Why is the Side of My face Drooping? All about Bell’s Palsy

shutterstock_142857034A few weeks ago a family brought their son in to the clinic because one side of his face including his eye and lips were not moving symmetrically with the other side.  Of course they were worried about the possibility of him having a stroke.  He’d had an upper respiratory infection that started about one week before and had a slight fever with runny nose.  He’d never had any neurological problems before.  He had a condition called Bell’s Palsy.

Bell’s Palsy is a problem with the nerves on one side of the face and it causes the muscles of the face to have decreased ability to move.  The muscles of the face can become weak or even paralyzed.  Patients often complain that one of their eyelids starts drooping or they drool out one side of their mouth.  When they smile, one half of the mouth doesn’t seem to move.

Most people who get Bell’s palsy recover entirely but a small number of patients have symptoms for the rest of their life.

Causes:  Inflammation of the facial nerve on one side of the face is the cause of Bell’s palsy.  A virus is the cause and there is some evidence that it’s the virus that causes cold sores (Herpes Simplex Virus – HSV) that causes the condition.  Other viruses may cause Bell’s palsy however including the viruses that cause Chicken Pox and Mononucleosis.

Symptoms:  When the facial nerve because inflamed from the virus, and the nerve may swell and get pinched as it travel’s through some tight spaces in the face.  If this happens it can cause weakness and even paralysis of the muscles of the face so you may see:

1)   Drooping of one eyelid

2)   Eyebrow that sags

3)   Corner of the mouth that does not move or sags

4)   One eye might not close completely

5)   Loss of taste in the front of the tongue

6)   Loud noises may cause pain on the side of the dysfunction

If your eye is not able to fully close, this can lead to dryness of the eye, so it’s important to seek treatment to prevent eye damage.

Treatment:  We don’t have any specific treatments for Bell’s palsy, but seeing a medical provider may be helpful to:

1)   Ensure the proper diagnosis, because the symptoms may be confused with a stroke or other neurological problems which can be dangerous if not treated appropriately

2)   Prevent damage to the cornea of your eye from dryness

3)   Steroids such as prednisone may be given to reduce the swelling of the affected facial nerve – this works better when started within the first 2-3 days of symptoms

4)   Antiviral medications such as acyclovir are sometimes given in hopes that they will help the body overcome the virus more quickly, however studies have not found any added benefits from using antiviral medications for Bell’s palsy

Recovery/Prognosis:  People who have less severe symptoms seem to recover more rapidly and have a better chance of full recovery.  If you are getting better within the first three weeks, the chances are better that you will totally recover.  A small group of people however have permanent moderate to severe muscle weakness in their face from Bell’s palsy.

Rare effects:  If there is severe damage to the facial nerve, it may heal in a disorganized fashion.  I have one patient who was bothered by tears coming from their eye when they salivate (before eating).   I’ve also had a patient whose eye would close whenever he smiled.  Fortunately this is not common with Bell’s palsy.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com


So what is a Stroke?

shutterstock_78690082I saw a patient the other day who was in her 30’s and was brought in the other day because she suddenly stopped speaking (we call this aphasia) and became weak and confused.  Patient’s sometimes come to the urgent care with symptoms of stroke or meningitis and these symptoms can be extremely anxiety provoking.

Stroke or CVA (Cerebral Vascular Accident) is the term that medical providers use to describe an event where part of the brain goes without blood for too long.  There may be permanent damage to the brain as a result.  The blood supply to the brain can get cut off if an artery in the brain or neck gets clogged or closes off or if there is an artery in the brain that starts bleeding.

Sometimes a patient may have a stroke and there are no permanent effects, while other people may lose important functions in their brain permanently.  The individual that I saw the other day became unable to speak and it was unclear if she was able to understand what was being said.

Symptoms:  The symptoms of a stroke depend on which area of the brain is affected.  Some symptoms of stroke may be recognized by the acronym FAST –

Face – Does the person’s face look uneven or droop on one side?

Arm – Does the person have weakness or numbness in one or both arms?  Does one arm drift down if the person tries to hold both arms out?

Speech – Is the person having trouble speaking?  Does his or her speech sound strange?

Time – If you notice ANY of these signs of stroke, call 9-1-1.  You need to act FAST because the sooner the treatment begins, the better the chances of recovery

Diagnosis:  Stroke is usually diagnosed based on the patient’s symptoms and specialized studies such as a CT scan (Cat Scan) of the brain, or perhaps an MRI of the brain.  Other tests might include ultrasound of the arteries in the neck and echocardiogram (ultrasound of the heart).

