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Having Headache In Both Occipital And Temporal Regions. Taking Amlodepine, Telma. TMJ Or Sinus?

Posted on Wed, 3 Apr 2013

Question: Hello Sir, I am 66 yrs old male taking hypertension med for over 30 yrs. Presently on Amlodepine 5 and Telma H 40 OD. BP is under control but goes to as low as 110/70. H was added recently about 2 months ago. I have been having headache/pain in both occipital and temporal regions for past 11 months. Contrast CT scan in of brain in Jun 12 showed "prominent vessel in left frontal lobe suggest underlying incidental venous angioma & prominant perivascular space in left basal ganglia". Found Vit B12 & Vit D deficiencies which have been made up now. My neuro phy put me on Amitone 10 mg OD and SOS Naxdom in Oct 12. Frankly I did not take Amitone as I read it was an anti depressant drug. My headaches are still continuing - coming down somewhat for a couple of days and back again. Need you help please. I read it could be TMJ?? I do have sinus pain which is much better with ayurvedic nasal drops, inhalation etc. etc. Pl advise. Thank you so much in advance.
XXXXXXX

Answered by Dr. Sudhir Kumar (24 minutes later)

Hi,

Thank you for posting your query.

First of all, I wish to reassure you that your symptoms and findings do not suggest any serious problem.

Your BP is under control, and hence is not the cause of headaches (high BP may cause headaches in about 10% of people).

Regarding the choice of BP medication, I would like to change amlodepine, as amlodepine is known to produce a side effect of headache. We can either increase the dose of telma H or replace with metoprolol.

Venous angioma as reported in the CT scan can be further studied with the help of MRI and veno/angiogram. However, I would like to clarify that venous angioma too is not the cause of headache, as it has not ruptured and caused any bleeding (there is a small risk of venous angioma rupturing and causing bleeding in the brain).

Also, TMJ and sinus are unlikely to cause these symptoms.

I would feel that the cause in you can be either vascular or muscle tension headaches. You could benefit from Sibelium (flunarizine), a calcium channel blocker.

I hope it helps. Please get back if you have any more queries.

Wishing you good health,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (15 minutes later)

Dear Sir,
Thank you v much for ur reply. Relieved that there could be no serious problem. My queries are -

1. I have been taking Amlodepine for over 9-10 years. The headaches are only 1 yr old. Maybe they could set in late. If I have to increase Telma H or can I just add only telma 40 in the evenings? metaprolol used to cause a lot of cough for my late father (a cancer surgeon himself).

2. I cannot do MRI as I have a Pacemaker. Any precautions to be taken for the angioma? If there are any bursts, what symptoms will it give?

3. I forgot to tell you that I started getting tiny flashes in the corners of my eyes. Can't really make out oif its one eye or both. This is from Oct 12. The Retinas are OK - just a small PVD in the left eye with no increased floaters.

4. What would be the dose of Sibelium? How long to take? Will it show results soon enough?

An akward question - pl excuse me for it. Do I need to see my phyiscian for the above suggested changes of medication. She may not appreciate my telling her I have gone online. Or can I go ahead with the medicine changes after you give me a final OK. I respect you highly as a neuro phy.

Thanks for the very prompt reply. XXXXXXX XXXXXXX

Answered by Dr. Sudhir Kumar (14 minutes later)

Thank you for getting back and providing more information.

Regarding your specific queries, below are my replies:

1. Adding one dose of Telma 40 mg at night may be better for you. As you suspected, the side effect of amlodepine may appear later.

2. MRI is not a must. Please watch for sudden attack of severe headache with vomiting, which could suggest a rupture of angioma. However, the chance of rupture is extremely low.

3. Tiny flashes are not a cause of concern.

4. Sibelium can be started at a dose of 10 mg at bedtime. Take it for one month, and we should see the difference.

I feel it is better to get a clearance from your usual physician. You could tell her that you discussed with another doctor- a neurophysician. You need not tell her it was online. It is better that she knows about the changes.

Best wishes,
Dr Sudhir Kumar MD (Medicine), DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (6 minutes later)

Thank you so much for the prompt reply Dr, XXXXXXX XXXXXXX One last query before I XXXXXXX my physician. Any side effects of Sibelium I should be wary about? I am under observation for high eye pressures - around 20 or so. (Due family history of Glaucoma) No drops started as yet since fields are OK.

I will XXXXXXX my doc and revert to you. Thanks so much once again.

Answered by Dr. Sudhir Kumar (2 minutes later)

Thank you for getting back.

Sibelium is a safe drug. Some people report mild drowsiness so it taken preferably at bed time. It may improve appetite, so, mild weight gain may be noted, if you increase the food intake. But no side effects to worry about.

Best wishes,
Dr Sudhir Kumar MD DM

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (1 minute later)

Thank you so much once again. My headache has rediuced by 50% already for now - interacting with you. With regards. XXXXXXX XXXXXXX

Answered by Dr. Sudhir Kumar (15 minutes later)

Dear Mr XXXXXXX XXXXXXX

Thank you and best wishes,
Dr Sudhir Kumar MD DM

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar