Severe Head and Neck Pain

by Lisa M
(Tuscaloosa, AL)

Severe Head and Neck Pain

Age: 50 Female; Never smoked
Symptoms:
1. pain in neck & trap muscles burning-diagnosed as arthritis/bone spurs but not severe enough to need surgery;constant pain,flare ups regularly.

2. headaches everyday ranging from 2-8 on pain scale; pressing down sensations as if the pain moves around causing pushing/fullness in back of throat at times and even pressing feeling on nose and cheeks. Comes and goes throughout the day. No way of knowing when.

3 Hormonal migraines one-two per month for 26 yrs-Take Relpax when I absolutely have to-do not like neck side effect but usually get relief. The "sensation" headaches are completely different than my monthly migraine.

There was a progression of headaches. Jan '10 I saw a neuro for my monthly migraines because I was having more than one per month. He treated me with several drugs over a 12 week period-Topamax; Naproxen; Skelaxin; Flexeril; Relpax,-can't remember all. Then my primary dr tried= Klonopin, Elavil, Lortab-I cannot remember all. I could not take some of them because they were too sedating. So he would try another one. The Relpax was only for when I felt the headache was going to be a migraine.

During this time I had my yearly ob/gyn appt. In sharing with my dr, she felt I needed to try an antidepressant-Pristiq was prescribed. The headaches then started resembling Occipital Neurolgia or as I call them Sensation headaches that creeped up the back of my skull and then clamped down.

Treatment= PT, massage, nerve blocks, trigger point shots,-NOTHING worked. In April '10, I was put in the hospital for testing because the neuro was so frustrated with me because the drugs were not working. In hospital, more tests-scans, another MRI, even thyroid=which did show small qoiters on right lobe but levels alright. For the next year, I suffered through everyday.

All total, I saw 3 neuro's, a neurosurgeon, my primary dr; had 2 MRI's of neck and head. Nothing showed up except for the fact I have 2 syrinx in my spine and do not have a "complete circle of willis"? whatever that means. I was told I was going to have to learn to live with it! According to the experts the syrinx has nothing to do with my pain & headaches.

On April 23, 2011, my primary dr weaned me off Pristiq and every other drug I was on at the time. The sensation Headaches got much better, but have now returned. They are similar but not exactly the same as before. The only thing I take now that is presription is for sleep-Zolpideum 10mg. I have an appt to see primary Jan.30 because neck pain has gotten much worse and the headaches are coming back. Afraid to go to Chiro due to neck pain!

Any insight would be appreciated so I can share with my primary dr. Thank you so much!

Lisa M.

Answer:

Hi Lisa,

Thanks for the very complete history. It does sound as if you have been through a lot!

Your primary care doctor and your neurologist are on the right track. You have what we in the headache field of medicine call cervicogenc headache which means most of the pain is coming from your neck.

Anti-spasmotics usually have to be on board for several months to get severe head and neck pain under better control and massage and trigger point injections should be done monthly (2 weeks apart). Most of our patients who come in for monthly trigger points do improve but it can take anywhere from 3-6 months of treatment.

I know it sounds hard to do, but stopping and starting medications may not help too much. The neurologist will tell you that for headache treatment, meds have to be on board for 90 days before you can really tell if they are working or not. Believe it or not, it takes the brain and spinal nerve tissue, that long to "remodulate" and make changes...in other words, 3 months at least to calm down nerve tissue in pain.

Arthritic spurs are common once over the age of 40 and can cause chronic neck pain and spasming. Do you exercise? If not this makes the problem worse. Spasming can be a consequence of de-conditioning. Regular exercise does help arthritis and sort of "keeps it at bay".

You were born with the incomplete Circle of Willis which is the circle of arteries in the brain. Don't worry about it as by now your body has grown other arteries to compensate for it. The syrinx however, can contribute to your severe head and neck pain depending on the size of it, especially the neck pain. Amitryptiline is a good choice for you but you might have to work up from 10mg 2 hours before bed to 30-40 mg. Zoldipem will help you sleep but nothing else. It doesn't help neck pain or spasming whereas amitryptiline will.

Finally, you might consider going to a headache specialist. Here is a list of headache specialists in the US. There are 3 listed in Birmingham and I think it would be worth the trip.

Good luck..
Mary Kay Betz MS RPA-C