Treatment:  The type of treatment depends on the cause of the stroke.  For patients who are having a stroke due to clogged arteries to the brain, they might receive medication to break up the clot or have a procedure to remove the blood clot.  They might also start medications to prevent future clogged blood vessels such as aspirin, Coumadin or Plavix.  Patients who have damage in the brain that make it difficult for them to walk might be treated with physical therapy to help them regain mobility. Sometimes it’s necessary for these patients to spend some time in an assisted care facility where there are nurses, physical therapists, occupational therapists and speech therapists available to help in the recovery process.  An assessment may be done at the patient’s house to look for possible safety problem areas and give the patient devices and tools to help the patient be able to retain independence in their home.

Prevention:  You can lower your risk of stroke by:

1)   If you have high blood pressure, keep your blood pressure in the normal range

2)   If you have diabetes, keep your blood sugar under good control

3)   Check your cholesterol and make sure your bad cholesterol and triglycerides are not elevated

4)   Avoid smoking

5)   Exercise for 30 minutes a day or longer on most days

6)   If you are overweight – work on weight loss

7)   Do not drink more than one alcoholic drink/day if you are female or more than two if you are a male

8)   Make sure you take your medications as directed by your physician

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com

Altitude Illness

shutterstock_163362512Much of this information comes from Peter Hackett, MD, a wilderness medicine expert on mountaineering and altitude related illness and treatment.

Altitude illness is usually due to the stress of decreased oxygenation in the setting of an individual who is not acclimatized.  It can happen at any altitude over 8,000 feet and usually occurs during the initial ascent.

Two areas of the body that are most affected by altitude illness are the brain and the lungs.  When altitude illness strikes the brain it is divided into two groups called Acute Mountain Sickness (AMS) and High Altitude Cerebral Edema (HACE).  Lung injury is usually due to lung edema called High Altitude Pulmonary Edema (HAPE).

Risk factors for altitude illness:

1)   Genetic susceptibility

2)   Live at an altitude of less than 3000 feet

3)   Fast rate of climb/ascent

4)   Past history of high altitude illness (HAI)

5)   Age less than 50 years old (for Acute Mountain Sickness – AMS)

6)   Heavy exertion/exercise

7)   Pre-existing illness (especially for High Altitude Pulmonary Edema – HAPE)

Acute Mountain Sickness (AMS): Diagnostic Criteria

1)   Recent gain in altitude

2)   Headache and any of the following

  1. Gastrointestinal upset
  2. Fatigue or weakness
  3. Dizziness or lightheadedness
  4. Difficulty sleeping

3)   Feels like a hangover

Treatment of Acute Mountain Sickness:  Usually gets better on it’s own.  Average duration of symptoms is about 16 hours.  It may persist for weeks at higher altitudes however.  There may be progression to High Altitude Cerebral Edema (HACE) with or without High Altitude Pulmonary Edema (HAPE).  It responds well to descent/treatment.

1)   Oxygen therapy

2)   Descent

3)   Hyperbarics

4)   Acetazolamide (Diamox) – 125 to 250mg every 8-12 hours – start taking the day before travel until day 2 or 3 at altitude.

5)   Hyperventilation

6)   Dexamethasone 4mg every 6 hours – careful because this can lead to adrenal failure if used at high doses and if it’s not tapered gradually.

7)   Treat symptoms of headache with ibuprofen/naproxen, codeine, etc. and nausea with Zofran or Phenergan

Acetazolamide Prophylaxis:  125-250mg twice a day (5mg/kg/day) starting the day before travel and continued until day 2 or 3 at altitude.  If allergic to sulfonamides (sulfa) be cautious.  Side effects of the medication are dose related.  More commonly a feeling of numbness/tingling, metallic taste in the mouth, generalized fatigue, nausea and blurry vision can occur.

Prevention of altitude sickness:

1)   Go up slowly in staging – avoid a sea level to 9,000 foot climb in one day

2)   Sleep at a max of 2000 feet higher elevation each night

3)   Acclimatize to 10-12,000 feet before going any higher

High Altitude Pulmonary Edema (HAPE):  Symptoms

Early:  Fatigue, weakness, dry cough, shortness of breath with activity.  May progress to increased respiratory rate, increased heart rate.

