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Neurology (Expert Forum)
Effectiveness on/the effects of, thermocoagulation on Occipital Neuralgia (?)
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Effectiveness on/the effects of, thermocoagulation on Occipital Neuralgia (?)
by It became me, Jun 03, 2002 12:00AM
What is the effectivenss of thermocoagulation as a treatment for my headache?
SYMPTOMS: I have been suffering from an acute and debilitating headache on the right side of my head for now 17 months. The pain is extremely intense & save the two occasions that it briefly faded—for no more than a week at a time—it has been constant day & night. The pain emanates from a very precise region, extremely sensitive to the touch, on my neck at the base of the skull on the right side, the width of 4 fingers, up & over the right hemisphere of my head & along the side to my temple & often times into my eye. It is throbbing & displaces itself along this area. The most severe aspect is the unceasing sharp shocks that seem to come as if from an electrical fork running up & down my head. My forehead aches all the time & my scalp is very sensitive such that contact with the pillow, for instance, is unpleasant in itself. The pain is such that it renders reading/ writing virtually impossible. In fact the tiny muscle contractions involved in these activities seem to do nothing but aggravate the pain. I have become severely depressed. No steroid injection or med of any kind has has relieved my pain except Indomethacin, quite minimally. (9 JAN 01) Headache began after a Parisian “Chiropractor” horribly misused a high-speed gun on the right side of my neck on the top vertebrae rendering my neck immobile; 2 days later, in an attempt to reestablish mobility, he manipulated my neck by brusquely rotating it. I did not feel well. The next morning I woke up with the aforementioned head & neck pain.
SYMPTOMS: I have been suffering from an acute and debilitating headache on the right side of my head for now 17 months. The pain is extremely intense & save the two occasions that it briefly faded—for no more than a week at a time—it has been constant day & night. The pain emanates from a very precise region, extremely sensitive to the touch, on my neck at the base of the skull on the right side, the width of 4 fingers, up & over the right hemisphere of my head & along the side to my temple & often times into my eye. It is throbbing & displaces itself along this area. The most severe aspect is the unceasing sharp shocks that seem to come as if from an electrical fork running up & down my head. My forehead aches all the time & my scalp is very sensitive such that contact with the pillow, for instance, is unpleasant in itself. The pain is such that it renders reading/ writing virtually impossible. In fact the tiny muscle contractions involved in these activities seem to do nothing but aggravate the pain. I have become severely depressed. No steroid injection or med of any kind has has relieved my pain except Indomethacin, quite minimally. (9 JAN 01) Headache began after a Parisian “Chiropractor” horribly misused a high-speed gun on the right side of my neck on the top vertebrae rendering my neck immobile; 2 days later, in an attempt to reestablish mobility, he manipulated my neck by brusquely rotating it. I did not feel well. The next morning I woke up with the aforementioned head & neck pain.
Doctor's Answer
by CCF-Neuro-M.D.-JT, Jun 05, 2002 12:00AM
Not familiar with the "high speed gun" used by the chiropractor, but it sounds like you may have a cervicogenic headache, which is a headache that stems from prior injury/trauma to the neck region. Imaging of the cervical spine either with MRI or plain films may be helpful in looking for any abnormalities of the neck and spine which may have been the result of the chiropractic manipulations. Indomethacin is usually reserved for cluster headaches and is dosed up to 200mg/day. Local injections with anesthetic agents such as lidocaine rather than steroids at tender points in the back of the head may also be helpful. Botox injections to release the muscle constrictions are a new treatment modality that we are experimenting with in our headache clinic, very expensive but has provided some patients with complete relief. As for the thermocoagulation, this is a neurosurgical procedure that destroys the trigeminal nerve which carries pain fibers to the head. There have been a handful of reports in the literature that have shown SOME improvement for patients with refractory headaches, but it is certainly not routine and we tend not to recommend it unless everything has been tried as there are side effects. You also have to find a good neurosurgeon that you trust. Talk to your doctor about the other alternatives mentioned above. GOod luck.
I didn't have space to add the following collateral, though important question:
How much Indomethacin is necessary to give relief to O.N. headaches? (The idea of taking Indocin, by the way, came from reading your MEDHELP archives. It is not a med commonly give here.) I am currently on 100mg daily.
I forgot to mention that since the accident mentioned in my post occured, I developed a painful tic in my neck--the neck jerks sharply, rotates to the right--almost exclusively at bedtime. I take anti-convulsants for it.
I hope you will have time to answer my post so I can decide if I need to travel to the States for decompression surgery or not. The alternative is the thermocoagulation but i don't know if it IS a real alternative. I have gotten so much contradictory info from a myriad of doctors here. I need the pain to stop, once and for all.
Thank You.
Most sincerely,
Alejandra
For a year prednisone worked better than any painkiller. The only other relief comes from percocet. Doctors had also tried imitrex, zomig, maxalt, dhe, tegretol, elavil, topomax, neurontin, calan, verapamil.
Indomethacin works but I have some side-effectes. I had an injection of something called toradol the worked.
Local nerve block injections of bipulvicaine make the pain WORSE. Root block injections last about a week. I finally had an injection at C2 that worked 2 weeks and now I'm going for a C2 gangliotomy.
I also had a medtronics neurostimulator implanted that is right under the nerve. My doctor wants to move the lead into the epidural area but my insurance won't pay.