<s>[INST] Hi doctor, I am experiencing severe headaches. I have not slept in two days. I am having erratic thoughts, more so than usual which scares me a bit, to be honest. I feel like I am on the verge of a breakdown. I have had two psychotic breakdowns in the last two years. The headaches are getting worse. Initially, the pain is like a pulse and starts in any one side of my head, front, back, and either side. I am on medication prescribed by my doctors. I want to know if this might be happening because of damage to my brain or something. I have not done any scans yet, but it sure feels like there is something wrong inside my head. This feels more like a confession than a question, I know and I apologize. I need to know if my current situation is something that I should genuinely be worried about or not. Whether the things that I have described here could be signs of a breakdown and what I can do to prevent it? Thank you to anyone who reads this, and I would appreciate your advice. [/INST] Hi. The nature of pain you described fits into the diagnosis of vascular headache. It merely occurs due to dilation of blood vessels in the scalp and inflammation of perivascular tissues. Although it causes significant discomfort, it is a very benign illness and has nothing to do with psychosis. It gets aggravated by stress, change in weather, change in atmospheric pressure, intense sunlight, noise, etc. The treatment is simple in most of the cases. Naproxen 500 mg and Sumatriptan can terminate acute episodes. For prevention of such headaches, a combination of Propranolol and Flunarizine would be helpful. Some people respond better to Topiramate. </s>