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Sharp, pain near my left ear.
Hello. My name is Ryan and am 14 years old. I have been having sharp, pulling, and stretching pains on the left side of my head for the past few years now, but it seems to be getting more fequent. It started when I was in third grade, and I got a touchdown during touch football. I ran into the endzone and I threw my hands up very fast and then it happened. I don't want to sound dramitic but it feels like a nerve in the side of head explodes. It only lasts for a few seconds and then it goes away. The worst it ever got was when I jumped in my house, trying to touch the ceiling, and it brought to my knees in tears.
I have gotten an MRI on my head and they didn't find anything abnormal. I then went to a neurologist in Jacksonville and they suggest that I get an MRI on my neck. They also suggest a German medicine called " Butterbur" to decrease the migranes.
It only happens when I am jumping or straining, not when I am at rest. The frequency of the paines range from 1-2 times a month.
Please, if anyone knows anything about this condition or may have advice about what to do, don't hesitate to comment.
Thank You.
Ryan
I have gotten an MRI on my head and they didn't find anything abnormal. I then went to a neurologist in Jacksonville and they suggest that I get an MRI on my neck. They also suggest a German medicine called " Butterbur" to decrease the migranes.
It only happens when I am jumping or straining, not when I am at rest. The frequency of the paines range from 1-2 times a month.
Please, if anyone knows anything about this condition or may have advice about what to do, don't hesitate to comment.
Thank You.
Ryan
I know this discussion was a while a go but I'm wondering if Ryan ever got an answer on why this was happening. My son has the same problem and we want to know what is going on. We took him to a Nuelogist and he had a MRI and a Xray and they came back normal. This zapping on the back of his head only happens when he is playing an activity or turns his head. He is 11 years old and it happens to him maybe a few times a week. Would appriciate help with this one. Thanks!
Ryan,
I see a couple of possibilities that I would be better able to assess with a more detailed picture of where you really feel the pain. First, the quality of your pain is highly suggestive of a neuralgia--explosive and , paroxysmal, and of long standing without getting much worse (ie no indication of progressive pathology).
the unusual aspects of your pain are 1) it appears to be triggered by abruptly/vigourously raising your arm on the affected side (throwing your hands up--touching the ceiling) and
2) it appears to be triggered by coughing
the nerves likely to be inolved on the side of the head are
1.the greater occipital nerve from c2
2. the lesser occiptial nerve from c3
3. the 3rd occipital nerve also c3 and
4. the greater auricular nerve form the cerical plexus
You should absolutely have the neck MRI and flexion/extension x-rays of the neck (a c2/c3 disk can absolutely present this way and would be expected to trigger with coughing. defintieley get these studies but I think they will be negative. if you really do have a bad disk you should be able to reporduce your pain by having someone (your parent-gently press down on the top of your head to reproduce the downward force created by neck muscle contraction during your coughing. by doing this you seperate the downward force from the muscle contraction so you can see wheich aspect is the critical factor. if it is a muscle nerve entrapment pushing down on your head should do nothing.
If I had to guess I would guess you have a functional entrappment of one of these nerves
Both the lesser occipital and greater auricular can pass thorugh the sternocleidomastoid muscle and could be pulled by having that muscle contract vigouously otherwise they emerge between it and the muscle underneath--the levator scapulae muscle. The levator scapulae is strongly activated when you vigourously elevate your arm on the same side way above your head. contraction of bothmuscles when you cough could explain that association.
but if I had to guess I would guess that you have a greater occipital nerve that passes through rather than over the trapezius muscle as it does usually.
you may have an entrapment of the greater or 3rd occipital nerves which arise from c2 and c3 respectively. these then have to pass through the muscles of the back of the neck (semispinalis capitis and possibly trapezius) to reach the skin on the side of the head. these muscles are more taught and contracted --particularly the trapezius-- when you raise your arms fully over your head (especially with concurent neck extension--ie to look up at what ou were reaching for). In contrast a bad disk or neuroforaminal stenosis should be releived by neck extension.
print this out take it to an adult pain clinic at the nearest major universisty medical center and let them help sort this out with you. You will need a very good doc to parse this out--but the above should help.