Late:  Pink or blood-tinged sputum from lungs, crackles heard with stethoscope in the right axilla/arm pit.

Treatment for HAPE:  Oxygenation is the highest priority.  Descend with minimal exertion.  For mild/moderate cases use bed rest with oxygen.  For severe illness use high flow oxygen with descent and perhaps a hyperbaric bag.  There is some thought about using pulmonary vasodilators such as calcium channel blockers, nitric oxide, Viagra and/or Dexamethasone.

Preparation:  Take a medical kit with Diamox and dexamethasone and albuterol inhalers.  If you’re with medical providers, you may have access to nifedipine or Viagra also which may be helpful.

For more information:

1)   www.altitudemedicine.org

2)   www.hypoxia.net

3)   Auerbach’s Wilderness Medicine

4)   DuPoint Travel Medicine

5)   Tintinelli Emergency Medicine

If you are interested in learning more about wilderness medicine, a great resource for information is the wilderness medicine society:  http://www.wms.org/

This document is for informational purposes only.  Please consult your medical provider before attempting high altitude travel.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com

Head Injury – Concussion vs. more serious injury


This document is for informational purposes only and is not a substitute for being evaluated by a medical provider.

Head injuries are common all year long in the urgent care setting.  In the winter months, skiing or snowboarding is one of the leading causes of head injuries.  In the summer months, more sports injuries occur with the improved weather in the Seattle area.

Most head injuries are not associated with brain injury or longer-term complications.  Rarely, however more significant injuries may develop which could be due to bleeding around the brain.

Causes of head injuries:  Most of the time falls are the cause, but motor vehicle accidents, pedestrian or bicycle accidents and sports-related trauma also cause head injuries.  In the medical setting, we also have to be alert for signs of child abuse as well.  The risk of brain injury depend on the type of trauma and the age of the patient.

Higher risk injuries:

1)   High speed motor vehicle accidents

2)   Fall from a great height

3)   Being hit by a high speed, a heavy or sharp object

4)   Inflicted injury such as abuse

Symptoms of head injuries:

1)   Scalp swelling

2)   Loss of consciousness/passing out – Happens only 5% of the time and usually lasts less than 60 seconds

3)   Headache – Occurs in 20% of patients.  In children who are too young to speak, they may become irritable.

4)   Vomiting – occurs in about 10% of patients.  Children who have a head injury and vomit, do not necessarily have a serious brain injury.

5)   Seizures – Less than 1% of patients have a seizure right after a head injury.  A few of these patients will have a serious head injury.  We will usually do a CT scan of the head if  the patient has a seizure.

6)   Concussion – common symptoms include confusion or inability to remember events around the time of the injury, headache, vomiting, and dizziness.

When to seek help:

1)   The patient has recurrent vomiting

2)   The patient has a seizure (convulsion)

3)   The patient loses consciousness after the injury

4)   Severe headache after the injury, or it worsens with time

5)   Head injury in a child with behavior change (lethargic, difficulty to wake, extremely irritable, other abnormal behaviors).

6)   Difficulty walking, is clumsy or has lack of coordination

7)   Slurred speech or confusion

8)   Dizziness that is not resolving

9)   Blood or watery fluid comes from ears

10)  The patient is a child less than 6 months of age

11)  There is a cut that will not stop bleeding after pressure is applied for 10 minutes

12)  The patient fell from a height greater than 5 feet, or was hit with a high speed object or with great force

13)  Patient’s friends/family are concerned about how the patient is acting

When do I need a Cat Scan/CT Scan of the brain?  A CT scan is a special X-ray that expose children/adults to radiation and should be avoided if possible.  Sometimes, however a Cat scan will be recommended to diagnose more severe injuries.  Some possible symptoms which may prompt your medical provider to order a CT scan are:

1)   Prolonged loss of consciousness

2)   Persistent or severe memory loss/confusion

3)   Persistent vomiting

4)   Seizure

5)   Severe, persistent or worsening headache

6)   Suspicion of intentional injury (abuse)

7)   Behavioral changes (lethargy, decreased alertness, extreme irritability)

8)   Signs of skull fracture such as a bulging fontanel or skull deformity

9)   Abnormal neurological exam

10)  Severe scalp bruising or swelling in a very young child

Why not an MRI?  We use CT scanning instead of an MRI to look for brain injury in most head injuries because it is available at most hospitals, and CT is relatively quick compared to MRI.  MRI requires patients – including children to be completely still for at least 30 minutes and that can be challenging.

