8 weeks ago I was in a rear end auto accident, with no prior issues. After the accident x-rays showed severe whip lash, MRI found bulging discs at c-5, c-6. I have had a severe headache since the accident and after many treatments and tests ( medications, PT, trigger shots) was diagnosed with Occipital Neuralgia. Beside 12 hours of relief from the trigger shot, I have had no relief from the headache. I still have a lot of pain in my lower neck, right shoulder and pain that sometimes radiates down my right arm. I am under the care of a Neurologist, GP, and Physical Therapist. I am getting confused because one says the ON is unrelated to the disc's, and another says they are related. I have also been told the treatment (PT) for these two issues conflict with one another (while treating one, it aggrivates the other). I am so confused! My Neurologist is now talking about Botox injections as a treatment option, but am finding conflicting reports about it as a treatment option. I am getting desperate, this headache is all consuming. PLEASE HELP. Any and all resource information would be a great help!
In most people, the occipital nerve arises from the C2 dorsal root ganglion, though some of the fibers from C1 and C3 often make up part of the sensory pathway along the occipital nerve distribution. Nonetheless, this is almost a moot point, as the combination of pain along the occipital nerve distribution along with known trauma to the cervical spinal column makes it clear that you have had some trauma to the nerve tissues around C1 - C3 in addition to the damage seen at C5 and C6. In fact, many (if not most) ON cases are not detected by MRI or other imaging studies. My own severe, chronic (and constant) ON has never been evident on MRIs, CTs, or X-Rays. My first surgery was performed nearly 30 years ago, though the pain has *only* been constant and severe for the past 14 or so years.
Botox may be helpful, but I suspect that you have nerve damage in multiple points, and you'd have to be extremely lucky to get good coverage from any procedure (including Botox injections) that covers relatively small areas.
You will probably be better off with a combination of medications used to minimize the transmission of pain signals. A good neurologist may be able to come up with a combination that works well for you, but most people with ON seem to do best with a good pain clinic physician, particularly if the pain clinic is associated with a major teaching hospital.
If you are interested, I can provide a list of meds to try (this response is already longer than I planned). Good luck, and let me know if you need further information.
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