Severe neck pain with headache

Over 30 days ago I started having pain in my neck which caused severe headaches (not related to any accident).  My  Dr. put me on muscle relaxers and anti inflammatory drugs which did nothing.  The Dr. finally precribed but/apap/caf with codeine which at least helps with the pain.  My Dr. ordered a neck x-ray, as well as a non-contrast MRI of the brain and neck.  I was told there was a slight bulging of the C 5 and 6 disc, but it was not enough to cause what I was experiencing.

He has now suggested physical therapy.  I wonder if it will do any good since no one can tell me what's causing the pain, which is daily.  

Should I consider seeing a neurologist.  The codeine helps with the pain, but I don't want to have to take it every day.  If possible I would like to find the root of the problem.  Is it possible a ligament or muscle problem is causing this.  Also, even though it hurts when I do it, I have a full range of motion when I move my neck.

[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.

The more common 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.

Physical therapy is used frequently to treat people with pain syndromes. You may benefit from a referral to a neurologist with a specialty in headache to optimize your medications.

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