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Neurology (Expert Forum)
Chronic neck pain (upper left)
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Chronic neck pain (upper left)
by Shelbell36, Sep 09, 2005 12:00AM
I've had frequent headaches & migraines for over 20 years. (I'm 36 yrs old) They've gotten worse & more frequent over time. I've also had neck pain in the upper left side of my neck since I was about 18 yrs old. The bulk ("root") of the pain seems to be at c-3. I've gone to chiropractors for years, which give some help temporarily. X-rays have been "normal," a CT scan for migraines came out "normal," a recent MRI for neck pain & headaches came back "normal." Given the great pain I'm in almost constantly, it's hard to believe no doctors can find anything!
For migraine prevention, I'm currently taking 100 mg atenolol daily, 300 mg neurontin 3 x day, and 500 mg Keppra 2 x day. For actual migraine attacks, I've tried Amerge (which used to work but doesn't work well anymore), Relpax, Axert, Imitrex, & Migranol. Sometimes they work, but sometimes not.
I also have tried physical therapy, facet joint injections, trigger point injections, and botox injections. The trigger point & botox helped for a very short time. The other injections & physical therapy didn't help. I'm going to try trigger point & botox again to see if repeated doses will improve my reaction. I feel like I'm going crazy. My chiropractor thinks I have nerve & muscle pain. The pain specialist isn't sure, but thinks I've got the tightest balled up muscle he's ever felt on the c-3. Also c-3 tends to stick out more to the left than my other bones.
Are there any other tests or types of specialists I should check into? A neurosurgeon, orthopedic doctor? Nobody seems to understand what's going on...
For migraine prevention, I'm currently taking 100 mg atenolol daily, 300 mg neurontin 3 x day, and 500 mg Keppra 2 x day. For actual migraine attacks, I've tried Amerge (which used to work but doesn't work well anymore), Relpax, Axert, Imitrex, & Migranol. Sometimes they work, but sometimes not.
I also have tried physical therapy, facet joint injections, trigger point injections, and botox injections. The trigger point & botox helped for a very short time. The other injections & physical therapy didn't help. I'm going to try trigger point & botox again to see if repeated doses will improve my reaction. I feel like I'm going crazy. My chiropractor thinks I have nerve & muscle pain. The pain specialist isn't sure, but thinks I've got the tightest balled up muscle he's ever felt on the c-3. Also c-3 tends to stick out more to the left than my other bones.
Are there any other tests or types of specialists I should check into? A neurosurgeon, orthopedic doctor? Nobody seems to understand what's going on...
Doctor's Answer
by CCF-Neuro-M.D.-PW, Sep 13, 2005 12:00AM
You seem to have been through a wide range of therapies for your pain, which (although I'm speculating without knowing your case) is probably musckuloskeletal, especially if your MRI does not show a root entrapment. A CT myelogram may be useful to confirm no trapped roots, as it can pick things MRI does not. Flexion/Extension xrays of your cervical spine may be useful also if not already done - this allows a look at the way neck movement affects the bones which MRI cannot do.
There are a variety of other neuropathic pain medications you could try (assumming part of the pain is from a nerve), including a new one called Pregabalin (just approved this month)
Botox is pretty good for muscular pain - maybe bigger doses may be needed, a minority of patients develop antibodies which reduce the effectiveness of Botox - use of Myobloc another form of Botulinum toxin is then helpful.
If the pain is still intractable, and it is nerve related, you may be a candidate for a spinal cord stimulator, although I cannot assess this here, you would need to be referred to a participating center (liek the Cleveland Clinic Pain Center)
Good luck
There are a variety of other neuropathic pain medications you could try (assumming part of the pain is from a nerve), including a new one called Pregabalin (just approved this month)
Botox is pretty good for muscular pain - maybe bigger doses may be needed, a minority of patients develop antibodies which reduce the effectiveness of Botox - use of Myobloc another form of Botulinum toxin is then helpful.
If the pain is still intractable, and it is nerve related, you may be a candidate for a spinal cord stimulator, although I cannot assess this here, you would need to be referred to a participating center (liek the Cleveland Clinic Pain Center)
Good luck
Well, I'm gonna have the anesthetic injections this week & then we'll repeat the botox next month ('cause you can only do botox every 3 months).
Ugh-- I've gotten a headache every day for the past week. The preventative meds don't seem to be helping.
thanks so much for your reply...
Shel
I do appreciate your help. Hoping to find a pain center in my area to put in a concerted effort in figuring this out.
TOS info:
http://www.nismat.org/ptcor/thoracic_outlet/
http://tos-syndrome.com/newpage12.htm
http://tos-syndrome.com
http://www.doctorellis.com
http://www.tellmeabouttos.com
http://www.causeof.org/posture_tos.htm
http://intraspec.ca/tos.php