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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5657
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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I have been taking 2 TRAMADOL 50mgs aday for the past 2

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I have been taking 2 TRAMADOL 50mgs aday for the past 2 years, together with 6 CO-DYDRAMOL a day, for Muscular-Skeletal pain.
2 months ago I banged the top of my head and I have had severe headaches ever since.
I went to A and E and they tested my reflexes and they seemed to be ok, I was sent home with some Ibuprofen to take. They diagnosed post concussion syndrome. I was told that
if the headaches persist, I should come back to see them.
3 weeks later, the headaches were getting worse so I went back to A and E , they tested
my reflexes again, which were ok.- - and they told me to see my GP for a referral to a
2 weeks ago I saw my GP for the continuing headaches. My GP thinks the headaches are due to my use of Tramadol, even though I have never suffered this side-effect before.
My GP refuses to refer me to a Neurologist, and has asked me to cut down the Tramadol
to 1 a day for the first week, and then to stop taking it altogether.
I am doing my best and have cut down to 1 Tramadol a day, but my headaches are as
bad as ever.
I would like your comments or opinion on whether the Tramadol could be causing the headaches and whether the Neurologist referral is required.

I would agree with both of these statements. Chronic use of pain killers can, ironically, lead to what are called rebound headaches or overmedication headaches. The treatment is weaning off the pain killers and then reassessing the situation. A neurologist experienced in managing headaches can develop a treatment plan for managing the pain while coming off the tramadol and co-dydramol.

Customer: replied 1 year ago.
Dear Dr BobCan it really be a coincidence that I have been getting headaches ever since I banged my head, given that I was
not getting headaches before, even though I have been taking the same medication long-term, associated with a long
and complex medical history going back to a car accident in 1978.

While coindidence is certainly possible, and this would have developed anyway, it is also possible that you "triggered" the syndrome when you banged your head. In other words, you were predisposed to getting rebound headaches but they did not start until you injured your scalp and skull (where the pain fibers are) or suffered a concussion with injury to the neurons of the brain (that don't actually feel pain, ironically)...or both. It is certainly possible that these new headaches, whatever the cause (and it might be a complex interplay of forces) will subside within the expected timeframe of a concussion (3-6 months). It is also possible that your clinical situation has changed for good now. This is why working with an experience neurologist could be so important.

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