the cranial neuralgias suggested by the other doctor are reall and can affect the ear but ar not commonly associated with exacerbation based on activity, cough, or posture. if it is really affected the scalp behind the ear as well as the ear think greater auricular and lesser occiptial nerves.
good luck
Ian
I see a couple of possibilities that I would be better able to assess with a more detailed picture of where you really feel the pain. First, the quality of your pain is highly suggestive of a neuralgia--explosive and , paroxysmal, and of long standing without getting much worse (ie no indication of progressive pathology).
the unusual aspects of your pain are 1) it appears to be triggered by abruptly/vigourously raising your arm on the affected side (throwing your hands up--touching the ceiling) and
2) it appears to be triggered by coughing
the nerves likely to be inolved on the side of the head are
1.the greater occipital nerve from c2
2. the lesser occiptial nerve from c3
3. the 3rd occipital nerve also c3 and
4. the greater auricular nerve form the cerical plexus
You should absolutely have the neck MRI and flexion/extension x-rays of the neck (a c2/c3 disk can absolutely present this way and would be expected to trigger with coughing. defintieley get these studies but I think they will be negative. if you really do have a bad disk you should be able to reporduce your pain by having someone (your parent-gently press down on the top of your head to reproduce the downward force created by neck muscle contraction during your coughing. by doing this you seperate the downward force from the muscle contraction so you can see wheich aspect is the critical factor. if it is a muscle nerve entrapment pushing down on your head should do nothing.
If I had to guess I would guess you have a functional entrappment of one of these nerves
Both the lesser occipital and greater auricular can pass thorugh the sternocleidomastoid muscle and could be pulled by having that muscle contract vigouously otherwise they emerge between it and the muscle underneath--the levator scapulae muscle. The levator scapulae is strongly activated when you vigourously elevate your arm on the same side way above your head. contraction of bothmuscles when you cough could explain that association.
but if I had to guess I would guess that you have a greater occipital nerve that passes through rather than over the trapezius muscle as it does usually.
you may have an entrapment of the greater or 3rd occipital nerves which arise from c2 and c3 respectively. these then have to pass through the muscles of the back of the neck (semispinalis capitis and possibly trapezius) to reach the skin on the side of the head. these muscles are more taught and contracted --particularly the trapezius-- when you raise your arms fully over your head (especially with concurent neck extension--ie to look up at what ou were reaching for). In contrast a bad disk or neuroforaminal stenosis should be releived by neck extension.
print this out take it to an adult pain clinic at the nearest major universisty medical center and let them help sort this out with you. You will need a very good doc to parse this out--but the above should help.
the cranial neuralgias suggested by the other doctor are reall and can affect the ear but ar not commonly associated with exacerbation based on activity, cough, or posture. if it is really affected the scalp behind the ear as well as the ear think greater auricular and lesser occiptial nerves.
good luck
Ian
Hi Ryan
I will try to make this more of an educational response than therapy as many medical students visit this site and also your case is taken good care of ( your investigation , so far, are normal (awaiting the neck MRI ? ))
Otalgia, or ear pain can be
1-primary (ear pain resulting from pathologic conditions of the ear itself) where other signs of inflamation or ear examination could easly point at it.
The ear canal is heavily innervated, and the skin lining the canal lies directly against the bone without an intervening subcutaneous layer; therefore, even mild pressure, swelling, or inflammation in this area can cause immediate and severe pain
2-or secondary (pain referred to the ear from other sites) usually in the distributions of cranial nerves 5,7 , 9, or 10, or the cervical plexus (neck problem)
.
e.g a branch of the mandibular division of cranial nerve 5 (ie, V3) innervates the skin of the tragus and part of the helix of the external ear, the anterior and superior walls of the external auditory canal, and the anterior portion of the tympanic membrane.
Ear pain can also be referred via cranial nerve 5 from the teeth, gums, mouth, jaw, and face.
The facial nerve (nerve 7) innervates the posterior tympanic membrane and part of
the posterior wall of the external auditory canal.
The glossopharyngeal nerve ( the nerve 9) innervates the posterior portion of the external auditory canal and meatus, the posterior portion of the tympanic membrane, the mastoid, and the Eustachian tube plus the tympanic branch goes to middle ear and forms the tympanic plexus before proceeding as the lesser petrosal nerve to the otic ganglion.
