Kathi49 & Headaches

[joeworkflow]

Hi Kathi,

If I remember right you had replied to one of my posts saying the traced your cervicogenic headaches to c3/4 is that correct?

I'm seeing a NS on Wed and do have a herniation at c3/4 with it pushing on the spinal cord. My PM docs that could be the cause of these goofy headaches I've been getting, but they go just over my ears and at times actual feel like I have earaches??? Did yours feel like that too? I can't remember exactly what you wrote.

Thanks for your help!

Joe

[lobelsteve]

The C3,4,TON nerves are implicated in cervicogenic headaches.

Bogduk, N On the concept of third occipital headache. Journal of Neurology, Neurosurgery, and Psychiatry 1986;49:775-780

He has had other more recent articles on the topic, but none as eloquent (in my opinion). This is a classic journal article for Pain Medicine and is noted and quoted by all who practice ISIS based guidelines.

[Kathi49]

Hi Joe,

Yes, I had the cervicogenic headaches (originally diagnosed as occipital neuralgia). And, yes, the pain was severe and followed a "rams horn pattern" that the docs spoke of. Sometimes the pain felt like earaches. My pain would start at the base of my skull, then travel up to the top of my head and over the ears. I would also have electrical jolts or stabs that would occur periodically throughout the day. That was bad enough but the constant pressure of feeling like my head was in a vise was awful. My current PM, to make an extremely long story short, tracked it to the C3/C4. The nerve roots were totally compressed with osteoarthritis. Actually, you couldn't see them. My PM referred me to the NS in the group I see and I had a fusion done in 2004. The fusion totally rid me of the cervicogenic headaches. However, I want to add that he also said the fusion did NOT guarantee pain relief, more so stability. But, for me, the fusion took care of those horrendous headaches. Keep us posted as to what the NS says and I wish you well. :)

[joeworkflow]

However, I want to add that he also said the fusion did NOT guarantee pain relief, more so stability. But, for me, the fusion took care of those horrendous headaches. Keep us posted as to what the NS says and I wish you well. :)

Thank you...

That's what scares me, to be perfectly honest. I've been working with a PM doctor for the past year now because the fusion I had a c5/6 didn't rid me of the pain I was experiencing. It DID improve the radiculopathy down my left arm, however, even that still gets me at times. My pain is predominantly in my neck and into my left shoulder, with the right shoulder being not as intense. It's just a killer with these headaches now, and they are almost exactly as you describe, although mine are probably not as severe as you experienced.

I don't have the jolts you described, but I sometimes feel my head go numb along that same pattern or at various points along the way. It's really odd. Again, something I've never experience before.

[lobelsteve]

Sounds like an easy fix- but it is not.
If you are close to Indiana- I know two excellent pain docs in your area.
Double diagnostic paradigm for cervical facet blocks followed by RF if they are successful.

[oh_snap]

Sounds like an easy fix- but it is not.
If you are close to Indiana- I know two excellent pain docs in your area.
Double diagnostic paradigm for cervical facet blocks followed by RF if they are successful.


Can you come to the west coast? :D oh, and thanks for the feedback on the other thread...are you that witty with all your patients? :D

[Kathi49]

lobelsteve is right...it is NOT an easy fix. I am sorry if I sounded like I was advocating a fusion. I wasn't. I was just relaying my story. I DID go through 3 years of conservative treatment; you name it, I tried it all with the EXCEPTION of an RF. I had my reasons for opting out of the RF. But in the long run the C3/C4 was so unstable I had to go with a fusion. And I was told right off the bat that I would eventually need a fusion. I don't regret that decision as it needed to be done. I count myself one of the lucky ones as far as obliterating those headaches. And again, my NS did NOT guarantee pain relief; just stated it would be an added benefit if I could get pain relief. But I also realize everyone is different and you have to choose what is best for you based on your doctor's recommendation(s). :)

[slipnslide]

joeworkflow,

Just to throw a wrench into things, may I add my two cents?...LOL:D I often get headaches similar to what you describe, but without the numbness. It's pretty much constant dull pain across the base of my skull and up behind the ears.

