migrain and disc herniation neuralgia

I am 32 yr old female with a history of migraines non responsive to triptans and ant seizure medication..  My recent cervical MRi show a c4-c5 mild herniation without rupture not spressing on nerves and forming a concave deformity of the subarachnoid space.  There is no noted stenosis, or degenerative disorders.  Could this becausing my migraine, neck spasms, and neuralgia on the the occpital area of the head that extends to the right  along the scalp and up behind the ear.  I had a L5-S1 discectomy about 15 yrs ago.

also my mother had OPLL and had cervical spinal fusion.  Could this bea gentic disorder

[Nassim Abi Chahine, MD]

Yes, a cervical disc herniation can cause headache, mostly named cervical syndrome. Sources claime that the disc should be above C4, to cause head symptoms, but in my opinion any herniated disc above the cervico-thoracic junction -including the C7-Th1- can cause a cervical syndrome with frontal head ache and similar manifestions, simply throughout mechanical disturbances and chronic over activation of the nuche muscles and their occipital insertions. Thus I think it is time to rebuilt the old definitions of cervicogenic headache.

An acceptable testing act can be a 3-7 days of rigid cervical collar wearing, if the episodes of  headache decrease in frequency, we can assume that the disease can be treated by treating the cause which is the neck problem in this case. If the pain continue to appear, we cannot confirm that the headache has other causes (I mean the test is just unidirectional).

Soft cervical motor rehab, low weight longterm traction and some other lifestyle changes can be an effective treatment, whereas a surgical fusion can always be effective.

Dr Nassim Abi Chahine