Head injury treatment at home:

1)   Rest – lie down or participate in quiet activities

2)   If the head is bleeding, clean the area with soap and water and apply pressure with gauze.  If bleeding does not stop, the child should be evaluated

3)   Tylenol may be given in most cases for pain/headache.  If the headache worsens, please have the child evaluated (see above).

Monitoring after head injury:  The patient should be observed for signs of worsening injury.  Please call your healthcare provider if any of the following are noted:

1)   Vomiting more than once or vomiting continues for 4-6 hrs after the injury.

2)   Severe/worsening headache

3)   Becomes more drowsy or hard to wake up.

4)   Confused or not acting normally.

5)   Has trouble walking, talking or seeing

6)   Develops stiff neck.

7)   Has a seizure (convulsion) or any abnormal movements or behaviors.

8)   Cannot stop crying – children

9)   Has weakness or numbness involving one side of the body.

Return to normal activities:  Patients who have sustained a concussion are at a risk for serious or even fatal complications of they have a second injury within a short time after the first injury – this is called second impact syndrome.  It important not to participate in high impact sports or risky activities for 6 weeks.

Post-concussion syndrome:  Sometimes the patient who has sustained a head injury may develop a group of symptoms in the first few days after the injury called “post concussion syndrome.”  These symptoms can include headaches, anxiety, irritability, dizziness, or impaired memory or concentration.  In 85-90% of patients, this resolves within a few weeks-few months after the injury.  There isn’t any specific treatment for post-concussion syndrome.

Head injury prevention:

1)   Wear a bicycle helmet when riding bikes, skating , sledding or participating in activities where you may hit your head

2)   Install car seats/booster seats correctly.  At least a booster seat is needed until the child is at least 4 feet 9” tall.  Individual states may have additional regulations about the use of booster/car seats.

3)   Use gates on stairways to prevent injuries in infants/young children

4)   Install window guards on all windows above the first floor

5)   Do not use wheeled baby walkers

6)   Teach kids to safely cross the street.  Young children should never cross the street alone.

7)   Discuss sports safety with your healthcare provider.  Be sure that a child has appropriate protective equipment.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com

Dizziness, Vertigo and Lightheadedness – A discussion of possible causes

shutterstock_134577920Patients present to the urgent care or medical clinic with dizziness quite frequently.  Finding the cause is sometimes challenging.  Hopefully a discussion on the topic will answer some questions if you or someone you know has dizziness/vertigo.

Dizziness:  often described as feeling that you are spinning or tiliting, or that you are about to fall or pass out.  Dizziness can also cause you to feel light headed or have difficulty walking straight.

Vertigo:  A specific type of dizziness that causes a sense of spinning, dizziness, swaying or that you are moving or the world is moving around you.  Several different issues within the inner ear or brain can cause vertigo.  Some of these issues are not serious and others are more concerning.

These feelings can last days, hours or just seconds and can come and go.  It may feel worse when you change positions (roll over or stand up) or move your head.  You may also feel nauseated or vomit, have a headache and be sensitive to light or noise, have double vision, have a racing heart

Causes:  Possible causes include:

1)   Inner ear problems – infection in the vestibular system, or small pieces of calcium can cause dizziness

2)   Meniere’s disease

3)   Benign paroxysmal positional vertigo

4)   Medications

5)   Migraine headaches

6)   Stroke or TIA

7)   Bleeding in the brain

8)   Brain tumor

9)  Heart problems such as low blood pressure or a rapid heart rate

10)  Motion sickness from a boat ride or similar motion

11)  Infection such as a bladder infection (especially in the elderly

When to seek help:  Warning signs that should prompt you to speak with a medical provider include:

1)   New or severe headache

2)   Fever greater than 100.4 degrees F

3)   Trouble seeing or double vision

4)   Trouble talking or hearing

5)   Weakness of an arm or leg

6)   Inability to walk without assistance

7)   Passing out

8)   Numbness or tingling

9)   Chest pain

10)  Persistent vomiting

11)  The patient is elderly

12)  The patient has had a stroke in the past

13)  The patient has high blood pressure, diabetes or smokes

Treatment:  The treatment is tailored to the individual patient and the cause of their dizziness/vertigo.  In addition to treating the underlying cause, other treatments may include:

1)   An antihistamine such as Benadryl or meclizine

2)   Anti-nausea medications such as Phenergan or Zofran

3)   Eply maneuver:  If the problem is due to benign positional vertigo due to small stones in the inner ear being out of place.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com

Help with low back pain

shutterstock_115219366Low back pain is very common, in fact about 80% of people have at least one episode of low back pain during their lifetime.

