Q: I am a 33-year-old man and since January this year I have been suffering from persistent headaches.
They occur almost every other day and sometimes last for days.
I did a 2.4km run a few months ago and the pain got so bad it lasted for three days. I have done an MRI scan which, thankfully, did not reveal any abnormalities.
As I am allergic to painkillers such as Diclofenac and Synflex, the specialist I consulted prescribed Propranolol, which I am supposed to take on a daily basis and in increasing doses. I do not like relying on long-term medication and after doing some research, discovered that Propranolol can lower one's heart rate and blood pressure.
Is it safe for me to engage in rigorous exercise while on this medication? Also, what are the possible causes of my headaches?
A: The condition you described is medically termed chronic daily headaches.
The causes can be categorised as secondary - headaches caused by an underlying condition e.g. infection, tumour or haemorrhage - or primary - headaches not caused by an underlying condition.
A doctor will conduct investigations such as a brain scan to exclude the former before considering the latter.
Examples of primary chronic daily headaches are chronic tension headaches, chronic migraines and chronic cluster headaches.
The management of primary chronic daily headaches often involves avoiding trigger factors, use of pain relief medication on a when-needed basis and use of a regular daily preventive medication.
The daily preventive medication is for reducing the frequency and severity of the headaches. These effects are usually seen only after the medication has been taken for several weeks. It is then usually continued for a few months and tailed off after the condition improves.
Your MRI scan, showing no abnormalities, rules out several possible secondary causes. However without the details of your examination and investigation findings, it is difficult to know which form of headache you have.
If you are taking a high dose of Propranolol, you should be cautious when engaging in rigorous exercise.
There are many other daily preventive headache medicines available and you may want to discuss using an alternative with your specialist. You should also discuss possible trigger factors and how to avoid them.
Dr Chan Yee Cheun is a counsultant neurologist at National University Hospital.
