Brief Answer:
Have you seen a headache specialist?

Detailed Answer:
Good evening. As a headache specialist there is something about your story that doesn't sound quite right to me and makes me question the actual indication or need to have gotten so many epidural shots in the neck. The fact that the headache was persistent for 23 days with dramatic symptoms despite all those shots suggests to me that they did not have much success determining what the underlying cause for these headaches were in order to suggest the most likely treatment to dispense with them. I wouldn't expect a 29 year old woman to have cervical radiculopathy to the point of leading to actual migraine symptoms and "dizzy" spells. I don't know whether you're describing DIZZY as being imbalanced, head feeling full, being lightheaded, or feeling vertiginous (spinning).

There are headache types that are based upon the symptoms of VERTIGO and MIGRAINE referred to as MIGRAINOUS VERTIGO. There is also the more rare condition of MENIERE's disease which is usually accompanied by significant vertigo, nausea, vomiting, tinnitus (ringing in the head), and HEARING LOSS on one side. However, again, in a 29 year old woman this is a rather rare condition.

I believe you are on far too much medication which is more likely than not contributing to some of your symptoms. I absolutely do not use all of that medication (especially opiate drugs) for these sorts of situations especially if there is no firm diagnosis as to what is being treated. I also insist that my patients keep careful track of their headaches, the symptoms that accompany, the duration of the headaches and other symptoms, and analyze these records to find trends, possible triggers, and situations that are part of the clinical picture.

I also do perform proper diagnostic testing such as bloodwork, imaging studies (typically MRI with gadolinium contrast in a patient with your demographic profile) looking for something that could be present in the brain that could be underlying the headache problem at the outset.

My suggestion on your limited information and without the advantage of being able to physically exam you neurologically is to find a HEADACHE SPECIALIST or at least a NEUROLOGIST to go over your history and review the medical notes and procedures performed to this point. I would be very insistent that your medications be scrutinized and streamlined so as to get rid of things not having any effect and those things potentially contributing or causing headaches.

There is an entity referred to Medication Overuse Headache (MOH) which describes headaches which are caused precisely by the OVERUSE of pain medications used primarily to TREAT headaches. These are more often than not over the counter types of agents such as Tylenol, Motrin, Advil, Aleve, Excedrin but also just as easily involve prescription medications such as fiorinal, fioricet, Imitrex, Maxalt, Cafergot, Lorazepam, and other medications. Meclizine is one of the medications which in my opinion is way overused for the benefit that it gives. I see hundreds of patients monthly in my clinic with dizziness and never even think meclizine.

In my opinion your type of headache picture is misunderstood by both physicians as well as patients. There needs to be a much more careful approach to diagnosing and treating such headaches. The diagnosis has to be known or at the very least aggressively sought after using a headache diary and appropriate testing BEFORE embarking upon an intervention whether or not medication is in the equation. LESS is MORE in such cases and the danger of jumping to treatments that are not helpful is that the headaches will become chronicified and more difficult to treat as time goes on. These need to be taken care of as soon as possible.

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 53 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

---

Brief Answer:
You can call technical support to see if audio appointments exist

Detailed Answer:
I'm not sure if such an option exists on this network. Perhaps, there is a way to do that but you'd have to call Technical Support and find out. I've never received any phone calls from patients on this network.

It doesn't XXXXXXX me to hear that you have a much longer history than just the story you tell in the beginning. Therefore, they should be looking at you as a chronic migraineur and offering you treatments on that basis. I still would highly recommend you seek out a HEADACHE specialist or at least a neurologist who had some training in headache medicine. It has its nuances....and one is how headache logs and diaries can often times direct us to interventions (not even medications all time) not otherwise obvious from just "guessing" at the next medicine in the pharmacopeia that you may not have tried yet.....which is unfortunately, how many physicians seem to operate. There needs to be logic and a purpose with how interventions and/or medications should be chosen.

And what about NON-pharmacological approaches as well? Are you familiar with what is known as a THERMAZONE DEVICE, or a newer NON-invasive device which delivers medications intranasally to perform what is known as a SPHENOPALATINE block (not the conventional style...BUT RATHER by going through the nose with a specially designed device to depot medication up in the area of the sphenopalatine ganglion?). Then, there is BOTOX injections and then, there are Magnesium infusions...if appropriate which can be wildly successful under the right circumstances.

I also note that you have PTSD which also implies a strong psychological underlying component which is likely a big contributor to your headaches and is probably causing negative impacts on your sleep hygiene which will clearly lead you to what we refer to as a SLEEP DEFICIT and that in and of itself is HUGE in terms of causing worsening of baseline headaches for which virtually no medication is any good for.....headaches secondary to sleep deprivation must be treated by PAYING THE SLEEP DEFICIT back. And if there are NIGHTMARES mixed in with your night's sleep (as I see in a huge segment of my military population just returning from overseas) then, we need to get rid of the nightmares.....preferably at their source....but at the very least using specific medication such as PRAZOSIN which doesn't address the CAUSE of the nightmares but it can bridge patients over long enough to get sleep deprivation under better control which will then, improve the frequency, intensity, and variety of symptoms that accompany each headache and makes them easier to treat with standard medications.

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 70 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

---