# Headaches

All this is based on personally going through the entirety of the ichd-3 headache directory, this occurred on 06/10/26

I have been tried on the following medications which have not helped at all:

- 50mg Sumatriptan tablets
- 10mg Amitriptyline

I get two distinct types of headaches, one on my left side the other on my right

### Left side headache

This usually is a pain akin to having a railroad spike crammed through the top of my eye/through the area just above my eyebrow through my eye down to my wisdom teeth in almost a straight line. These are extremely painful, even comparatively low level instances being a tier above any other form of pain I've experienced. Occasionally I have had the similar stabbing sensation in my temple and top of my head, I have also had instances of burning. All pain is around eye, top of head or temple and stays consistent for the entire duration of the headache.

The headache is always  one sided, always on my left side and usually appears at the same times every day aside from instances where one has been triggered.

The pain has been bad enough that each stab has given me a flushing feeling of adrenaline, on top bringing along feelings of self harm. The most blatant of which was an instance where I wanted to shatter my own eye socket against a wall in some pointless attempt to try and help the pain, the main thought process along with this was the idea that doing an action of physical harm like that, could not hurt more than the current pain I was in.

These headaches follow a daily pattern, they appear around 3 times a day, the same time every day within an hour. Typically they appear around 8am, 12pm and 4pm.

This comes with other symptoms aside from the pain such as:

- My eye on the side of the face being noticeably wetter however not excessive tearing
- Drooping of the eyelid/feeling that it is misplaced/too heavy
- Nasal congestion on the side of the pain
- Side of the face being significantly warmer
- I have also noticed a few times my pupil being constricted on that side

As far as triggers go I have found the following:
 
- Alcohol - if I don't already have one it will trigger a headache otherwise it will make the current one rise a few levels in terms of pain. This has been significant enough I have stopped drinking all together
- Exercise/heat? This is either one or the other or a combination I am yet to work out, but shortly after an intensive walk/trip I always get a headache once sat down again for a bit

### Right side headache

The headaches on my right side are alot harder to explain. I've had such a broad variety of sensations. The worst in recent memory was a while of feeling as if I had placed razor blades between my teeth on the right side and completely tore up my gums with it. I've also had stabbing eye pain similar to that of headaches on my left side, through to it constantly changing, going from stabbing in the eyes, to side of the head, to top all the meanwhile feeling a sense of like staticy noise throughout the area that's affected at the time. It's really quite a bazaar sensation. I've also had shorter lasting pain similar to this, but that seems rarer

This particularly is triggered by air conditioning blowing in my face. This has been the case for most of my life

This being such a wide topic to talk about makes it hard to write down a proper description of how this is. The pain is still pretty bad, but it's nothing compared to how bad the pain on my left side can be 

## Migraine without aura

Based on the content of the [page](https://ichd-3.org/1-migraine/1-1-migraine-without-aura/).

> Headache attacks lasting 4-72 hr (untreated or unsuccessfully treated)

Even accounting for instances where I have failed to notice a break in the headaches (as they follow a stop start pattern) I have never had one longer than a maybe 8ish hours

> pulsating quality

My headaches follow far more of a stabbing sensation than pulsing, this is not due to intensity of the headaches as I have had fairly low instances of pain that follow either the same sharp stabbing pain or a constant burning

> aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs)

I have never got aggravation while doing something active, however if I am initially active, and then rest, after a brief period the pain does intensify and then calms back down. This seems non-characteristic of for criteria

> During headache at least one of the following:
> 1. nausea and/or vomiting
> 2. photophobia and phonophobia

The only times I have experienced nausea due to these have been after eating, where it seems the pain makes processing food drastically harder and disrupts that, never from just the headache alone, this is more characteristic of gastroparesis due to the high pain levels than it being caused by the headache itself. Ontop of this I have never got photophobia nor phonophobia alongside my headaches

I believe this diagnosis does not explain either style of headache I have

## Migraine with aura

Based on the content of the [page](https://ichd-3.org/1-migraine/1-2-migraine-with-aura/).

