at a loss

I am a obese 28 yr old female. smoker. I have had chronic ear infections on the right side, tubes were put in as a child several times, tonsils were removed, pneumonia as an infant.
I'll give a list of symptoms first and then short med hx
right side ear pain, jaw pain and stiffness, pain going from ear down the neck, elevated temp, fatigue, unable to concentrate, HA behind rt eye, tenderness in temple (draw a line from top of ear back about 2 inches) and around ear,( hearing loss but this is probably due to surgery) in the past two days i am now having tenderness on shoulders and upper arms not muscle pain but tender to the touch this is new also extreme tenderness below ear just behind jaw.
HX; beginning of last year severe ear infection and mastoiditis giving 3 round antibiotics
6 months later another ear infection tube put in rt ear 12-6-11
still infected multiple drops and office visits
ct done mastioditis referred to specialist who did mastoidectomy and repaired inner ear 4 wk follow up was told ear looked good and symptoms were not related to ear
symptoms went away until shortly after finishing antibiotics they are progressively getting worse
went to my DR who put me on prednizone for possible TMJ didn't help he sent me to ENT, ENT is now sending me back to specialist. I would like to go in with some valid ideas, the things Ive found are not common. I do have MRI scheduled of IAC w and w/out contrast for possible soft tissue involvement or infection or anything else that might show.
I also use a bite guard in case i grind my teeth

[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.

Some 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.

Another 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 agree that you should have further imaging of your head/neck. I would suggest to have fat suppressed MRA study to evaluate for dissection. You may also benefit from a lumbar puncture (i.e., spinal tap) to evaluate for chronic meningitis.

Seeing specialists are a good idea. Continue working with them. It sounds like you have a difficult history.

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