Constant Head Ache

My head has a constant dulling pain in the back half of my head. I have had this pain for a couple of years going on three now. The pain is always there and at times it is very intense causing me to lay down for a while until the pain is bearable. I have not found any over the counter pain meds that do anything to reduce the pain I have tried them all. I have been to doctors (Family, ENT, and Neurologist) and have had a MRI about 1 year ago. Nothing was found to be causing the pain. I gave up on the doctor that I was seeing after I felt that she didn't have anything left to offer. I haven't been back to a doctor since. The pain in my head is starting to worsen and at times become very sharp. I do know that spinning or swinging aggravates the pain in my head and the pain becomes worse for a while. What I want is to find out what is causing the pain in my head and to make the pain go away. What should be my next step? Is there a good doctor to recommend to me to see? I live in Salt Lake City, Utah so I would prefer a local specialist.
Thank you,
James

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Causes of neck pain associated with headache are cervicogenic headache and occipital neuralgia.

Cervicogenic headache is a headache that is "referred" to the head from bony structures, muscles, and other soft tissue in the neck and shoulders. Symptoms are usually one-sided and include: precipitation of head pain by neck movement or awkward neck positions, head pain when external pressure is applied to the neck or occipital region, restricted range of motion of the neck, and neck, shoulder and arm pain. Treatment for cervicogenic headache includes physical therapy, medications, behavioral therapy, and other modalities.

Occipital neuralgia is caused by irritation or injury to two nerves that run from the upper neck to the back of the head. The irritation could be due to neck trauma, pinching of the nerves (by muscles or arthritis), and other causes. Symptoms include a piercing sharp pain that travels from the upper neck to the back of the head and behind the ears. It is usually a one sided pain but can be on both sides of the head. Treatment includes physical therapy, medications, and in some cases injections, "nerve blocks", during which a physician injects the irritated nerves with an anesthetic.

A concerning cause of neck pain associated with headache is a dissection: a small tear in the blood vessels that travel up the neck to the brain. This can occur spontaneously in people with certain conditions that affect the blood vessels, after neck trauma, or after chiropractic manipulation of the neck. The pain is often but not always associated with some sort of neurologic deficit as a dissection can often lead to a stroke. A dissection is diagnosed with a specific type of MRI test (MRA with fat saturation) or an CT angiogram.

These are just a few of the causes of posterior headache. I do agree that seeing a specialist in headache medicine would be appropriate. I do not have any recommendations for a specialist in Salt Lake City.  

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.