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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What could cause headache in the back and behind eyes, muscle pain, weakness, balance issues, and strength problems?

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Dr. Yogesh D

General & Family Physician

Practicing since :2009

Answered : 927 Questions

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Posted on Wed, 17 Oct 2018 in Brain and Spine
Question: hello... i have been to so many doctors. my primary and many specialists. I have been suffering with headaches (primarily in back of head and behind eyes, some lasting a short while other hours on end ..worsened by activity or excercise) fatigue, muscle pain, weakness, balance issues, strength problems, concentration, lack of finding the right words, can't sleep, pain all over, and on and on. i've been diagnosed with sleep apnea, I have used cpap for about a year. but all symptoms are still getting worse. they did lymes test that was negative, mri found a chiari malformation 4-5 mm, found spot on my pituitary, testosterone tests are ok, rhuematologist cleared me, infectious disease specialist cleared me, my neurologist is about to perform an emg test this week, i've seen 2 endochrinologist that cleared me, see foot doctor (gave insoles that helped some pain, but not rest) had xray of feet, legs, chest,back, ultrasound of abnomen checking kidney/liver etc. had tons of bloodwork done. nothing definitive. i feel like i am losing my mind! i don't know what to do. my primary asked me to try acupuncture. and after that she was going to start pain managment meds....
doctor
Answered by Dr. Yogesh D 3 hours later
Brief Answer:

Need to consider thalaminc syndrome or fibromyalgia syndrome.

Detailed Answer:

Hello and welcome,

I am sorry for all the suffering you are going through.

Considering all your symptoms together and all the investigations you have undergone, I suspect either thalamic pain sydrome or fibromyalgia syndrome.

Please continue care under your PCP and neurologist.

Ask your neurologist to consider these two possibilities during your next visit.

Fibromyalgia can be effectively managed with medicines like SSRIs.

I hope this information will be of some use, please do write back to me if you need any further clarification.

Wishing you good health.

Regards,

Dr. Yogesh D,
General & Family Physician
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Yogesh D 42 minutes later
could the thalamus be affected by the Chiari malformation? I've been seen a well known neurosurgeon at NYU that deals with Chiari and I'm scheduled for a 2nd follow up with him as he wants to do a csf flow MRI to see how the malformation effects me, and if surgery is a thought. it's currently up to me. my neurologist and rheumatologist don't think I have fibromyalgia, but if I do, I probably can't take anything for it as I'm on meds for epilepsy. (as per my neurologist, says the meds interact) , I had 2 siezures in my late teen/early 20s. and one in 2009. (that is when I was diagnosed with epilepsy and started meds). I read that thalamus pain syndrome is typically caused by stroke, I've never had one... that I know of at least. so I don't know if that changes things.
doctor
Answered by Dr. Yogesh D 1 hour later
Brief Answer:

Thalamus not affected in Chiari Malformation, simple analgesics can help.

Detailed Answer:

Hello again,

Many of the neurological symptoms do point towards Chiari malformation which needs to be ruled out, as your neurologist is actively pursuing that, you can wait for the tests to be done.

Fibromyalgia is a diagnosis of exclusion, all other probable causes need to be ruled out before considering fibromyalgia as the cause for pain.

Yes, your neurologist is right in avoiding medications for fibromyalgia since you are on antiepileptic medications.

Thalmic pain syndrome need not always be caused by a stroke, many times it is idiopathic. Moreover, thalamic XXXXXXX strokes may not be recognised either by clinical exam or by MRI scans done later.

You can wait for the MRI scans and further neurological exams.

Let us hope for the best.

Hope the answer is helpful. Do keep in touch and keep me posted so that I can help you further.

Regards,

Dr. Yogesh D,
General & Family Physician
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Yogesh D 16 minutes later
thank you. I'll talk to my neurologist when I see him Thursday for my emg test. my csf MRI is March 6th. hoping for answers. work has become a struggle and my personal life has become almost impossible. sleep is so difficult in pain and don't like taking so much pain killers. afraid of damaging my insides.
doctor
Answered by Dr. Yogesh D 22 hours later
Brief Answer:

Too many pain killers are not advisable, let us wait for the MRI reports.

Detailed Answer:

Hello again,

Thank you for writing back.

Let us hope you will get some clear answers sooner. I understand how difficult life must be. Please discuss with your neurologist and see how it goes.

Hoping for the best for you.

Regards,

Dr. Yogesh D,
General & Family Physician
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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