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Dr. Andrew Rynne

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Suggest treatment for headaches and occipital neuralgia compression like symptoms

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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3631 Questions

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Posted on Fri, 30 Oct 2015 in Brain and Spine
Question: 50 years old great shape workout last 20 yrs eat pretty healthy, never had headaches in my life and now all of a sudden the last 21 days in a row now there is a pain in the back top of my head and it only last about 2 seconds and then just has been coming back just maybe 15 to 20 times a day and 3 weeks straight. doesnt really hurt just a weird strange feeling that ive never had in my life and can come at anytime, doesnt seem to be going away. had back and spinal problems before and do lift weights but my neck doesnt really hurt and my back or spine hasnt bothered me in 10 years. did have 2 slipped disks but has been 10 yrs since they have bothered me, starting to get nervous about something serious, please help so im not so scared
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Answered by Dr. Olsi Taka 30 minutes later
Brief Answer:
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Detailed Answer:
I read your question carefully and I understand your concern.

Judging by that description of short lasting mild intensity pain in the back of the head I would say that there is no reason to panic, not unless there are other symptoms. It is not typical for any type of brain lesion like stroke, tumor, inflammation, infection etc. In any of those there is more intense constant pain and accompanied by other symptoms either from the beginning or over the course of the following weeks. So no reason to suspect something serious, rest assured about that.

Now what could it be. One possible explanation might be occipital neuralgia compression of the occipital nerve exiting from the upper part of your cervical spine from chronic degenerative changes of the spine. The pain is usually more intense but there is variability among individuals and the rest of your description fits well. I would suggest you avoid heavy exercising for a while, medication or local nerve block can be tried but since they address only the pain, the need depends on how much is it bothering you as you describe no real pain.
Tension type headache can also manifest such abnormal sensations although typically it is more consistent. It is the most common type of headache in the population, often triggered by stress and anxiety, usually relieved with over the counter drugs like Ibuprofen.

Another thing to consider is blood pressure fluctuations. Even if you have not been suffering with high blood pressure in the past, it is a condition which often develops with age and can present with such symptoms so it should be checked over these coming days.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka 1 hour later
thanks for your help and it does make me feel a bit better, there is something i just realized as well that was strange about 4 months ago i was driving in the car
and just lost focus in my right eye it felt real watery and just like you were crying for a bit and you kind of lose vision for about 30 seconds but this lasted 20 minutes and i could see out of eye but it was greyish tone and very blurry and just couldnt focus anything in and then 20 minutes later it just went back to normal. that has happened to me 3 times total over the last year but has been at least 4 months ago so doubt it is related to these strange pains im getting in my head. My vision otherwise is perfect and dont wear glasses or contacts. I dont have high blood pressure and had it checked about 30 days ago and also had the carotid arteries checked and had a heart scan they didnt find anything at all. what if the pain doesnt stop soon seeing how its 21 days long and it hasnt missed a day yet. what should i do thanks for your help
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Answered by Dr. Olsi Taka 3 hours later
Brief Answer:
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Detailed Answer:
Thank you for the feedback.

I do not think the eye episode is related to this recent headache. At the time one might have suspected a transient ischemic attack, a subtype of stroke. However you seem to have had the necessary heart and neck vessel investigations needed to find a possible origin of an ischemic attack. Also the fact it has repeated in the same identical way 3 times makes it unlikely, as blood clots wouldn’t go to the same artery over and over again. So it might either be a visual migrainous aura (visual phenomena due to localized electrical discharges, usually preceding migraine but which can happen also in the absence of headache – nothing to be worried), or a benign eye phenomena such as floaters.

As for the present symptom and what to do what to do next…I would give it some more days, about a week during which I would try to avoid as I said weight lifting or other hard activities and try relaxation exercises. An over the counter anti inflammatory drug such as Ibuprofen may also be used. If the symptoms persist beyond that period I would see your doctor. The aim would be first to have a physical and neurological examination to look for some other possible subtle sign which you might have missed as well as possible neuralgia signs such as local tenderness on nerve palpation. If there are indications in that direction a nerve block may be tried which is not only a possible therapy but also a confirming diagnostic tests. If there are no indications on that regard (if yes no further testing may be needed) then some routine blood tests to look for other potential reasons like anemia or infection (do not think it likely but they are simple routine tests) and also since the issue has been present for a long time which is not typical for common primary headaches like tension type headache a MRI can be scheduled (primary headaches are headaches with no identifiable cause such as migraine, tension type headache to name the most common). That again would be not because I suspect something in particular by your history but only because of its persistence, the fact you report no prior episodes in your past and doesn’t completely fit the picture of a primary headache so it does arise the need to be cautious and look for uncommon presentations. Hopefully you’ll be better in the coming days and it won’t be necessary at all.

I hope to have been of help.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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