I have some minor problems at C3/4 and I had a C5/6/7 fusion back this past June with no pain relief:( , but I consider the stability I gained to be a success:) . Since Nov. '06, I've had the RF test blocks and RFA procedures done in my abdomen and at the L2/3 level for the ilioinguinal and lateral femoral nerves. I also had the RFA facet blocks done in my neck at C3/4/5 on the right side with no relief what-so-ever to any of the pain in my head, neck, shoulders or arms. Three weeks ago, I had 3 more RFA facet blocks done on the left side of my C5/6/7, which were the first blocks to give me relief from the neck and shoulder pain. I'm scheduled for the RFA for those levels this coming friday. I'm praying that these work this time since I've not had any significant results with the RFA's so far.

In my situation, as far as pain relief goes, for 7 months I had been through physical therapy, chiropractic care, physiotherapy, have had tens units, ultrasound therapy, done ROM exercises on my own and nothing helped. Any good surgeon won't guarantee pain relief, they operate to ensure stability, they don't treat pain, but they will usually tell you what pains may (if you're lucky) or may not go away once the nerves are decompressed. Since my surgery I've done Physiotherapy and RF's and have had no pain relief with the exception of the last facet block at C5/6/7 which lasted just a couple hours with relief just on the left side of my neck and shoulder. So, success with the RF's has yet to be seen.

I believe leaving the nerves compressed for too long actually does more damage than it's worth and if they are decompressed early enough, the nerves have a better chance at recovering. My EMG/NCS 4 months before my surgery showed some problems, but when another EMG/NCS was done 5 months post-op, it showed so much more problems that I can't help but think leaving those nerves compressed actually did more damage.

Of course, these are just my experiences and opinions, so take it for what it's worth....lol;)

Best wishess,

Kim

[Kathi49]

Joe,

I am glad to see Kim come along and give her input regarding RF's. I want to make it clear that I am not against RF's. I just had one done in my lumbar/sacral area at L4/L5 and S1. And, I have experienced significant pain relief. But those problem areas are strictly the facets and not the discs.

My neck is another matter altogether. An RF may or may not have rid me of pain. But in my opinion and based on the problem(s) at the C3/C4 all the RF would have done is to put a bandaid on something that needed repair. The C3/C4 is a very serious level considering the phrenic nerve. And, yes, I was very frightened to go forth with a fusion. But I was more frightened if nothing had been done.

Anyway, Kim also has a great point about decompression of the nerves. I just had the C5/C6 fused in September and, yes, I have one good disc now in between those fusions which is another scary thought. But, I no longer have the neurological deficits going on; that much is gone. There is a little residual pain in my shoulders and a few spasms; that's about it.

Back to the decompression though. I should have stated earlier that I was given every med known to man which in actuality made me sicker and sicker. And did nothing to treat the pain. I had one NS tell me, "No surgery until we see neurological deficits". This was in regards to the C3/C4. I tried over and over again to explain to him that the pain was going up the back of my head at that time; not down into my arms. In looking back, it was absolutely ridiculous to have suffered so many years and the whole time the nerves were being completely squashed with instability to boot.

So, then, after my C3/C4 was fused I develop idiopathic small fiber neuropathy. My Neurologist tested me thorougly; not once but twice and every test came back negative. We went through every med I have ever taken, etc., etc., etc. but nothing was ever found to be a culprit. So, could I blame it on the fusion or rather having those nerves compressed? I am not sure. But is awfully coincidental to have the PN come on 4 months after surgery. I may never know what caused the PN, I just have to treat it. I will say it is finally gone in my hands and pretty much gone in my feet. But it has taken a couple of years for it to dissipate.

I am like Kim in that I consider both fusions to be a success in regards to stability (the C5/C6 was encroaching on the spinal cord). I just wish I had known about the group I go to now and I could have had the fusion done earlier perhaps and avoided an uphill battle of severe pain. According to my current NS, and at that time, he even said, "Three years is much too long to be in that kind of pain." But then again, even he couldn't guarantee pain relief.

I may still have a little residual pain but nothing compare to what it once was. :)