Daily Vet How to know if your pet’s got a headache

Have you ever wondered if your dog gets headaches when he’s under the weather? Whether your cat feels a sinus-ey stabbing pain behind her eyes when she’s got a cold? How would you know?

I’ve recently had cause to wonder whether my own dog gets headaches. As some of you may be aware, Sophie Sue’s been strangely “off” lately, likely the result of some brain tumor-related issue (she was diagnosed with one a year ago and subsequently underwent radiation therapy to shrink it).

Her symptoms? She’s been sluggish, preferring to sleep longer and ambulate less. She’s also been head-shy, preferring not to be petted on top of her head (not like her at all). In fact, when she sees a hand move towards her head (as if to pet her)...she flinches. But she’s also weak in her hind legs, she’s wobbly, and a week ago she had a twitchy kind of seizure in the middle of the night.

That’s why I took her to have her brain re-imaged yesterday at Cooper City’s Animal Medical Center (Veterinary Specialists of South Florida). The MRI showed that her brain tumor was about a third of the size it was when we embarked on the 18 courses of radiation almost a year ago. Good news. It also demonstrated an increased fluid volume in her ventricles and in her middle ears. What’s up with that?

So far we have no idea what it all means. Dr. Ron Burk, a boarded radiologist at VSSF is currently reviewing them. A disk with her then and now images are also in my possession, ready to get scrunched into an email and sent to Dr. David Lurie, top radiation oncologist at the University of Florida (soon to be at Miami Veterinary Specialists across the street from me in Miami).

With all the vagaries of animal heads to be considered, the question is not only “what the heck is going on?” for me it’s also, “what the hell is she feeling?”

You can always tell your doc your head hurts. An infant might dig at her ears when they’re in pain. Your toddler will point to where it hurts. But pets? We don’t have much to go on when it comes to headaches––or pain, in general. For animals we have to guess. And try different therapies. And hope we hit upon one that does as little harm as possible in our quest to bring them back to what we assume is their normal state.

It always comes down to the age-old question: Can they see what we see? Do they feel what we feel? How do they experience the world? Do they get headaches?

One thing I do know: When I told the oncologist (not the one I mentioned above) I suspected a headache, he kind of made a face––the kind of face that says, “OK, now you’re acting like a emotional pet owner and not like a scientist.”

Stick to what we can know is the medical mantra. Yet, as a pet owner, how can I help not wondering? And as a veterinarian, how can articulating that curiosity and investigating it not help me arrive at better decisions?

June 2nd, 2009

Add Comment64 Comments

I wanted to bring up a couple of point or maybe more like questions on this subject.

I unfortunately have had way too much experience with "human" brain tumors, their treatments, side effects of those treatments, etc. I'm wondering......do animal also suffer from the necrosis that the "dying brain tumor" leaves behind? The headaches, weaknesses, loss of complete faculties were all things I saw with a brain tumor (even when it was NOT growing). I was wondering if they attributed any of your dog's symptoms to the necrosis? I can tell you for sure......even when the tumor wasn't growing headaches were experienced from fluid build up around the site.

Also, do animals get the same classification of brain tumors? My family member had the worst Glioblastoma Multiforme...affectionately know as GBM. Do animals get the same variations?

Regards,

Patti Dennis

patti dennis June 2nd, 2009 10:01:04 AM

I wonder if part of the oncologist's issue is how the medical establishment has difficulty accepting the seriousness of pain issues. At least in humans, pain management is often overlooked in many medical conditions, experiencing pain is viewed as a subjective symptom and worth treating directly, and the use of pain medication is viewed as chemical dependency.

zandperl June 2nd, 2009 10:32:45 AM

This is one thing I dislike. Why can't you use the term headache to describe your dog without ebing labelled an over-emotional pet owner? Think about it, it appears her head bothers her, her avoidance of having her head touched would be an indicator that it is uncomfortable. Pain in the head = headache. Perhaps you should put it into medical terminology to make it more appetizing for the vet, but what about those pet owners without such knowledge that are trying to describe the issues their animal is having?

