Foot Pain and headaches
by DanO0707, Sep 05, 2008
I have been experiencing numbness and pain in my right foot for over 5 years.  When I stand still for over 3 or 4 minutes both my foot and lower leg go completely numb.  I have fallen 3 times because of this.  Probably unrelated, I have recently been experiencing severe headaches in the back of my head for almost a year.  Does anybody have a possible solution?  (I am taking 600mg of neurontin 3 times daily).
by Neuro ForumBlank, Sep 07, 2008
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 your doctor.

Without the ability to examine you and obtain a history, I can not provide you with a diagnosis. However, I will try to provide you with some information and suggestions.

The numbness and pain in your foot that occurs after standing for a time may be caused by spine problems. This is suggested by the fact that it occurs after you have been standing for some time. The possibilities include a disc hernation compressing on the nerves as the exit the spine, spinal canal stenosis (narrowing of the spine), or arthritis pressing on the nerves. Spinal canal stenosis is suggested when the symptoms worsen with walking and improve with bending forward (which opens up the spaces in the spine).
Other possibilities are non-neurologic, including certain positions preventing blood flow to the leg. I suggest you see a neurologist. one way to evaluate your spine is to have an MRI which can provide useful information. If your symptoms only occur when standing, a neuropathy (damage to the peripheral nerves) is unlikely. However, compression of the nerves in the pelvis as they go to the leg may also cause these symptoms. A neurologist can help determine this and another test that might be helpful is called and EMG/NCS, which tests how well electricity is conducted along the nerves. Finally, though least likely, the intermittent leg numbness could be caused by a brain problem, such as a TIA (what is often referred to as a "mini-stroke), transient decrease in blood flow to the area of the brain caled the frontal lobe, which could for example occur if your blood pressure drops when you stand up and if you have a narrowing in your artery. Just given the description of your symptoms, this is unlikely. If your leg symptoms are causing you to fall, I strongly suggest you have this evaulated by a neurologist.

The headaches are likely unrelated to the leg. The one thing that THEORETICALLY (but VERY UNLIKELY) could combine the two is if there is a lesion (such as a tumor) in the brain compressing on the leg area in the frontal lobes. This is highly unlikely, as if this were the case your symptoms in the leg would include weakness that occurs all the time, not just when you stand for prolonged periods, and things would probably have progressed over a 5 year period.

More likely, you have either tension type headaches or cervicogenic headache. Tension type headaches often occur in the back of the head and there are specific medications that can be used for them. 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. Cerivcal spine problems (arthritis, stenosis) can sometimes lead to headaches. Other causes of severe headaches in the back of the head include occipital neuralgia. 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.

Again, I suggest you see a neurologist for all these symptoms. Neurontin is a good medication but depending on what the neurologist feels, he/she may choose to increase your dose or try other medications to control your headache and leg symptoms. The cause for the leg symptoms needs to be determined, and an MRI of the spine might be useful for this. 1 MRI of the brain to make sure there is nothing causing the headaches is also a good idea (headaches can be either primary i.e. of no cause, or secondary, due to tumors, blood vessel malformations, etc. When headaches start occuring in someone who has never had headaches before, it is a good idea to make sure there is not an underlying cause to the headaches).

Thank you for using the forum, I hope you find this information useful, good luck.

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