> One or more of the following fully reversible aura symptoms:

I have only ever have a single one which could be described as this. Just above my eye brow often feels numb-ish during and before a headache. This lasts during the headache until everything has disappeared. So while it could be an aura, this is uncharacteristic especially due to the following:

> at least one aura symptom spreads gradually over ≥5 minutes

It is immediate and only covers a small area

> two or more aura symptoms occur in succession

I have only ever had this single one

> each individual aura symptom lasts 5-60 minutes

It has no timeframe, it lasts as long as the headache is there

> at least one aura symptom is positive

This has never been positive

> the aura is accompanied, or followed within 60 minutes, by headache

Sometimes I have got the sensation without it ever triggering into a headache. However, based on my tracking of them and the rhythmic nature of these headaches these do occur during my usual slots

I believe while this could be the case, the diagnosis feels flimsy and inaccurate. This sounds similar but too many details don't match up and do cause me to miss the diagnostics criteria. Ontop of this the criteria specifies:

> Recurrent attacks, lasting minutes, of unilateral fully-reversible visual, sensory or other central nervous system symptoms that usually develop gradually and are usually followed by headache and associated migraine symptoms.

As the symptoms develop gradually this is one of the strongest points against this, as my headaches tend to be very fast acting in terms of pain. Never gradual more as if someone has turned on a switch

## Tension-type headache (TTH)

Based on all subcategories of this [page](https://ichd-3.org/2-tension-type-headache/).

This does not match my headaches at all. Requiring bilateral location, a pressing sensation, and a mild to moderate intensity. None of which are true. I would describe my headaches as extreme and I do not use this lightly, it is a pain unlike anything I have ever felt before

## Cluster headache

Based on this [page](https://ichd-3.org/3-trigeminal-autonomic-cephalalgias/3-1-cluster-headache/).

> Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes (when untreated)

My headaches have been so severe to the point I have completely remapped my pain scale into two categories. It has been extremely noticeable watching my pain tolerance increase as I have more and more of these headaches. My worst was in june, which was a level of pain I have had flashbacks to, I have had panic attacks about. It was a level of pain that keeps you up at night and I have broke down discussing with friends. I would classify all my headaches I get on my left side as severe, and that instance was one I could consider very severe. I have never experienced anything like it. Even as I write this it has given me such a level of fear thinking about I am physically trembling, I cannot express enough how bad this instance was. The pain points also entirely map up. The only issue with this criteria I could see would be the times, however as I have noted before my headaches follow a stop start nature. Usually I believe they have gone only for the them to start up again 5 or so minutes later, under greater amounts of pain tracking the timings gets hard and one headache blurs into another which I believe can account for this

> at least one of the following symptoms or signs, ipsilateral to the headache:
> - conjunctival injection and/or lacrimation 

I have not noticed any reddening of my eye, but I had some tearing however it has not been excessive in the ways described here. Far more similar to getting something in your eye

> - nasal congestion and/or rhinorrhoea

Usually whenever I have a headache nasal congestion occurs on the side of the pain has been true for every one I have checked.

> - eyelid oedema
> - forehead and facial sweating

I have never had either of these symptoms, however the pain side of my face has been extremely warmer 

> - miosis and/or ptosis

I have received both of these symptoms, however the drooping of the eyelid to a lesser extent. Often when I have these headaches I get a heavy/misplaced feeling of my eyelid

> - a sense of restlessness or agitation

This is perhaps the greatest point against but I believe this can also be explained. Under extreme instances of anxiety I compulsively lock up, this is not a physical issue but is far more of a mental one, I believe it has it's roots in cptsd, it has not been uncommon to freeze like this. During the course of the headaches I have also noted that when the pain gets to a certain level I do start to freeze up in exactly the same ways. On top of this I do experience agitation, the pain being so severe I will isolate myself to prevent lashing out at others. I do also ensure I have distractions, the main one I rely on is messaging friends who can help usually getting immediate responses. Any forms of media be it games, shows, videos etc just provoke my agitation further during extreme instances

> Occurring with a frequency between one every other day and 8 per day

This frequency fits what I have experienced

While this obviously is a popular diagnosis people jump to when doing their own reading, I do believe there is a case to be made here, the symptoms I have noted here are highly indicative of cluster headaches. Speaking to the lived experiences of those who do have them with a diagnosis, the aura like sensation I get above my eyebrow can also be explained as a form of shadow. This is perhaps a route to go down

## Paroxysmal hemicrania

Based on the [page](https://ichd-3.org/3-trigeminal-autonomic-cephalalgias/3-2-paroxysmal-hemicrania/).