I hope you find out what is bothering Sophie Sue and are able to keep her comfortable.

Jen June 2nd, 2009 11:03:11 AM

I think one has to approach veterinary medicine from both sides; with what we know, and what we sense. I never learned if the middle ear density in my kitty was a tumor or a severe inflammation. Her MRI was read by multiple radiologists across the country and it just didn't seem possible to pinpoint. I do know that she had head pain and suffered. How could I think otherwise with the way she held her head and was just 'so off' as with Sophie Sue. I was fortunate to have this well-received with concern by sensitive and proactive specialists.

I wonder what the oncologist's response would have been if he'd been questioned about his perceived reaction? Maybe he did think the headache comment was an overly emotional one, but I wonder about the list of other things that may have been going through his mind. If it was the former, I'd like to think that he (and his patients) could benefit from hearing more of Dr. Khuly's impressions. It's so hard to know without engaging in open discussion.

If our animals can't speak on their own behalf and have to rely solely on their humans to help them, wouldn't it be best for each of us to communicate openly and lend ourselves toward an effort to understand what everyone is thinking in regard to medical care and support? We can learn so much more from each other this way, even if we don't care for the other's view. Plus, we can clear up any misconceptions that might have a negative slant. No client (whether in the profession or not) should ever walk out of their veterinarian's office confused or wondering if the doctor has understood their concerns.

With her high level of skill and compassion, Dr. Khuly is fortunate to be able to act on her own behalf as a veterinary professional and a client (notwithstanding the very personal and emotional aspects of Sarah Sue's case). She can also bring this to the table when dealing with her own clients who are very lucky to have her as their veterinarian.

I'm writing this on the heels of several calls over the past week from a client of my own who has walked out of his veterinarian's office feeling frustrated and confused over his little dog's situation. For the office it is a basic medical case. For the client, it is a life altering concern. Taking the time, and exchanging more information than we think is needed can clear a lot up from the start, including developing an understanding of where each of us is coming from.

In the end, at least we're acting fully as ambassadors for our special little creatures.

Renee June 2nd, 2009 12:17:43 PM

Horses clench their teeth much as people do, when tense or anxious or in pain. Since using a muscle repeatedly makes it stronger, and horses have freaking huge muscles, you can actually *see* when a horse has been clenching his teeth a lot. An overdeveloped, tender-to-the-touch muscle indicates overuse.

Horses can't *tell* us if they have headaches, but that precise issue (jaw clenching and tight muscles as a result) is often the root of human tension headaches. I strongly suspect that horses with these tender, overdeveloped muscles DO get tension headaches--these horses are often cranky and irritable, too. But that's not really something most people expect, since we tend to go overboard trying NOT to anthropomorphize. Ascribing anything remotely human to animals usually makes us a laughingstock, even when it does make sense.

I also find that dogs with tender-to-the-touch/overdeveloped temporalis muscles seem to be anxious or irritable types. So I wonder if they get tension headaches too. I wonder if dogs get dehydration headaches (as I do when dehydrated) if they are sick and get dehydrated. I wonder if they experience nausea as a side effect of some of their meds. Do they sometimes lie in one position long enough that a leg "falls asleep"? That would explain an intermittent mild lameness in one of my dogs that seems to have no other apparent cause. One of our dogs gets cold--shivering, teeth chattering, only improves with a thick blanket or sometimes even a heating pad--every time he gets into his food allergen, even in the middle of summer; what's behind that? What's he really feeling?

If identical situations in people cause pain or other symptoms, it's reasonable to think that dogs are experiencing symtoms they can't convey. Surely, if increased fluid volume would give a human a headache, then it would give Sophie a headache, right?

Galadriel June 2nd, 2009 12:18:43 PM

Sorry-I miss typed Sophie Sue's name. I know a Sarah and the names get crossed in my head :]

Renee June 2nd, 2009 12:19:21 PM

Can you try presumptive treatment with pain medication to see that helps? If she improves with Tramadol or an NSAID, that's a strong indicator that she is in pain, whereas if there is no change, it's less likely. You could try something stronger (narcotics) to be more sure.

