Are my forehead and side headaches, which began after a carbon‑monoxide concern and persist with anxiety, likely anxiety‑related tension‑type headaches that can be ruled out as such?

Your Headaches Are Almost Certainly Anxiety-Related Tension-Type Headaches

Based on the temporal relationship between your headaches and specific anxiety triggers (carbon monoxide concern, car overheating), combined with the characteristic pattern of symptom fluctuation with attention and distraction, these are tension-type headaches driven by anxiety and stress.

Why This Is Tension-Type Headache (TTH)

Your description matches the classic presentation of tension-type headache in several key ways:

• Location: Frontal and bilateral temporal (sides) distribution is the most common pattern for TTH 1
• Quality: The sensation of "feeling your head" rather than sharp pain is typical—TTH is characteristically described as dull, pressure-like, or band-like rather than throbbing 1
• Attention-dependent intensity: The fact that distraction reduces symptoms while focusing on them intensifies the pain is a hallmark feature of tension-type headache, not seen in more serious secondary headaches 1
• Temporal pattern: The headaches appeared immediately after anxiety-provoking events (CO concern, car problems) and resolved when the first concern was addressed, only to return with a new stressor 1

Ruling Out Carbon Monoxide Poisoning

You can confidently rule out actual CO poisoning for several reasons:

• CO headaches are highly variable and nonspecific: While frontal headache is common in CO poisoning (66% of cases), the headache characteristics cannot reliably diagnose or exclude CO exposure 2
• Your temporal pattern excludes ongoing exposure: True CO poisoning causes headaches during active exposure; your headaches persisted after leaving the suspected source and resolved when anxiety about that source resolved 2, 3
• The "reality testing" worked: When you confirmed your car wasn't producing CO, the headaches disappeared—this wouldn't happen with actual CO poisoning, which causes persistent symptoms even after exposure ends 1, 4
• No other CO symptoms: CO poisoning typically presents with multiple symptoms including dizziness, nausea, vomiting, confusion, or altered mental status at levels that cause persistent headaches 1, 4, 5

The Anxiety Connection

Your insight about stress-related headaches is correct:

• Anxiety and depression are major contributors to headache-related disability and can both trigger and perpetuate tension-type headaches 1
• Catastrophizing and hypervigilance (focusing on symptoms and fearing the worst) significantly worsen headache intensity and frequency 1
• The mind-body connection is real: Anxiety activates muscle tension in the head, neck, and shoulders, which mechanically triggers TTH 1

What You Need to Do

Immediate Management

• Acute treatment: Ibuprofen 400 mg or acetaminophen 1000 mg can be used for active headache episodes 1
• Avoid overuse: Don't use acute medications more than 2-3 days per week to prevent medication-overuse headache 1

Getting Back on Your Medications

This is your priority. You've correctly identified that you need to restart your psychiatric medications:

• Untreated anxiety perpetuates the headache cycle through both psychological and physiological mechanisms 1
• Amitriptyline is specifically recommended for prevention of chronic TTH and also treats anxiety and depression, making it an excellent option if you're not already on it 1
• Your baseline psychiatric condition needs treatment independent of the headaches—the headaches are a symptom of inadequately controlled anxiety 1

Non-Pharmacologic Approaches

While restarting medications, implement these evidence-based strategies:

• Physical therapy or aerobic exercise are recommended for both TTH and migraine management 1
• Cognitive-behavioral approaches to reduce catastrophizing and attention-focusing on symptoms 1
• Stress reduction techniques to break the anxiety-headache cycle 1

Red Flags You Don't Have (But Should Know About)

You can be reassured because you lack concerning features that would require emergency evaluation:

• No thunderclap (sudden, severe, "worst headache of life") onset 6
• No fever, neck stiffness, or altered consciousness 6
• No focal neurologic symptoms (weakness, vision changes, speech problems) 6
• No progressive worsening independent of anxiety levels 6
• Normal pattern with clear psychological triggers 6

Bottom Line

Contact your prescriber immediately to restart your psychiatric medications. Your headaches are real (not imagined), but they're tension-type headaches triggered and maintained by anxiety, not a sign of CO poisoning or other dangerous pathology. The fact that you're having intrusive thoughts ("believing things that aren't even real") and difficulty maintaining stability without medication confirms that treating your underlying psychiatric condition is the definitive solution for both your mental health and these headaches.