Symptoms:  Pain in the lower spine along the lumbar spine.  It may be worse with bending, twisting or getting into a seated position.  Sometimes patients with low back pain have irritation of the nerve root due to arthritis or a disk protrusion, but most of the time the muscles that support the back are the cause of the pain.  Radiation of pain, numbness or tingling or muscle weakness in specific areas can be due to radiculopathy or a “pinched nerve.”

Sciatica:  Pain that occurs when one of the 5 nerve roots branches of the sciatic nerve are irritated. This causes sharp burning pain that extends down the back or side of the thigh, usually down to the foot or ankle.  You may also feel numbness or tingling.

When to seek help:  Most patients who have low back pain can be seen and treated by their primary care provider.  If the pain is caused from a serious condition, a surgeon may be recommended.  Please contact your primary care physician if you have any of the following:

1)   Age 70 or older with new onset of back pain

2)   Pain that does not improve even when laying down at night

3)   Weakness in one or both legs

4)   Loss of control of bowls or bladder

5)   Back pain accompanied by unexplained fever or weight loss

6)   History of cancer or weak immune system

7)   History of osteoporosis

8)   Back pain as a result of falling or an accident, especially if older than age 50

9)   If pain does not improve within 4 weeks.

Diagnosis:  In addition to a physical exam and taking a history, your doctor may order tests to help determine the cause of your low back pain if it is not improving.  Some possible tests include x-rays, CT (Cat scan), or MRI.  Xrays can be helpful to look for vertebral compression fractures or alignment problems.  MRI or CT scans give more detailed images  of the soft tissues and bony structures of the back.

Bulging disk:  With time, the body breaks down bulging disks, taking pressure off the nerve.  A bulging disk is usually not an indication for surgery.

Treatment:  Remaining active is one of the best things you can do to help the pain.  Prolonged bed rest may actually make the pain worse.  Studies have shown that people with low back pain recover faster when they remain active.

Using a heating pad can help low back pain during the first few weeks.  Sometimes alternating between ice and heat is helpful.  Most physicians will recommend that patients with low back pain continue working if it is possible to avoid prolonged standing, sitting, heavy lifting or twisting.

Medications:  Pain medications such as aspirin, Tylenol, ibuprofen, or Aleve may be helpful.  In addition, we often use muscle relaxants such as baclofen or Flexeril for pain but they can cause drowsiness.  You should be careful if you need to drive and are taking a muscle relaxant or narcotic pain medication that can interfere with your ability to drive or operate heavy machinery.

Exercises:  We usually don’t recommend stretching routines or back exercises right after a new episode of back pain because sometimes this can make the pain worse.  As symptoms are improving, a program of exercises can help increase flexibility.

Physical therapy:  A healthcare provider may recommend physical therapy if the pain persists for more than 4-6 weeks.  They will work to help strengthen muscles of the back and stretch out other muscles that could be contributing to the back pain.

Osteopathic manipulation:  An osteopathic physician (Doctor of Osteopathic Medicine) may use manual techniques to treat acute or chronic back pain.  The theory is that reduction in range of motion to one part of the body can contribute to low back pain and low back pain may contribute to reduced range of motion.  Improving range of motion of the body may reduce the pain and break the cycle of pain.

Massage/Yoga:  Relief of pain can also be achieved with massage or yoga with the goal of improving range of motion and thereby allowing the body to heal itself.

Acupuncture, injections, manual traction, and braces may all be useful in some patients.

Sometimes surgery is recommended for the treatment of low back pain.

Prevention:  Staying active and flexible can help prevent low back pain.  Regular exercise can help strengthen the muscles of the hips/torso and abdominal muscles.  Avoiding activities that involve repetitive bending, twisting or high impact activities that increase stress on the spine can also be helpful.  Bend and lift correctly – at the knees rather than back.  Stretch out the hamstrings, quadriceps, piriformis and glute. muscles regularly.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com

Headaches – Migraines, chronic daily headaches, cluster and tension headaches

shutterstock_142814494We see patients with headaches in the medical clinic almost everyday. Although they are usually not life threatening they can be quite debilitating.

