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Suffering from tension headache, back pain and neck pain. What should be done to get relief?

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i am a doctor myself,i have been suffering from tension headaches for the past 8 and half years.i have tried almost everything-innumerable doctors,relaxation exercises,tensionheadaches.com-which teaches exercises and stripping and digging technique to be done on the neck and shoulder to relive the trigger points,all pain killers etc.,lot of physiotherapy.
i was operated for pituitary macroadenoma growth hormone secreting nearly 8 years back and then completely recovered.neurosurgical cause of headache has been ruled out for sure.
it is the stiffness in the muscles which is causing spasmodic pain and is not getting relieved by anything.
i have not left a single stone unturned in the treatment of this headache.
i have chronic back and neck pain.i feel stiffness in the back and neck muscles .
my 25 hydroxy vitamin d levels were 10 which are grossly low.i have started vitamin d cholecalciferol sachets 0000 i.u. a week.so far i have taken 3 sachets.till now no change in headaches.
what is the role of arichitol inj. 6 lacs i.u. inj in treatment of tension headaches.

according to latest research vit d deficiency is a documented cause of tension headaches.

what shall i do.almost all options of treatment are over.

i have been to the best of doctors but to no avail.

your suggestion may be of great importance

thank you

Posted Wed, 12 Dec 2012 in Headache and Migraines
 
 
Answered by Dr. Sumit Bhatti 3 hours later
Hi,

Thank you for your query.

1. Along with Vit D, get adequate sunlight for atleast half an hour a day and take a calcium supplement if your calcium is low. Arachitol injections will be required if your Vit D levels are not rising. A good Vitamin D supplement is Cap. Celol, Tab. Alfacal Plus or Tab. Densical C.

2. Get you cervical spine examined to rule out cervical spondylosis. I am assuming that any migraine variant headache has been ruled out.

3. Ask your physician to prescribe Tab. Retense (flupirtne) or Skelebenz cyclobenzaprine).

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Suffering from tension headache, back pain and neck pain. What should be done to get relief? 20 hours later
hello

migraine has been completely ruled out.

my alkaline phosphatase and parathormone is also normal.

some time back even DEXA was also done which was normal.
cervical spine xray was also normal.so spondylosis also ruled out.

i have tried almost all drugs ,pain killers and antispasmodics but to no avail.

after taking supplements cacirol the aches and pains,fatigue has decreased.so definitely that was because of vit d deficiency.but the stiffness in the back and in the neck which is very resistant,is that due to vitamin d deficiency.
you can check WWW.WWWW.WW in that they have explained that poor posture is the cause of tension headaches.i have tried it and with their technique i finished all the trigger points in the neck and shoulder but still no symptomatic result and they asked me to continue to work on the muscles of neck and back.

i dont want to take any other.i have already tried plenty.

the cause of this headache is purely muscular.bones are ok.

the day stiffness goes away ,the headache will also wither away.

arachitol are also required if because of low vit d levels ,parathormone and alkaline phosphatase levels XXXXXXX raised and hence affect bones,but inn my case both are normal.

usually vit d levels are quite common in the spectrum of population.but the levels should never be less than 32ng.

so my question is that the low vit d levels can account for the stiffness in back and neck ,which in turn is causing tension headaches.as low vit d causes weakness of muscles.as vit d levels have atleast helped me in aches and pains,fatigue.
even calcirol sachets are also good enough,once a week scahets.then there might be no need of tabs.
the vitamin d deficiency might have made the muscles in back and neck so weak that even with bending forward for some time ,i causes pain.
the stiffness in the head lasts for the whole day nonstop and it has been there for many yrs.
usually one will have to take the sachets for atleast 4 to 6 weeks .then a maintenance dose.
so do you feel the vit d can help in relieving the stiffness in next few weeks.


my calcium was 9mg/dl and phosphorus also normal.

thank you
 
 
Answered by Dr. Sumit Bhatti 31 minutes later
Hi,

Thank you for your query.

1. Vitamin D deficiency may cause muscle stiffness in addition to muscle ache and fatigue. AS you have mentioned, you need to take more sachets of Calcirol and then get your Vitamin D levels checked again.

2. Try a magnesium and Vitamin E supplement for the muscle stiffness as it is not responding to Vitamin D alone.

3. I am till not convinced of the fact that there is no neurosurgical cause as your history of the headaches and pituitary surgery are similar in duration. Did the headaches precede the surgery or start after it? Did they start after the diagnosis of the pituitary macroadenoma?

4. Get your ionic Calcium and Potassium levels checked. Get your ESR, Thyroid Function Tests, Uric acid, XXXXXXX XXXXXXX RF and CRP tests done.