This shares alot of the same criteria as cluster headaches. So I will try not to repeat myself, instead see that section

> Severe unilateral orbital, supraorbital and/or temporal pain lasting 2-30 minutes

While the locations are correct, I regularly have headaches longer than this, while it is possible I have missed a stop start point, this seems unlikely and I am highly sure they have been longer than this regularly never having seen one as short as 2 minutes

## Short-lasting unilateral neuralgiform headache attacks

Based on the [page](https://ichd-3.org/3-trigeminal-autonomic-cephalalgias/3-3-short-lasting-unilateral-neuralgiform-headache-attacks/).

The timescales for this do not fit my headaches at all, especially being seconds long. However I have had similar instances to this on my right side however I don't feel this is the cause due to a lack of any of the other symptoms associated with this which to my knowledge have never appeared on my right side

## Hemicrania continua

Based on the [page](https://ichd-3.org/3-trigeminal-autonomic-cephalalgias/3-4-hemicrania-continua/).

> Present for >3 months, with exacerbations of moderate or greater intensity

This does not fit my situation at all, since my occur at regular intervals not for longer than 3 months

> a sense of restlessness or agitation, or aggravation of the pain by movement

As mentioned in the migraines section my headaches are not directly aggravated by movement, only once resting after movement

This does not seem like a fit for what I experience

## Other primary headache disorders

Having gone through this section I feel none of these fit my situation however I can go through them in greater detail upon request

## Secondary headaches

As I have had no physical trauma, nor any other changes in my physical health I have elected to skip this section for now, as it is long and I have limited time. However as with the primary headache disorders I can go through this on request

## Trigeminal neuralgia

Working off the [page](https://ichd-3.org/13-painful-cranial-neuropathies-and-other-facial-pains/13-1-trigeminal-neuralgia/13-1-1-classical-trigeminal-neuralgia/)

This is completely uncharacteristic for headaches on the left side of my head however this is now entering familiarity with pain on my right side. Having had alot of frequent pain on the left side of my face since I was a child

> A disorder characterized by recurrent unilateral brief electric shock-like pains, abrupt in onset and termination, limited to the distribution of one or more divisions of the trigeminal nerve and triggered by innocuous stimuli

I have received this a number of times, breezes especially trigger this

> Additionally, there may be concomitant continuous pain of moderate intensity within the distribution(s) of the affected nerve division(s).

This I have also been receiving alot, since childhood this has been a frequent issue, especially around air conditioning like that in a car. It often leaves me with longer bouts of pain following the descriptions on this page

> In a few patients, pain may radiate to another division, but it remains within the trigeminal dermatomes.

This has been frequent for me. Bad attacks often radiating through this area, going from one sensation in one place to another hopping between them

This seems like a likely explanation to the pain I get on my right side, however there are a great many types and subtypes to this, far too many for me to even begin delving into

# Conclusion

Having read so much on all of these topics and properly engaged with this. I feel the most likely candidates would be cluster headaches to explain the pain on my left side or potentially some other form of TAC since it's so characteristic of such however the other forms don't seem to fit as well as that does. This would also fit with the current meds I have been trialed on not making any difference

As for my right side some form of trigeminal neuralgia seems to be the closest bet, especially with the former cluster headaches giving it some credit with it being common enough that the ichd-3 page explicitly mentions:

> Some patients have been described who have both 3.1 Cluster headache and 13.1.1 Trigeminal neuralgia (sometimes referred to as cluster-tic syndrome). They should receive both diagnoses. The importance of this observation is that both conditions must be treated for the patient to become headache free.

This indicates a pairing like this is common enough  that this needs to be explicitly mentioned.

However, I have written this to be an aid to help properly list and compare all my symptoms against various diagnoses but the understanding here is that I am not a doctor, I have no authority, expertise nor training. I simply felt this would be a useful thing to do for my own treatment