Ear pain can also be referred via cranial nerve 9 from the posterior tongue, tonsils, and pharynx.
The auricular(ear) branch of the vagus nerve (nerve 10) innervates part of the external auditory (hearing) canal, the posterior wall of the external auditory canal, and the posterior portion of the tympanic membrane.
Ear pain can also be referred via cranial nerve 10 from the pharynx, larynx, trachea, diaphragm, thyroid gland, and esophagus, among other thoracic and abdominal structures
.The upper cervical nerves the neck nerves (C2 and C3), particularly the posterior branch of the great auricular nerve, innervate the posterior surface of the external audi canal .
Anatomically , worth mentioning that the somatic afferent fibers from cranial nerves 5,7,9, and 10 as well as the cervical plexus (C2 and C3) all synapse (join together) in the spinal trigeminal nucleus in the caudal medulla and the upper cervical spinal cord (the Neck MRI will reveal any injury).
generally speaking most cases of otalgia in children are primary, whereas less than half of the cases of otalgia in adults are primary.
Most cases of primary otalgia are not neurologic. The most common cause in children is otitis media, but various infectious, inflammatory, traumatic, and malignant conditions of the external and middle ear can cause otalgia
Rare causes of primary otalgia include neuralgias of the
1-geniculate ganglion
2- or the tympanic branch of the glossopharyngeal
Which should be considerd if your neck MRI is normal
God bless
Bob Hilton
I will try to make this more of an educational response than therapy as many medical students visit this site and also your case is taken good care of ( your investigation , so far, are normal (awaiting the neck MRI ? ))
Otalgia, or ear pain can be
1-primary (ear pain resulting from pathologic conditions of the ear itself) where other signs of inflamation or ear examination could easly point at it.
The ear canal is heavily innervated, and the skin lining the canal lies directly against the bone without an intervening subcutaneous layer; therefore, even mild pressure, swelling, or inflammation in this area can cause immediate and severe pain
2-or secondary (pain referred to the ear from other sites) usually in the distributions of cranial nerves 5,7 , 9, or 10, or the cervical plexus (neck problem)
.
e.g a branch of the mandibular division of cranial nerve 5 (ie, V3) innervates the skin of the tragus and part of the helix of the external ear, the anterior and superior walls of the external auditory canal, and the anterior portion of the tympanic membrane.
Ear pain can also be referred via cranial nerve 5 from the teeth, gums, mouth, jaw, and face.
The facial nerve (nerve 7) innervates the posterior tympanic membrane and part of
the posterior wall of the external auditory canal.
The glossopharyngeal nerve ( the nerve 9) innervates the posterior portion of the external auditory canal and meatus, the posterior portion of the tympanic membrane, the mastoid, and the Eustachian tube plus the tympanic branch goes to middle ear and forms the tympanic plexus before proceeding as the lesser petrosal nerve to the otic ganglion.
Ear pain can also be referred via cranial nerve 9 from the posterior tongue, tonsils, and pharynx.
The auricular(ear) branch of the vagus nerve (nerve 10) innervates part of the external auditory (hearing) canal, the posterior wall of the external auditory canal, and the posterior portion of the tympanic membrane.
Ear pain can also be referred via cranial nerve 10 from the pharynx, larynx, trachea, diaphragm, thyroid gland, and esophagus, among other thoracic and abdominal structures
.The upper cervical nerves the neck nerves (C2 and C3), particularly the posterior branch of the great auricular nerve, innervate the posterior surface of the external audi canal .
Anatomically , worth mentioning that the somatic afferent fibers from cranial nerves 5,7,9, and 10 as well as the cervical plexus (C2 and C3) all synapse (join together) in the spinal trigeminal nucleus in the caudal medulla and the upper cervical spinal cord (the Neck MRI will reveal any injury).
generally speaking most cases of otalgia in children are primary, whereas less than half of the cases of otalgia in adults are primary.
Most cases of primary otalgia are not neurologic. The most common cause in children is otitis media, but various infectious, inflammatory, traumatic, and malignant conditions of the external and middle ear can cause otalgia
Rare causes of primary otalgia include neuralgias of the
1-geniculate ganglion
2- or the tympanic branch of the glossopharyngeal
Which should be considerd if your neck MRI is normal
God bless
Bob Hilton
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