Headaches while tapering

Posted by lynd @lynd, Jan 21, 2023

I have been having headaches & a senstive scalp while tapering from 6 to 5 mg of Predsolone for PMR. GP ruled out GCA as blood tests did not show increased inflammation.
Went to an Optometrist eye pressure was OK. Should I be worried?

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Hello @lynd, Welcome to Connect. Headaches can be a symptom of prednisone withdrawal but I'm not sure of sensitive scalp. My doctor was always asking me if I had any tenderness in the scalp or temple areas due to the concern of GCA. I don't think blood tests alone can diagnose GCA. Here's more information on the topic:

"How is GCA diagnosed?
The best way to confirm a diagnosis of giant cell arteritis is by taking a small sample (biopsy) of the temporal artery. This artery is situated close to the skin just in front of your ears and continues up to your scalp."
-- Giant cell arteritis - Diagnosis and treatment:
https://www.mayoclinic.org/diseases-conditions/giant-cell-arteritis/diagnosis-treatment/drc-20372764.

@tsc and @zaa may also have some thoughts on headaches and sensitive scalp while tapering to a lower dose of prednisone. Have you tried bumping the dose back to 6 or splitting a 1 mg tablet and going up to 5.5 to see if the symptoms go away?

REPLY

Hi @lynd, if Giant Cell Arteritis could be diagnosed with blood tests, then a biopsy of the temporal artery would not be necessary. Tenderness of the scalp is one of the symptoms, as is jaw pain, difficulty chewing, visual disturbances, headaches. I also had an itchy torso with no rash, a dry cough, especially at nights, extreme fatigue, due to anemia, a very stiff neck with pain that went up both sides of my head, and short stabbing pains in my face from the ear to the nose. The day before my biopsy I counted 25, Untreated, GCA can cause blindness or stroke. It requires a higher dosage of prednisone than PMR. Can you get a referral to a rheumatologist?

REPLY
@johnbishop

Hello @lynd, Welcome to Connect. Headaches can be a symptom of prednisone withdrawal but I'm not sure of sensitive scalp. My doctor was always asking me if I had any tenderness in the scalp or temple areas due to the concern of GCA. I don't think blood tests alone can diagnose GCA. Here's more information on the topic:

"How is GCA diagnosed?
The best way to confirm a diagnosis of giant cell arteritis is by taking a small sample (biopsy) of the temporal artery. This artery is situated close to the skin just in front of your ears and continues up to your scalp."
-- Giant cell arteritis - Diagnosis and treatment:
https://www.mayoclinic.org/diseases-conditions/giant-cell-arteritis/diagnosis-treatment/drc-20372764.

@tsc and @zaa may also have some thoughts on headaches and sensitive scalp while tapering to a lower dose of prednisone. Have you tried bumping the dose back to 6 or splitting a 1 mg tablet and going up to 5.5 to see if the symptoms go away?

Jump to this post

Hi thank you for your message. I will try the 1/2 dose as suggested as dropping from 6 to 5 is more than the 10% recommended. If no improvement I will see my Rheumtalogist. What is the best medication to take for the headache?

REPLY
@tsc

Hi @lynd, if Giant Cell Arteritis could be diagnosed with blood tests, then a biopsy of the temporal artery would not be necessary. Tenderness of the scalp is one of the symptoms, as is jaw pain, difficulty chewing, visual disturbances, headaches. I also had an itchy torso with no rash, a dry cough, especially at nights, extreme fatigue, due to anemia, a very stiff neck with pain that went up both sides of my head, and short stabbing pains in my face from the ear to the nose. The day before my biopsy I counted 25, Untreated, GCA can cause blindness or stroke. It requires a higher dosage of prednisone than PMR. Can you get a referral to a rheumatologist?

Jump to this post

Hi thank you for your message I really only have headaches no other symptoms, I have seen 2 GP's, (who have dismissed GCA), as my Rheumatologist has been away, hopefully I can get an appointment this week.

REPLY
@tsc

Hi @lynd, if Giant Cell Arteritis could be diagnosed with blood tests, then a biopsy of the temporal artery would not be necessary. Tenderness of the scalp is one of the symptoms, as is jaw pain, difficulty chewing, visual disturbances, headaches. I also had an itchy torso with no rash, a dry cough, especially at nights, extreme fatigue, due to anemia, a very stiff neck with pain that went up both sides of my head, and short stabbing pains in my face from the ear to the nose. The day before my biopsy I counted 25, Untreated, GCA can cause blindness or stroke. It requires a higher dosage of prednisone than PMR. Can you get a referral to a rheumatologist?

Jump to this post

I was told by my Neuro-Ophthalmalogist that a biopsy is the “gold standard” for GCA.

REPLY
@lynd

Hi thank you for your message. I will try the 1/2 dose as suggested as dropping from 6 to 5 is more than the 10% recommended. If no improvement I will see my Rheumtalogist. What is the best medication to take for the headache?

Jump to this post

@lynd, I normally take Tylenol when I have a headache but I don't have one often. I'm wondering if Teri @tsc might have some thoughts on what helps best when you also have PMR and possibly GCA. Are you able to call the rheumatologist or your doctor and ask when over the counter med would be best for you?

REPLY
@lynd

Hi thank you for your message I really only have headaches no other symptoms, I have seen 2 GP's, (who have dismissed GCA), as my Rheumatologist has been away, hopefully I can get an appointment this week.

Jump to this post

My scalp tenderness only lasted two weeks. It was odd. I only felt it when I touched my scalp with my fingertips.

REPLY
@johnbishop

@lynd, I normally take Tylenol when I have a headache but I don't have one often. I'm wondering if Teri @tsc might have some thoughts on what helps best when you also have PMR and possibly GCA. Are you able to call the rheumatologist or your doctor and ask when over the counter med would be best for you?

Jump to this post

Hi @johnbishop and @lynd, acetaminophen is the analgesic recommended for pain when taking prednisone. The standard dosage is two 325 mg pills or tablets. NSAIDS like Ibuphrophen should be avoided when taking prednisone.

REPLY
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