Unexplained neck pain/headaches...

well I guess I can start with what I am experiencing, about 3-4 weeks ago, I started getting a pain down at where the skull and neck meet accompanied by headaches that would occasionally hurt my hears and eyes. When it all started, I wouldn't wake up with this pain but it would gradually show up and then get worse by the end of the day. Now, unfortunately, I am waking up with the pain, and then it gets worse by the end of the day. I don't know what is going on. Some background history, I have hypothyroidism as well as anxiety/depression (however the anxiety is more of an issue I think). I am being treated by a neurologist for seizures as well (but I they are under control and am almost at 2 years seizure free). When it started, I was about 2 weeks away from my cycle so I was thinking it could have been PMS (I am also diagnosed with PMDD even though I have never had this problem before) but it getting worse has driven me away from those thoughts. Then I thought that it could be that my neck was out, so I went to a chiropractor to have it adjusted. It was out, but the adjustment did not help. So I went to my doctor, and he gave me an X-ray (I am still waiting for the results), muscle relaxers (just got today so we will see), naproxen, and physical therapy(appointment is tomorrow). He also told me to make an appointment with my neurologist. I have made an appointment but unfortunately the only one available was for three weeks away). I know this forum is not to take the place of an appointment with the doctor, but I would really like some advice while I wait to see my neurologist. Thanks:/   <---- no happy face because of pain....

[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.

Headaches can be a primary headache (such as a migraine) or secondary headache (such as from a structural lesion in the brain). One type of headache in the posterior part of the head is a cervicogenic headache. This headache 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.

Another type is occipital neuralgia. This headache 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.

I also mentioned that structural lesions (such as a mass) can cause posterior headaches.

As you can see, the differential for headaches without more information is broad. If you are not a headache person and this is a new headache or a change from prior headaches or if you develop weakness/numbness/speech abnormalities, you should be evaluated ASAP. Eventually, you may need an MRI of the brain.

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