by a car as I was crossing the street. I lost consciousness and was admitted to hospital with skull fractures and blood flowing out of my left ear.

I have constant headaches since the time of the trauma. The pain begins with the heaviness in the back of my head on either right or left side, spreads upwards till it reaches my forehead, and then shifts to either of my temples. This is often accompanied by short sharp pain in my eyes. At the time like this my head is heavy as if the steam under pressure was weighting on my skull. The pain stops only when I take Maxalt (10 mg). Maxalt starts relieving the pain in approximately 40 minutes. After I take it, but in about 3-4 hours the heaviness in the back of my head returns.

I am currently taking:
Cymbalta (60mg)
Amitriptyline (20 mg before sleep)
Soma (1 pill in the morning)
Fioricet (1 pill at 4 PM)
Maxalt
Both Soma and Fioricet relieve pain for 3-4 hours.

Treatment:
After the trauma I was taking Tylenol (1 pill twice a day) for several months. I constantly had a dull pain in my head, but I did not take Maxalt. My physician prescribed me Gabapentin (300 mg 3 times a day). It helped for only about 2 weeks. In September, 2005 neurologist Dr. Rosenthal prescribed Desipramine (25 mg). It helped for 2 months in that I did not have severe headaches if I could lie down every 1-2 hours for 30-40 minutes. Then I broke out in a rash and started having a headache every morning. I stopped taking it. I was also treated the following: Topamax (25 mg), Lamistal (25 mg), Doxepin (25 mg), and 3 injections of nerve block. None of those worked. I still had constant headaches.

In September, 2006 my physician prescribed me Amitriptyline (10 mg) and Fioricet twice a day. The pain in my head stopped. The effect lasted for 2 months, then the pain returned. I increased the dose of Amitriptyline to 20 mg and the pain went away again. Like before, the effect lasted for 2 months.

In March, 2007 a neurologist cancelled Amitriptyline because one of its main side effects is gaining weight. He prescribed Vivactil (10 mg), Petadolex (1 pill twice a day), Fioricet (7 days a week), and Maxalt. I still had constant headaches. At that time I also had vomiting that lasted all day and my blood pressure that day was 140/100 (usually it is 116/80). I tried Nadolol, but broke out in a rash.

In May, 2007, he gave me Botox shots (low doses) in my forehead, temporal and occipital areas. He cancelled my previous medications and prescribed Amitriptyline (10 mg), Fioricet, and Maxalt as needed. This resulted in an improvement in that I did not have a headache when I was able to lie down often, but when I stayed in vertical position for more than 2-3 hours, I had a headache and took Maxalt.

I cannot lift my head and hold it that way because I immediately get a headache.

3 months later I got another Botox injection. The other medications I was taking at that time were Amitriptyline (15 mg), Fioricet, Maxalt, and Topamax. In the first 2 weeks after the injection my condition deteriorated. I had constant headaches and muscle pain in my neck and shoulders. Then I started having headaches every other day when I had to go out (e.g., take my daughter to school). In November the doctor cancelled Amitriptyline (15 mg) and Fioricet and prescribed the following: Soma (1 pill in the morning) and Maxalt (10 mg before sleep). I had headaches almost every day; 3 times I had severe vomiting, headache, and blood pressure 140/110.

In 2008 I got another Botox injection, Amitriptyline (20 mg), Soma (1 pill a day), and Fioricet (1 pill a day). The headache appears toward the evening and I am taking Maxalt almost every day. The effect of Botox is as follows: almost no pain in the temporal areas, but dull, pressing pain in the middle of my head, in my eyes, and in the back of my skull.

In 2009 my condition hasn't changed.