5. The differential for tension headaches includes cluster headaches, paroxysmal hemicrania and so on. Try the newer medications mentioned above.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Suffering from tension headache, back pain and neck pain. What should be done to get relief? 44 hours later
hello

neurosurgical cause of headache has been ruled out by all drsthe character of this headache is quite different from tumor related headaches..the headache started before the tumor was diagnosed.the dr had labelled the headache as chronic daily headache and asked for MRI which revealed tumor.

i have tried all drug earlier.dont want to try any more now.

this headache is not cluster headache.

why ionic calcium is being asked for.and why other tests XXXXXXX XXXXXXX RF,CRP.patassium was normal earlier.

please do check WWW.WWWW.WW even after all the trigger points were finished the headache has not vanished.the stiffness in the neck persists.
i feel stiffness in the back.so i need to do back muscle exercises.

this is the last question of 3 consultation package.

thank you
 
 
Answered by Dr. Sumit Bhatti 2 hours later
Hi,

Thank you for writing back.

1. Various types of headaches are the main initial symptoms of pituitary tumors. Since the headaches preceded the diagnosis of your pituitary macroadenoma, it is not possible to rule out the connection. Did the headache pattern change after the surgery?

2. Did you have any features of acromegaly? What are your current growth hormone and other pituitary hormone levels? Did you receive any long term medical therapy after the surgery?

3.Ionic Calcium is a more accurate test as your current reading is 9mg/dl which is on the lower side of the normal 9-11 mg/dl. (Unless your lab. reference values are different). Other tests such as ESR, Thyroid Function Tests, Uric acid, XXXXXXX XXXXXXX RF and C-RP will help reveal any other chronic process which may be responsible for your muscle stiffness.

4. Websites such as WWW.WWWW.WW are very common marketing sites of very little medical value.

5. There is a cause besides only Vitamin D deficiency in your case. I would still suggest that you try the newer medication still such cause is determined.

Wishing you good health. Hope this helps.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Suffering from tension headache, back pain and neck pain. What should be done to get relief? 2 days later
hello

the character of headache remained the same post op.it was a frontotemporal heaviness.i consulted many neurologists ,but nobody could help me.then a pain specialist dr applied 100 units of botox inj all over the scalp ,as the studies say that botox has some role in headaches.but later the character of headache changed to tight band like sensation around the head.
role of botox in causing stiffness in head was ruled out as the botox effect is temporary.

it was a growth hormone secreting tumor.and now gh levels are normal.i am on thyroxine,10mg hydrocortisone and testoveron inj 250mg one in 3 weeks.now all hormone reports are normal.
post op MRI is normal.

why RF is being asked ,as there is no joint involvement .no rheumatoid arthritis.

do you feel the role of poor posture in causing headaches as explained by the WWW.WWWW.WW they had mentioned trigger points or knots which were truly present in the neck and after their physio technique it subsided,but headaches remained the same.
i had history of wry neck many yrs ago.but it was occasional.after an antispasmodic it used to subside.

a XXXXXXX neurologist some yrs ago had told me non pharmacological treatment.as all drugs had been tried.

i had consulted a rheumatologist ,made a diagnosis of pain amplification syndrome,advised some drugs ,but didnt help either.

i have tried so many drugs that now i am a bit averse to drugs.

i just dont understand what to do.even the best of drs have not been able to help me.but something is being missed ,thats why headache is persisting.

please specify what exactly the earlier mentioned drugs .what they do.

if the muscles ache on bending forward then that is characteristic of weak muscles.in my case the back muscles are weak.but how to get rid of neck stiffness.after hot fomentation on the neck i feel some improvement in neck pain.
the director of pain management centre in USA also endorses the program ,tensionheadache.

thank you



 
 
Answered by Dr. Sumit Bhatti 24 hours later
Hi,

Thank you for writing back.

1. Botox therapy is temporary. However a few patients get permanent effects. The principle is muscle relaxation.

2. It is good to hear that your hormone levels and pot operative MRI is within normal limits.

3. RF is a part of the normal battery of tests. There is no harm in getting it done. What are your your ESR, Thyroid Function Tests, Uric acid, XXXXXXX XXXXXXX and CRP test results?

4. Poor posture is more likely to cause backaches than headaches. Headaches from eye strain and bad neck posture due to electronic media is very common now. Wry neck is very common.

5. Retense (flupirtne) is a centrally acting non-opioid analgesic with muscle relaxant properties or Skelebenz (cyclobenzaprine) is a muscle relaxant medication used to relieve skeletal muscle spasms. You may have already used Thiocolchicoside (Myoril) which is a muscle relaxant with anti-inflammatory and analgesic effects.