Is there any treatment for the fluid that was found that you could try to see if that helps?

Mary Straus June 2nd, 2009 12:28:56 PM

Mary: Since she's already on prednisone and doing significantly better (though she seems to have reached a plateau), I'm just starting with the tramadol now. I've also got some amantadine on hand to see if it helps, too. One thing at a time.

Dr. Patty Khuly June 2nd, 2009 12:53:55 PM

patti: We can't biopsy this tumor (it's in the brainstem) so we don't know what it is (we suspect it's some kind of meningioma). The possibility of necrosis was there from the first, though the imaging isn't consistent with necrosis--that I know. The possibility of meningitis is there, though, as well as symptoms from the tumor (even though it's 1/3 the size it was at the first MRI). Lots of variables: How long she was on pred, etc.

Dr. Patty Khuly June 2nd, 2009 12:56:46 PM

If a muscle that a dog seems to have strained or pulled puts off heat, and you can feel the heat with your hand, it's sensible to assume that's it's inflammed and the dog is in pain. There are times when one of my dogs comes to me, with a pitiful look and a hanging down head, and when I put my hand on his head, it's noticably hot. Whether it's a fever or a headache, it doesn't matter to me, I know he doesn't feel well. I give him a Tramadol to see if he'll feel less achey, and he usually does.

KateH June 2nd, 2009 01:37:33 PM

I have a grandchild with hydrocwphalus. She has had a shunt since she was two days old and she is going on 7. She has a buildup of fluid due to her ventricles are not formed correctly. She gets terrible headaches when a low front comes thru- the low pressure affects her shunt and the fluid in her head.

YES SOPHIE SUE HAS A HEADACHE! Please get that baby some pain meds! Increased pressure in her head from the fluid is horribly painful- why don't people understand that pain isn't limited to humans?????

agadoremama June 2nd, 2009 02:19:06 PM

hydrocephalus not hydrocwphalus wish I could type better!!!

agadoresmama June 2nd, 2009 02:21:23 PM

Stick to what you "can" know? Well, duh, what causes headaches? Of course dogs and other animals get headaches! Do they even get "stress" headaches? PROBABLY since that is a simply biological reaction to stimulus, physical or other. God forbid we should be offended by the arrogance of a doctor who is dismissive and uncaring and making faces is certainly indicative of both (and I hope he reads this). Well, I'm offended AND it makes me wonder what other medical issues he isn't paying attention to for Sophie Sue and his other patients. I have zero tolerance for any "scientist" who is dismissive of pain issues. Dr. Oncologist should be slapped!!!

BTW, there are quite a few studies now showing that under-treated pain is near the top of the list of things that interferes with healing because the body is directing energy toward dealing with the pain instead of other healing. It is LONG past time for ALL doctors to adequately treat patient pain!!! It is absurd and cruel not to treat pain in animals. It isn't like they need to drive to work.

I'm so tried of some of the absurd, counter-intuitive presumptions underlying so much of "scientific fact".

PJBoosinger June 2nd, 2009 03:09:28 PM

It makes sense to focus on what is known, but to call it "thinking in human terms" doesn't make sense to me. Why would humans alone, of all animals, get headaches? We know they can be caused by simple physical things like sinus pressure or dehydration, withdrawal from alcohol etc. as well as stress and tension. Why wouldn't dog get headaches? They have nerves in their heads, don't they? Now, we may not be able to say when or how severe, but if we have to prove an animal feels pain before we treat it I think that's a shame.

Anne June 2nd, 2009 03:26:21 PM

The posters comments are terrific, thank you to all, especially patti for sharing her sad human-side experience. Shame on the vet oncologist, it is one thing to debate emotions in animals, but physically caused pain? Gee whiz, are dogs supposed to have thimble sized brains with a few cells and missing parts?

