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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Suggest treatment for stiff neck and dull headaches

Answered by
Dr.
Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3650 Questions

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Posted on Tue, 9 Aug 2016 in Brain and Spine
Question: Stiff neck and neck muscle/throat pain predominately on left side but with like (but much lesser symptoms). Also, ear discomfort (mostly a "flutter" type sensation). Plus, frequent dull headaches. I do not have much difficulty swallowing; rather a constant stiffness/ache ranging from lower left neck up thru left ear and under jaw area.
Please note in March, I had my left salivary gland removed on left jaw line due to a blockage. However, I had the above issues prior to this surgery. Last, note, I had a C7-C8 fusion fusion 15 years ago thus the region has had a lot of activity. That said, the pain described above is recent as of late last year. I've 2 CT 2 ENT exams, 2 CT Scans, a Bone Scan, X-Rays, Blood Tests and seen several orthopedic specialists,.and an MRI - nothing of note found save abovementioned blockage. Physical therapy has not helped much. I just can't shake the pain. soreness.....


doctor
Answered by Dr. Olsi Taka 10 hours later
Brief Answer:
Read below.

Detailed Answer:
I read your question carefully and I understand your concern.

It might have been useful to have been more specific with the medication as you have stated simply everything. That way it is difficult for us doctors to recommend additional treatment, to know if we are recommending anything useful or something you have tried and failed.

Given the many tests that you have had you should feel reassured that there is not any threatening issue causing your symptoms. Based on the description I would have put a diagnosis of an infection of the surgery site or the middle ear, but the CTs and MRIs should’ve excluded that. A metabolic issue such as electrolyte alterations can cause such spasms but I imagine blood tests have ruled those out.

Most probably the pain and spasms that you feel are due to the local trauma to the muscles and the peripheral nerves initially from the blockage and later from the surgical procedure.

It should improve with time, however to alleviate the symptoms medication for chronic and neuropathic pain is usually beneficial. Such medication involves two main groups of medications either anticonvulsants gabapentin, pregabalin or antidepressants like duloxetine, amitriptyline. I hope that you have not exhausted these options already.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 6 hours later

Thank you for your thoughtful reply. By way of a bit more background, the meds I'm taking Diclofenac Potassium 50mg 3 times daily and Baclofen 10md 3 times daily. Aleve as well.

In terms of other treatments I did have a procedure in late March whereby the nerve endings on the left side of my neck were burned. This left me with almost complete relief of all symptoms for 6 weeks until I foolishly carried some luggage across the airport. 3 days alter the pain/discomfort was back. My doctor is reluctant to perform the procedure again as he felt lifting luggage should not have caused the pain to return when the nerve ending were deadened? He suspects another cause that can't be pinpointed. Plus, it's a procedure that is typically only once a year. Disappointing as the results until I did too much were great. Thus, since the mid May airport adventure, I am back to where I was pain wise since early this year.

I had a cortisone shot in XXXXXXX that had no impact.

Please note my last CT Scan was before the early March salivary gland removal thus an infection is possible. I did see my ETN in April and May and she felt I was coming along as expected.

My more recent concerns are the increased headaches, and more persistent discomfort on the left side of neck and ear, plus a bit like more pain on the right side. I do feel some discomfort in my throat but it does not seem to impact my ability to swallow. More to the point, the pain seems next to my throat rather than "in" it. Not quite sure.

Frankly, I am at a loss as to how to get better. The situation is really lessening my quality of like. I've seen many specialists covering throat/neck/mouth, Ortho specialist, Ortho surgeons, etc...... from Northwestern, University of XXXXXXX and Rush in XXXXXXX and yet some 11 months later other then the "nerve burn" procedure", nothing has worked. Perhaps a post gland removal CT Scan might be appropriate.

Thank you.





doctor
Answered by Dr. Olsi Taka 52 minutes later
Brief Answer:
Read below.

Detailed Answer:
Thank you for the additional information.

The fact that the pain initially subsided after the procedure and symptoms reappeared after lifting weights does render the possibility of post procedure complications less likely than I suggested (normal ENT exam as well) and makes the possibility of a neck issue more likely. While the fusion you have had was on the lower cervical levels, such procedures such as fusion by limiting the mobility at that level put other cervical levels at higher stress and over the years there is the risk of there being arthritic changes in other spinal neck levels. The pain they cause may irradiate also toward the ear, so it could well be the cause.
For that reason I would see a neck MRI as a more appropriate initial exam at this point. As for the treatment my previous recommendation for adding to your current regiment a medication for chronic pain such as Gabapentin is reinforced. Physical therapy sessions are necessary as well if neck arthritis is confirmed to be the cause.

Let me know if I can further assist you.

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