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Nerve Pain in Back of Skull

  My mother aged 78 years, fell some 40 years ago and crushed the coccyx. She is now suffering from arthritis and some degeneration of the spine including her neck. She has arthritis of the shoulders and neck. Periodically since she fell 40 years ago she has suffered tenderness in the back of her head. Over the last year, this has worsened. She is now in agony 24 hours a day. It hurts her even to move the hair over this area which measures about three inches by three inches. She is suffering from severe balance problems which the doctor blames on the arthritis in her neck causing restriction on the blood supply. She is constantly falling through giddiness especially early in the morning. She has seen two doctors in the practice who write off this head pain as arthritis. She has now at last managed to get it across to them that it is nerve pain stemming from her old injury and bears no resemblance to arthritis pain. She cannot take aspirin or ibuprofen (or any other anti-inflammatory) due to serious bowel problems. We should like to know if it is theoretically possible for the nerves involved to be identified and severed. And if there are specific painkillers or treatments for pain. She has no quality of life whatsoever now, and is desperate for help. Is there a medical term to describe this pain in this area? I need to find out more of what is available so that I can ensure she receives the best possible advice, care and treatment and at the moment we are up against a brick wall. Please please, even though we are in England, please help.
  Debbie and Pat
Dear Debbie and Pat:
It is possible that your mother has what is called "occipital neuralgia". In the typical form of the syndrome, a lancinating pain or sharp shock-like sensation shoots from the back of the head upwards on to the scalp, especially if there is stimulation or pressure over the back of the skull, such as from tapping, or from resting the head against a hard surface. In some cases, head turning or head movement causes such pain. It is believed that occipital neuralgia is associated with degenerative cervical spine disease. The therapeutic test (and effective treatment) is a nerve block at the site that triggers the pain. Surgery to clear or even cut the nerve may benefit individuals who have recurrent pain after repeated blocks. Conservative treatment with drugs such as carbamazepine or gabapentin may also be quite beneficial.
I am unsure about the cause of your mother's dizziness. Most experts believe that degenerative disease of the cervical spine is not a common cause of vertigo; nor is such degeneration a cause of compromise of blood supply to the brain.

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