Cervical Fusion

by Anonymous

Do you think I have "cervogenic headaches"?

I am a 55 year old female. Here's my story (abbreviated):

I seldom had headaches until late in 2005, when I had a headache that wouldn't go away. It took a while, but finally I was diagnosed with a non-union type II fracture of Dens. Posterior fusion of C1/C2 in July 07. I spent the next 3 months in a Miami J collar. Fusion was successful, and all symptoms EXCEPT the headache are resolved.

The headache is awful at times and my face and scalp are tender to the touch always. In every illustration I've seen on the web, my head hurts at ALL the places shown. I take Valium and/or ibuprophen when it gets really rough and that only dulls the pain. My PA put me on Lyrica, but the side effects are unacceptable to me (makes me feel slightly buzzed and I don't trust myself to drive). My natural good humor is suffering as is my ability to concentrate. I'm missing a lot of work because of the headaches.

I've been to physical therapy several times, had cortisone shots and predisone treatment, and get massage therapy 2 to 3 times a month. Intense exercise seems to aggravate the pain as does high stress situations, extended computer sessions and telephone calls.

Any suggestions would be greatly appreciated!

Answer

Hi,

It is common for people to have neck pain and then headache after a cervical fusion. I work with someone with your same profile and somedays I don't know how she does it!

Obviously you have seen a neurosurgeon or orthopedic surgeon who did the surgery. The problem is, (although we love our surgeons!) they don't manage pain too well. Basically, after the surgery, their job is done.

If you have some tingling or numbness in feet and hands, Lyrica might have been a good choice, but is a poor one for headache and spasming. If you have read a page or two on the site about cervicogenic headache, then you can see that what you are describing may fit this profile. But some things are different. You do sound like you have a lot of spasming in the neck, which is referring to the scalp and causing the tenderness.

But before I label you with just a cervicogenic headache, there are other things to consider. You have a history of a fusion and that may have irritated the cord and nerves around C1/C2. I posted the picture to show you how the cervical nerves influence headache. The trigeminal nucleus caudalis or TNC is the migraine center and many times a pathology at C1/C2 or C2/C3 kicks off migraines. See if you have any migraine symptoms.

I would recommend that you consider seeing a headache specialist if there is one in your area. You may have to ask around, or ask your provider.

You might also ask the PA to put you on amytriptyline which would be a good choice for you. The response is dose dependant..start at 10mg 2 hours before bed and work to the best dose for you. This is a pediatric dose and works well for daily headache, spasms, and helps calm down the spinal cord. Another choice might be tizanidine as that can be taken during the day, once sedation wears off (about 2 weeks). When starting that one I have patients take it at night for awhile, but it doesn't treat headache, just spasms.

Good luck!
Mary Kay Betz, MS RPA-C