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Have a bone spur in neck with spondylosis and spinal stenosis. Feeling pain in neck and head. Any treatment?

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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Pain at bridge of nose, at least once a week, starts upon waking but only in the back of the neck. That excruciating pain transfers to nose after 3-4 hrs. The nose pain lasts 24 hrs and cannot be predicted as to when it will hit. I've had ethmoid nerve ligation, trigeminal and facet jt injections, tried all types of migraine meds, only thing that works, sometimes, is Toradol combined with Percocet. I have a bone spur in neck with my spondylosis and spinal stenosis but they say nothing that could cause headaches. I've been to neuro at the Mayo clinic and got no help. I'm at my wit's end. Please help.
Posted Tue, 23 Oct 2012 in Brain and Spine
 
 
Answered by Dr. Sudhir Kumar 19 minutes later
Hi,
Thank you for sharing your medical details on Healthcare magic.
I can understand the discomfort you are facing on account of pain in the neck and head. Moreover, what adds to it is the lack of a clear cut diagnosis.
The commonest cause of intermittent pains such as these is migraine.
Neuralgic pains (such as trigeminal neuralgia) usually are of much more shorter duration, and they last for a few seconds to minutes. So, your symptoms are unlikely to be due to neuralgia.
I am sure you have undergone an MRI scan of the head and neck and that did not reveal any significant problems.
As you have mentioned you have taken Migraine medications, I assume you have taken topiramate or divalproex, which are more likely to be beneficial in your case.
If nothing has worked, Botox injections are another alternative treatment option.
Please get back for any follow up queries.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX consultant neurologist
Apollo Hospitals, Hyderabad
Above answer was peer-reviewed by
 
Follow-up: Have a bone spur in neck with spondylosis and spinal stenosis. Feeling pain in neck and head. Any treatment? 59 minutes later
Botox did not work. MRI/CT scans showed nothing. I have none of the symptoms of migraine and I have taken the meds you referred to. Could it be cervical nerve compression? What could be in the neck that refers pain to the face?
 
 
Answered by Dr. Sudhir Kumar 16 hours later
Thank you for getting back with more details.
As suggested by you, it could be cervical nerve compression. In some cases, the pain of cervical nerve compression may radiate to head also.
Other condition that can cause the pain to go from neck to face could be occipital neuralgia or trigeminal neuralgia. But the pain is often short-duration in both the cases.
As the pain becomes chronic, it may last for 24 hours, as in your case.
Have you tried neuropathic pain medications such as pregabalin, gabapentin or duloxetine. If not, they are worth trying in your case.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Have a bone spur in neck with spondylosis and spinal stenosis. Feeling pain in neck and head. Any treatment? 3 hours later
Sir,
I have tried various anti-seizure meds as you listed above but they did not work either. Please provide a list of any and all conditions you think might cause this and what treatment options that you would recommend. Any suggestions would be greatly appreciated. What kind of doctor should I try next? I've been to ENT's, neurologists, neurosurgeon and my general dr but they are all at a loss.
Thank you
 
 
Answered by Dr. Sudhir Kumar 3 hours later
Hi,
Thank you for getting back.
I must accept that yours is a difficult case to diagnose and treat. This is mainly because the MRI scans are normal.
Based on the description, following are the likely diagnostic possibilities:
1. Migraine- symptoms are not typical of migraine, and all migraine treatments have failed in addition.
2. Muscle tension headache- if you have not tried Dothiepin (dosulepin), sold as Prothiaden by Abbot, you could try at a dose of 25-75 mg at bedtime for a period of six weeks for the same.
3. Cervical nerve compression- medications such as pregabalin and gabapentin have failed. Physiotherapy is useful. In addition, nerve blocks work in some cases.
4. Neuralgic pain due to occipital or trigeminal neuralgia- symptoms are not typical and usual treatments for the same have failed in your case.
You could consult Pain Medicine specialists for further evaluation and treatment.
My best wishes are always with you...
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Have a bone spur in neck with spondylosis and spinal stenosis. Feeling pain in neck and head. Any treatment? 1 hour later
Thank you Dr XXXXXXX
 
 
Answered by Dr. Sudhir Kumar 2 minutes later
You are welcome!
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by
 
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