Several different types of headaches have been described in the literature including:

1)   Tension/Muscle contraction type headache

2)   Migraine headache

3)   Chronic daily headache

4)   Cluster headache

Muscle contraction/Tension headache symptoms:  pressure or tightness around both sides of head or neck, mild to moderate pain that is steady and usually does not throb, pain is generally not made worse with activity, pain can increase or decrease in severity, there is often tenderness in the muscles of the head, neck or shoulders.

Migraine headache symptoms:  migraines are a type of headache that seems to get worse with light, noise or motion.  Some people have nausea and vomiting with this type of headache.  Migraines can last for a few hours to up to 3 days.

Migraine triggers:  Some possibilities include:  Stress, anxiety, worry, menstral periods, birth control pills, fatigue, lack of sleep, hunger, certain foods or drinks (wine, any alcohol, aged cheeses, nutrasweet, MSG, nuts), etc.

Cluster headache symptoms:  Cluster headache are more rare.  They begin quickly without any warning and reach their peak within just a few minutes.  The headache is usually deep, excruciating, continuous and feels explosive, although can be pulsatile and throbbing.  The attack may happen up to 8x/day but usually only lasts for a short time (between 15 minutes – 3 hours).  The pain usually is around the eyes or temples and rarely starts in the face, neck, hear or side of the head.  It’s always on one side, and never on both sides of the head.  Most people who get this type of headache are very uncomfortable and can be restless and pace or rock back and forth when the attack occurs.  Cluster headaches can be associated with tear production, eye redness and runny nose, sweating and pale skin.  These types of headaches can begin at any age but have a genetic component.

Chronic daily headache/Medication overuse headache:  Headaches that occur as frequently as every day or present more than 15 days per month or at least three months are considered chronic daily headaches.  Most people with this type of headache have migraine or muscle contracture type headaches as the underlying type.  If you use medications frequently to treat headaches, a vicious cycle can occur where the frequent headache cause the patient to take medication frequently (non-prescription or prescription) and then a rebound headache occurs as the medication wears off.  Some types of medication that can cause these rebound headaches are:

1)   Narcotic medications such as vicodin or Percocet

2)   Butalbital medications such as Fiorinal or Fioricet

3)   NSAIDS such as Advil, Motrin, Aspirin

4)   Triptans (such as Imitrex)

5)   Excedrine (aspirin, caffeine and acetaminophen combo)

Other types of headaches:  Sinus headache or post-trauma headache

Danger signs of headache:  Seek medical attention of you have any of the following:

1)   Headache is the worst headache of your life

2)   Headache comes on suddenly and becomes severe within seconds or minutes

3)   Occurs with a seizure, personality change, confusion or passing out

4)   Beings right after vigorous exercise or a minor injury

5)   New headache and is accompanied by numbness, weakness or vision changes.

Do I have a brain tumor?  Headaches do occur in approximately 50% of people with brain tumors.  However, headaches are common and tumors are rarely found in people who are being evaluated for headaches.  If you are concerned about the possibility of brain tumor, please see a medical provider.

Treatment of headache:  The treatment is tailored to the individual patient.  Treating the underlying cause of the headache is the most efficient way to reduce the pain and frequency of headaches.  Sometimes  a headache diary can be helpful for people who have frequent and severe headache in order to help determine what might be triggering the headache.

For migraines, we break the treatment into two groups: acute management of the headache (medication you can take immediately for relief), and preventive management which include medications you can take on a regular basis to reduce the frequency of headaches that occur in the future.

Some medications which might be used to treat and acute headache are pain relievers such as aspirin, Tylenol, Toradol,  Excedrine, Triptans(such as Imitrex) for migraine, anti-nausea agents such as Reglan or Phenergan, Ergotamines, and sometimes narcotic pain medications.

For migraine prevention, commonly prescribed medications include beta blockers (propranolol is an example), tri-cyclic antidepressant medications such as amitriptyline, anti-seizure medications such as Depakote, Neurontin or Topamax, calcium channel blockers such as Verapamil.

Neurologists are doctors that specialize in the diagnosis and treatment of headaches.  To find a neurologist near you check out the American Academy of Neurology website at:  http://patients.aan.com/findaneurologist/

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com