I was mulling over similarities between my Mom & Sealyham Dottie's death. She had the sudden "eyes" issue, repeated nasal infections, strokes of some sort, and at the end, her ear canals were swollen shut.

And since Dottie's one eye pressure raised to horrid glaucoma values, why on earth wouldn't she have a "headache"? Isn't that what glaucoma sufferers cite as initial symptoms? Once relieved by treatment, she became a new girl for her last 7-8 months!

My Mom had a series of strokes also and never once said she had pain, even her last day conscious. But what I wanted to bring up, was the intermittent history of hallucinations. My friend's Mom and others have mentioned that this is not uncommon in the dying person. So this leads me to wonder if this may also be part of a companion animal's dying process, particularly if it involves 6 mos - year chronic progression.

And if it does, would this contribute to the so-referred to "look in the eyes" we accept as a signal to let go.

And to the easily offended---stop reading.

Am I to believe that Pocket did not experience excruciating pain in her entire body, particularly her brain when heated to a crisp as potassium chloride travelled through her veins causing her heart to bang relentlessly against the chest wall for 3 minutes...just because every single muscle in her body was contracted & frozen hard as a rock; including her clenched jaw that would have prevented even a muffled cry?

I think not, and neither does the AVMA, otherwise this chemical would not be absolutely forbidden in its use.

Coming soon: You're only as sick as your secrets, part 11

Barbara A. Albright/NH June 2nd, 2009 03:26:50 PM

I have recently been reading the book Animals in Translation, by Temple Grandin. She had a section in there that talks about 3 levels of the brain; While as humans our frontal lobes are more developed the more basic part of our brain (second level if you will) is pretty much exactly like animals. This is the area that would respond to pain (if I am understanding her correctly) so it would seem logical that animals could develop something like a headache. They may not be able to 'reason' that it is a tumor in my head for example but they know that they feel off. At any rate it is a very interesting book for those of you who haven't read it.

J.C. June 2nd, 2009 07:04:33 PM

Since headaches are caused by many different medical conditions from sinus pressure to brain tumors, it is fairly reasonable to assume that pets do get headaches. After all they suffer medical maladies that cause them. Even tension headaches seemingly could be caused by too much pulling on a leash.

Doesn't seem far fetched to me at all. OF course my favorite remedy for a headache is excedrine and that would be toxic to our pets, so I guess the issue isn't do they get headaches, but what is the best way to identify and treat the headaches.

LorriM June 2nd, 2009 08:07:41 PM

It is difficult to know if pets are suffering from pain. They are so stoic. They deserve the benefit of the doubt if pain is a possibility they should be prescribed safe pain medications.

Julie June 2nd, 2009 08:18:52 PM

Funny that after I posted this and got a couple of responses I decided to ask 4 more vets whether they thought Sophie might have a headache. None of them thought she looked painful, just "depressed' or "dull" ( a neurologic description of her mentation). Starting the tramadol tonight. I'll let you know how it goes.

Dr. Patty Khuly June 2nd, 2009 08:27:04 PM

I can assure you that chronic headaches make me both depressed AND dull! Exhausted and miserable, in addition. (I was just treated for a pinched nerve in the neck that was causing severe headaches.)

Galadriel June 2nd, 2009 08:38:09 PM

Dr. Khuly: You as Sophie S's Mom, knows her looks & interpretation the best. How about a 81 mg. aspirin? Would that be safe in her condition?

Pretty disheartening to learn of the assumptions about pain in the professional community. I'm sure you have taken a good look at her eyes?

Barb A./NH June 2nd, 2009 09:05:11 PM

I wonder how this oncologist would have responded if it had been a man that owned Sophie Sue and had suggested the possibility of a headache - would he have treated a man as if he were overly emotional? Aside from the animal pain issue, I think this doc may be reacting to the gender of the owner. If this doctor thinks you are an "hysterical female" he may not take your input seriously - and that could negatively impact the care of the dog.

