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Neurology (Expert Forum)
I need HELP!
Answered by
Lama Chahine, MD - Neurology
Cleveland Clinic
Cleveland - OH
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.
I need HELP!
by merlot3106, Nov 08, 2009 10:24AM
My name is Megan and I am 40 yrs. old.
I started seeing a chiropractor in 6/06 for lower back pain I was having and at that time he also started adjusting my neck. After my first neck adjustment I started having horrific daily headaches. They would start in my neck and then continue up the back of my head and they would go down my back to right past my shoulder blades. There was nothing I could ever do to make them go away. This neck pain has continued to get worse. I have seen so many Doctors over the past 3 1/2 years and no one could tell me why I was having the pain. All they could figure out was that I have arthritis in my neck and some disc degeneration but they found nothing that would cause me to have the horrible daily pain I was having.
I have tried every injection and procedure including nerve blocks I also tried traction because I was told by a NS that I had an unstable neck, this only made things worse.. I also tried acupuncture for 6 months but nothing would relieve my pain. I also tried a neurostimulator which didn't help any of my pain.
In 09 at the Cleveland Clinic I was dx w/ chiari, they did a cine MRI and found out my csf flow is not blocked. So they would not do surgery.
My NS did decided he wanted try a discectomy and fusion of discs c 5-6 and c 6-7 because they were bulging. I had that done Aug. 27, 2009. My pain is still the same since having the surgery nothing has changed. My NS said most people get relief right after surgery so he doesn't think that was my problem but he has no suggestions for me on what to do next.
I still wonder if this is the chiari causing my problems because the symptoms fit. I know most doctors don't recognize my small herniation as a chiari but what else could it be? Please help me I am at the end of my rope. I CAN"T take this any longer!
If you want a list of my symptoms please let me know.
I started seeing a chiropractor in 6/06 for lower back pain I was having and at that time he also started adjusting my neck. After my first neck adjustment I started having horrific daily headaches. They would start in my neck and then continue up the back of my head and they would go down my back to right past my shoulder blades. There was nothing I could ever do to make them go away. This neck pain has continued to get worse. I have seen so many Doctors over the past 3 1/2 years and no one could tell me why I was having the pain. All they could figure out was that I have arthritis in my neck and some disc degeneration but they found nothing that would cause me to have the horrible daily pain I was having.
I have tried every injection and procedure including nerve blocks I also tried traction because I was told by a NS that I had an unstable neck, this only made things worse.. I also tried acupuncture for 6 months but nothing would relieve my pain. I also tried a neurostimulator which didn't help any of my pain.
In 09 at the Cleveland Clinic I was dx w/ chiari, they did a cine MRI and found out my csf flow is not blocked. So they would not do surgery.
My NS did decided he wanted try a discectomy and fusion of discs c 5-6 and c 6-7 because they were bulging. I had that done Aug. 27, 2009. My pain is still the same since having the surgery nothing has changed. My NS said most people get relief right after surgery so he doesn't think that was my problem but he has no suggestions for me on what to do next.
I still wonder if this is the chiari causing my problems because the symptoms fit. I know most doctors don't recognize my small herniation as a chiari but what else could it be? Please help me I am at the end of my rope. I CAN"T take this any longer!
If you want a list of my symptoms please let me know.
Doctor's Answer
by Lama Chahine, MD, Nov 15, 2009 11:23AM
, Nov 15, 2009 11:23AM
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 tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.
If a Chiari malformation is minimal and there is no obstruction to CSF flow, then it would be unlikely to cause neck pain or other symptoms, including headache. Chiari malformations are not uncommon and are often considered incidental findings (just happened to be found on an MRI done for workup of various symptoms), and surgical treatment of Chiari's when they are not the cause of symptoms would not result in a benefit and could potentially cause harm.
If there are no structural abnormalities on MRI of the cervical spine, then further surgical treatment options would be unlikely to be beneficial, and are likely to cause more harm than good. Neck and back pain in the absence of structural findings (such as herniated discs, arthritis, narrowing of the spinal canal etc) are often due to musculoskeletal causes, such as myofascial pain syndrome. This causes pain coming from the muscles and connective tissue in and around the neck area. This should not be surgically treated. Rather, treatment may include medications (non-steroidals such as advil), sometimes a short course of steroids, temperature therapy (hot or cold packs), stretching and controlled physical therapy, muscle relaxants, and so on, these are best prescribed by an experienced physician, each has its own indications. If there are trigger points (spots that are very tender), these can be injected as well.
Evaluation at a chronic pain management program is recommended.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.
If a Chiari malformation is minimal and there is no obstruction to CSF flow, then it would be unlikely to cause neck pain or other symptoms, including headache. Chiari malformations are not uncommon and are often considered incidental findings (just happened to be found on an MRI done for workup of various symptoms), and surgical treatment of Chiari's when they are not the cause of symptoms would not result in a benefit and could potentially cause harm.
If there are no structural abnormalities on MRI of the cervical spine, then further surgical treatment options would be unlikely to be beneficial, and are likely to cause more harm than good. Neck and back pain in the absence of structural findings (such as herniated discs, arthritis, narrowing of the spinal canal etc) are often due to musculoskeletal causes, such as myofascial pain syndrome. This causes pain coming from the muscles and connective tissue in and around the neck area. This should not be surgically treated. Rather, treatment may include medications (non-steroidals such as advil), sometimes a short course of steroids, temperature therapy (hot or cold packs), stretching and controlled physical therapy, muscle relaxants, and so on, these are best prescribed by an experienced physician, each has its own indications. If there are trigger points (spots that are very tender), these can be injected as well.
Evaluation at a chronic pain management program is recommended.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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