What can I do to help treat my husband's post stroke headaches?

1 answer | Last updated: Sep 27, 2016
Sglassford asked...

My Husband had a series of 3 strokes on 4/21/11. Since the strokes, he has had a terrible headache everyday on his left side of his forehead and it affects the sight in his left eye. The headaches are so severe that he cannot function. The doctor has tried several pain medications but nothing takes away the pain. The forehead feels like he has a fever also. Any suggestions?

Expert Answers

James Castle, M.D. is a neurologist at NorthShore University HealthSystem (affiliated with The University of Chicago) and an expert on strokes.

The first thing I would do is make sure that all necessary imaging has been done. This would include an MRI of the brain and either a CT angiogram or MR angiogram of the vessels of the head and neck. Those would help assure that there is no "mass lesion" causing the pain, and no tear or abnormality of one of the arteries that would cause such pain. For the purposes of imaging his arteries, I do not think a carotid ultrasound, which is very commonly ordered, is sufficient. A "sedimentation rate" blood test would also be helpful to make sure there is no evidence of an inflammatory condition called "Temporal Arteritis".

If no dangerous cause is found, I have had the most success with three medications (which can be used alone or in combination). Those include pregabalin, gabapentin, and amitriptyline. I would ask your husband's doctor if they have tried those. If not, consultation with a pain medicine doctor might be very helpful with consideration of the use of narcotic pain killers (overseen carefully by the pain specialist).

I hope that helps.