Mary June 2nd, 2009 09:26:59 PM

My brother-in-law once described an incident with his younger sister's pet rat - the rat spent a lot of time roaming free in the lounge if his owner was home, and loved cola. Combine this with my BIL getting himself a very strong rum&coke drink and leaving it unattended on the coffee table, and you got one extremely drunk rat that had imbibed as much rum&coke as he could hold!

The poor rat acted very obviously intoxicated for a while, staggering when he walked and wobbling in circles, etc, crashed and slept for a couple of hours, and very definitely had one heck of a hangover when he woke up. My BIL described how the rat was sitting still, hunched up, eyes mostly closed and flinching every time there was a noise or a change in the light - he certainly thought it was obvious that the rat had a horrible headache!

So if that animal could get a headache in the same way as a human can, from the same cause, I'd say that any animal can get headaches from the same causes as humans do. It's a physiological reaction, not 'all in the mind'! Best wishes to Sophie Sue and I hope you can pin down and fix the problem.

Mel Redcap June 2nd, 2009 10:17:43 PM

I'm with Galadriel and would add that any pain, especially nagging chronic pain will lead to those symptoms. Dr. K, glad you're going to try Tramadol. In my experience, if the treatment for pain helps, ergo there was indeed pain. Mom's always know when their kids are hurting :) Trust your instincts on this one.

Maybe it's just me but it sounds very odd to accept "mentation" but not the possibility of headaches or other pain since they all present with many of the same outward observable signs. Reminds me of my neurologist who just kept pooh-poohing me when I said that my headaches weren't my usual migraines and he kept insisting they were just a different kind of migraine. He had that "it's all in your head" look on his face. Yeah, it was indeed all in my head - MINI STROKES. I took a certain amount of joy in getting well enough to send him a copy of my MRI report! (Yes, Mary, docs [male and female] tend to be more dismissive of women but they're all pretty dismissive of anything they can't see on an X-ray, lab report, or etc. in my experience; at least until the patient is proven right and then it's often too late.)

PJBoosinger June 2nd, 2009 10:29:53 PM

I spend a lot of time reading about how pesticides can adversely affect people and pets, and have often wondered what pets feel when pet pesticides are applied to them. Lethargy is a common side effect from flea and tick treatments. Loss of appetite, skin irritation (including chemical burns), vomiting, incoordination, increased sensitivity to external stimuli, tremors, and seizures are also possible side effects of pesticide poisoning. But do animals feel pain when we apply flea and tick treatments to them? I have had people tell me that their pets run away from them when it's time for a monthly application of these products.

Would it be possible for researchers to use an MRI to determine which parts of an animal's brain are active before and after pet pesticides are applied to them? Has this ever been done?

If I were in college trying to decide on a thesis topic, I would choose to write about this issue.

James June 3rd, 2009 07:51:56 AM

James: I don't know that any work has been done in this arena...for any kind of pain in animals. But I'll try and take a look. I recently read about brain scans being used on monkeys to determine whether they experience emotional responses similar to regret (and it seems they do)--but not anything related to pain per se.

As to Sophie 16 hours post-tramadol: She looks much brighter. Though I had been cautioned not to use it in case it made her "duller" I decided that 12.5 mg wouldn't likely make her much worse--and it would only be temporary, anyway. I think you'll all be impressed to hear that just a little opiate went a long way.

Barbara: As to the aspirin--not along with the prednisone. That's a recipe for a perforating gastric ulcer. Good to know, right?

Dr. Patty Khuly June 3rd, 2009 10:19:15 AM

Dr. K, Good for you (and for Sophie); glad the Tramadol helped her! Don't be hesitant to use it. The dullness from meds is different from the dullness from pain so you'll be able to see it if you've gone a little too far. Have to tell you that a little pain relief goes a very long way to better quality sleep that's so critical for us all.

PJBoosinger June 3rd, 2009 11:12:12 AM

Dr K- so happy to hear the tramadol helped!

