Pain in back of head

[aelroy]

I have had this happen on two occassions previous to this time. Both times I was sent to MRI and had various tests done with no results.

My symptoms are a strong throbing pain (relating to my pulse) about an inch above my ear and at the rear of my head, ocalized specificaly on the right. It is simillar to pressure, but is very painful. It comes and goes in episodes. I have noticed, while I have an attack, bending or rising up, even slowly exasurbate the pain trumendously. Also, state of excitement appears to bring on the pain much more. This is what made me gravitate to think it had something to do with my blood circulation or blood vessels, but both my family doctor and the Neurologist dismissed that idea. It has been getting worse by the day, and is now projecting to my right ear and at times to my right eye.

Meanwhile the Neurologist did an elecrical response test, and found an abnormal slowness of the senssory nerve system. He gave me Lyrica, which has so far not made any difference. His assumption is that some degenerative cause is at falut and that the head pain is just an expression of that. The neck MRI (no markers) showed nothing of significance except a bulged disk. Likewise standard blod test so far have not shown any abnormality.

I have located a series of post about Horner's Syndrom (syndrome) and Carotid Dissection, which seemed to correspond well to my experiences. Does this sound like a plaussible direction for further examination based on the facts I have presented? Could that diagnosis explain the nerve defficit I have mentioned?

Thank you very much in advance for your time!

[Abhijeet Deshmukh, MD]

Hello.

Horner's syndrome and carotid artery dissection are extreme diagnoses. Your symptoms are not suggestive of these. In my view, it could be the bulging disc that could be causing the problems. Aks you doctor if a nerve conduction study can be done. The bulged disc can impinge upon certain nerves going in the neck and lower head. Also, the neck moves while bending down, which can disturb the disc.

Regards

[Caliber2005]

Hi,
How are you feeling now?
Well first thing first, I don't think that you have Horner's Syndrome or Partial Horner syndrome in any manner. In Horner syndrome patients will experience miosis, visual disturbance, and mild ptosis.
Carotid artery dissection is a significant cause of ischemic stroke in all age groups. Spontaneous carotid dissection can occur, most frequently in the fifth decade of life. Dissection of the internal carotid artery can occur intracranially or extra cranially, with the latter being more frequent. Pain is the initial symptom of a spontaneous internal carotid artery dissection presenting to a physician. Head, neck, or facial pain on same side of the dissection is common.
The headache is usually described as constant and severe. Unilateral facial or orbital pain is also common, decreased taste sensation, may also be a presenting symptom.
Pulsatile ringing of ear can occur in up to 25% of patients with dissection of the internal carotid artery.
Your symptom sounds close to this pathology, but as you told your scans were normal.
I think you need a repeat evaluation by another neurologist, a Helical CT Angio and also an MRangio. Once results are out you can consult neurosurgeon and an interventional radiologist.
Hope this helps.
Bye.

[bigangel]

Curious what  the final diagnosis was.  I had a carotid dissection with no stroke over a year ago, and your pain sounds very much like mine.

[nolester]

Ditto what bigangel said.