u/Commercial_Rise4330

My case is complex because I have schizophrenia, persistent daily head pressure, and cognitive symptoms affecting my memory, concentration, and speech. I’m not sure whether these symptoms are related to my schizophrenia or if they have another underlying cause.

**Persistent daily head pressure** for about one year, present every day without completely going away.
**Constant baseline head pressure** that fluctuates in severity throughout the day (approximately **2–3/10 at best and 8–9/10 at worst**).
**The pressure is relieved only during sleep** and returns shortly after waking up.
**Occasional brief sharp (****“****ice-pick****”****) head pains** lasting a few seconds.
**Poor short-term memory**, with difficulty remembering recent conversations and events.
**Difficulty concentrating** and sustaining attention.
**Speech and word-finding difficulties**, making conversations and phone calls challenging.
**Cognitive slowing** and difficulty processing information.
**Blurred vision in the left eye**, with possible optic nerve abnormality currently under evaluation.
**History of schizophrenia**, currently treated with antipsychotic medication.
**Additional History That May Be Relevant**
The head pressure **began around the time my olanzapine dose was reduced and my fluoxetine dose was increased**, although it has persisted despite subsequent medication adjustments.
I have **tried multiple migraine medications without significant relief**.
My brain **CT and MRI have been normal**, and I am undergoing further evaluation, including **MRI with contrast**.
I am being evaluated by both **neurology and psychiatry** because it is unclear how much of my symptoms are neurological versus psychiatric.

Head Pressure History
Approximately one year ago, I developed constant daily head pressure. The onset was sudden and clearly remembered. The symptoms began shortly after my olanzapine dose was reduced from 7.5 mg to 5 mg while my fluoxetine (Prozac) dose was increased to 40 mg.
Since that day, the head pressure has been present every day and has never completely resolved.
The intensity fluctuates throughout the day, usually ranging from 2–3/10 at its best to 8–9/10 at its worst, but there is always a baseline level of pressure.
The pressure involves my entire head rather than one specific location. It is a constant pressure sensation rather than a throbbing headache.
The only time I experience relief is when I am asleep. As soon as I wake up, the head pressure returns.
Associated Symptoms
Significant short-term memory impairment
Poor concentration and attention
Difficulty following conversations
Word-finding and speech difficulties
I do not typically experience:
Photophobia
Phonophobia
Nausea or vomiting
Aura
Because of these features, I personally do not feel that my symptoms resemble a typical migraine.
Medication History
After the head pressure began, I later returned to a higher dose of olanzapine. The head pressure became less severe but never disappeared completely.
I have also tried several migraine medications, including Ubrelvy and Nurtec, without benefit.
Previous Evaluation
Brain CT: Normal
Brain MRI: Normal
Routine blood work: Unremarkable

Head Pressure History
Approximately one year ago, I developed constant daily head pressure. The onset was sudden and clearly remembered. The symptoms began shortly after my olanzapine dose was reduced from 7.5 mg to 5 mg while my fluoxetine (Prozac) dose was increased to 40 mg.
Since that day, the head pressure has been present every day and has never completely resolved.
The intensity fluctuates throughout the day, usually ranging from 2–3/10 at its best to 8–9/10 at its worst, but there is always a baseline level of pressure.
The pressure involves my entire head rather than one specific location. It is a constant pressure sensation rather than a throbbing headache.
The only time I experience relief is when I am asleep. As soon as I wake up, the head pressure returns.
Associated Symptoms
Significant short-term memory impairment
Poor concentration and attention
Difficulty following conversations
Word-finding and speech difficulties
I do not typically experience:
Photophobia
Phonophobia
Nausea or vomiting
Aura
Because of these features, I personally do not feel that my symptoms resemble a typical migraine.
Medication History
After the head pressure began, I later returned to a higher dose of olanzapine. The head pressure became less severe but never disappeared completely.
I have also tried several migraine medications, including Ubrelvy and Nurtec, without benefit.
Previous Evaluation
Brain CT: Normal
Brain MRI: Normal
Routine blood work: Unremarkable

I was diagnosed with schizophrenia and have been taking antipsychotic medications. Every time I reduce my olanzapine dose, my constant head pressure becomes more severe.

I have not experienced any hallucinations or delusions over the past year.

My symptoms only go away when I’m asleep

My symptoms include:

My head pressure had a clearly defined onset.
Since it began, it has been present every day for the past year and has never completely gone away.
The intensity fluctuates from about 2–3/10 at its best to 8–9/10 at its worst, but there is always a baseline level of head pressure.
Occasionally, I experience brief sharp pains lasting a few seconds, although I cannot remember exactly how often they occur because my memory has been very poor.
When the head pressure becomes unbearable, I sometimes bang my head against the wall in an attempt to relieve the pain.
At the onset, I was sensitive to sound, but that symptom gradually resolved.
My brain MRI was normal, although I understand that a normal MRI does not rule out a primary headache disorder.