What are the recommended diagnostic and management steps for a patient experiencing chronic posterior head pain and a "rolling" sensation for over a year, which resolves with flunarizine, clonazepam, paroxetine, and pain-relief medication but recurs upon discontinuation, despite a normal brain MRI?
Your symptoms of posterior head pain and a rolling sensation, which improve with flunarizine, clonazepam, and paroxetine, often point toward vestibular migraine or persistent postural-perceptual dizziness (PPPD). Because your symptoms return when you stop these medications, it is crucial not to discontinue them abruptly. I recommend seeing a neurologist or neurotologist. They can help establish a safe, gradual tapering plan, explore vestibular rehabilitation therapy (specialized physical therapy), and find a sustainable long-term management strategy.