I forgot to mention- all the neurologists missed KTBug's shunt malfunction about a year ago...her signs- dullness, lethargy, headaches, JUST NOT HERSELF- all hallmarks of shunt malfunction and increased cranial pressure. My daughter and I made three trips to different ER's, including the big city hospital that put in the shunt... they all poo poo'd Bug's symptoms as flu, a cold, or general malaise.

Thank God my daughter trusted her mom's instinct- her shunt line had come loose from her shunt and fluid had started to build up. The shunt was repaired before damage was done and Bug is fine and dandy.

Hope all goes well for Sophie Sue and her pain meds give her relief. Thank goodness you care enough for your pup to know her and do what is right for her.

agadoresmama June 3rd, 2009 11:28:02 AM

Right now every single veterinarian I've talked to about Sophie and taken her to see is absolutely stumped. Keep her on the meds they say. We'll do another MRI in a few weeks or a couple of months (at $2,800 a pop it's a lot easier said than done for most clients). Yes, sometimes even veterinarians are on the losing end of the "I don't know" diagnosis.

Dr. Patty Khuly June 3rd, 2009 04:28:10 PM

Oh, oh, I didn't know she was still on pred. You have done the thorough eye exam... my elder Scottie also developed an issue in one eye post-liver tumor diagnosis that created pain.

I hope you can keep discomfort at bay, this is one of the stressful times of having a dearly loved companion---trying to figure out solving symptoms, because a cure in the big picture isn't possible. Been there, over and over.

My good positive thoughts for Sophie S.

Barb A./NH June 3rd, 2009 07:37:22 PM

I'm so sorry to hear that "I don't know" diagnosis. Hang in there, trust your instincts, and do whatever you feel is right for you and Sophie.

PJBoosinger June 3rd, 2009 11:54:04 PM

I wonder if this is the sort of information animal communicators can pick up on :-).

Pets tend to hide their pain. My dog had a jaw abscess when I first got him. I didnt know him that well, and assumed moving away from my hand was normal for him, and being aloof. After the fifth vet, and finally diagnosis and surgery, he was suddenly extra friendly and demanded more attention. He was craving attention before, but touching him on that side of his face hurt, so he tried to stay clear of people.

What about pressing their faces into something hard, like a wall? Sign of headache? or discomfort at least? I feel like doing that myself when I have a headache, and Australian aboriginals would wrap braided human hair tightly around their heads when they had a headache, for some form of relief.

Robin June 5th, 2009 12:16:28 AM

Robin: Head pressing is also a common neurologic sign that seems unrelated to pain. For example, dogs with liver problems that affect the brain do this characteristic head pressing. More likely, headaches will take on individual appearances in pets--the same way any pain might. Head shyness, depression/dullness, closed or partially closed eyes (when light makes the headache worse), etc.

Dr. Patty Khuly June 5th, 2009 10:02:28 AM

I'm very late to this post, but after reading June 11, I've gone back to read this one. Thank you for sharing your experiences and insights, Dr Patty!

It's been a long time since I've seen a Veterinarian or trainer mention these conditions that cannot be so easily studied: headaches, light sensitivity, etc.

I wonder how often an a animal has indigestion, pain when he pees, headache, dull abdominal pain? Does one dog chew alot because it relieves his terrible heartburn a little? Do lots of labs chew because they have been accidentally breed to be predisposed to heatburn? Did Tucker bite the child because the dog has a migraine? Perhaps that line of "bad tempered" Lhasa's (mom, two daughters) all suffer from chronic pain, never to be able to relieve it or explain why they aren't joyful.

We humans can't always diagnose our conditions even with our abiltity to read: Is this a heart attack or muscle ache from shoveling snow? If we humans can't always tell the cause of discomfort, perhaps the "moody" dog snaps at the passing child because he suddenly felt a stabbing pain, and not knowing the source, blamed it on the child. That is another benefit of the new positive dog training methods. Imagine not feeling well and then going to dog school on a choker chain. So sad!

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