6. Use an Infra red heating lamp for the fomentation.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Suffering from tension headache, back pain and neck pain. What should be done to get relief? 58 minutes later
hello

thank you for the reply

thyroid function tests are normal i am on 50 mcg thyroxine replacement therapy.
other tests crp XXXXXXX XXXXXXX not done.

in tension WWW.WWWW.WW they had explained how bad posture,poor neck posture can cause headaches and mentioned that no drug will help.
hot water fomentation will have temporary effects only.

earlier i had done a lot of rowing exercises then the stiffness in the back decreased but somehow the stiffness in the neck not coming down,which in turn causes headache.

i have tried ultrasound therapy on the neck,diathermy,hydrotherapy sessions,

i have tried diazepam and nitrazepam,baclofen,centrally acting muscle relaxants,
i had an extrapyramidal effect with cyclobenzhexamine and then developed torticollis,which was later treated by phenargan inj.
so i just dont want to try many other drugs.

for past many yrs i have not tried even a single pain killer,antisapasmodic and any other headache drug.

at the end headache is still persisting.

thank you

 
 
Answered by Dr. Sumit Bhatti 5 hours later
Hi,

Thank you for writing back.

1. Get these tests done nad try these medications.

2. Do you have:
a. Any food. smell or hunger related headaches?
b. Bruxism?
c. Photophobia?
d. Excessive daytime sleepiness?
e. Vision disorders? Have you had an eye checkup?

3. Do you wake up with a headache? Is it worse at certain times of the day? How do you relieve it without medications?

4. Are you exposed to any industrial or traffic noise or pollution? Is there any strong magnetic field in your area? Is anyone else near you affected by similar symptoms?

5. Extrapyramidal Reactions are often encountered and are not harmful.

6. Do you use an orthopedic or a memory foam pillow?

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Suffering from tension headache, back pain and neck pain. What should be done to get relief? 4 hours later
hello

the food is not related to hunger,food,smell etc.
other problems quest 2 are also not present.
i wear glasses and regular vision check is being done.myopia and astigmatism both.

i wake up with headache.the headache is 24 hrs duration.it is always of the same intensity .but whenever it increases then i do hot fomentation on the neck and take rest.,but no drugs.

no industry ,traffic or noise pollution where i stay.no strong magnetic field nearby.nobody suffering from same ailment nearby.

i sleep with a bedsheet rolled under the neck so the neck during sleep is in hyperextended position or if i keep a pillow the next day neck stiffness increases.back muscles too also get more stiff and the headache also increases a bit.

i never ever without headache.its constant muscle stiffness.headache worsens mostly due to lack of sleep.so i always try to have a good sleep.its the biggest aggravating factor.

thank you
 
 
Answered by Dr. Sumit Bhatti 4 hours later
Hi,

Thank you for writing back.

1. Do you have any recent cervical spine X-rays or an MRI Spine that I can evaluate?

2. Use an orthopedic or a memory foam pillow instead of a rolled bed sheet.

3. Get a Sleep Study done. Sleep deprivation headache is very common.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Suffering from tension headache, back pain and neck pain. What should be done to get relief? 9 hours later
hello

latest cervical xray is normal.

what is a memory foam pillow.i have to use a pillow which does not cause flexion of the neck.the day i started using a bedsheet rolled under the neck i noticed some improvement in neck stiffness.

sleep is absolutely ok.

how different the medications mentioned earlier are different from nitrazepam,diazepam,baclofen which are all strong centrally acting muscle relaxants.

even if XXXXXXX CRP etc if come positive then do you have a plan of action for that.

you feel there is good chance of me getting out of this problem.

thank you

 
 
Answered by Dr. Sumit Bhatti 4 hours later
Hi,

Thank you for writing back.

1. Memory foam pillows are easily available.

2. Diazepam and Nitrazepam are benzodiazepines with sedative, hypnotic and anxiolytic action. Baclofen is an anti spasticity drug. Retense (flupirtne) is a centrally acting non-opioid analgesic with muscle relaxant properties or Skelebenz (cyclobenzaprine) is a muscle relaxant medication used to relieve skeletal muscle spasms. Thiocolchicoside (Myoril) is a muscle relaxant with anti-inflammatory and analgesic effects. Hence these medications are different.

3. If an auto-immune disorder is the underlying problem there are many treatment options. This should be discussed case any of these test results are abnormal.

4. There is a good chance of your getting out of the problem. It is good to hear that your Cervical X-rays and Sleep pattern is normal.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
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