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Dr. Tom
Dr. Tom, Board Certified MD
Category: Eye
Satisfied Customers: 263
Experience:  30 years experience treating patients with eye problems
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Since March I have had chronic waxing and waning pain just

Customer Question

Since March I have had chronic waxing and waning pain just below the occipital notch accompanied by tired, heavy sleepy eyes, along with a general sense of ill-being. As this occurs I can have a strong desire to sleep. Naps do not refresh me. I generally feel mostly "well" in the morning and get sick in the middle afternoon and then begin to feel better by about 10 p.m. Since March I have also had periods of irritability and occasional nausea. Any insight would be greatly appreciated.
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Tom replied 1 year ago.

Dr. Tom : Hi, I'm online now and would be happy to help you with your question.I understand what you are asking. Just reply and we'll get started. Dr. Tom
Customer :

Hello

Dr. Tom :

Good evening.....may I ask a couple of questions to get started?

Customer :

Yes

Customer :

Hi are you still there?

Dr. Tom :

Hello again...there must have been an error with the system.

Dr. Tom :

I will resend my questions....give me a minute to re-type them.

Customer :

ok

Dr. Tom :

Since this has been going on since last March, would you please tell me what types of medical exams and tests you have already had to try to sort out your problems?

Dr. Tom :

And please tell me more about the Occipital ( posterior scull area) pain you have.

Customer :

I am seeing my ophalmalogist on Friday. My GP doesn't quite know what to make of it. He did run some a chem screen and some pretty detailed thyroid tests - all normal. He also did a brain MRI, which was normal. I have sleep apnea and saw my sleep doctor today, but she said my machine has recorded few episodes per hour and within the normal range. The pain in the back of my head coincides with my feeling of sleepiness and general feeling of not being well. All of the symptoms come and go.

Dr. Tom :

Thanks for that additional information. I am very glad that you will be seeing your ophthalmologist. It will be important to rule out simple things that may be leading you to have the tired heavy sleepy I feeling. Something as simple as dry eye syndrome could be the reason. And this is very easily managed with over-the-counter artificial teardrops. As for the occipital pain, it is very common in people with anxiety and stress. Because yours tends to come and go, again it fits the pattern. I was wondering if you and your primary care physician have discussed the stress, anxiety, depression relationship with your ups and downs and sense of feeling "well" some of the day and irritable at other times?

Dr. Tom :

Do you have any dizziness, headaches or the feeling of being groggy?

Customer :

I forgot to mention that I tried Wellbutrin, with no effect. My doctor did say that people with depression typically have there most difficulty in the morning, i.e. they don't want to get out of bed. I am just the opposite. I feel my best in the morning and look forward to the day. I've had bouts like this before (and eventually recover after long periods) and the only possible diagnosis has been chronic fatigue syndrome. I really don't fit that pattern though. I don't have the typical symptoms, such as, sore throat, tender lymph nodes, no post exertional fatigue, etc. I feel like this is something other that dry eye though because the other symptoms are so profound and debilitating.

Customer :

The head pain does make it very difficult to concentrate. It's like a tightening pain in the lower part of the back of my head.

Customer :

No dizziness though.

Dr. Tom :

It is certainly easy to understand that you may become frustrated as your physicians go through working through your symptoms and the appropriate testing. And so far it sounds like the right approach is being taken. So one of the things that I would suggest that you speak to your ophthalmologist about is a condition called occipital neuralgia syndrome. There was a neuro ophthalmologist at Johns Hopkins who wrote a paper on his treatment of patients with the condition. He found that simple nerve blocks in the occipital region broke the cycle in many of his patients. I think it would be worth bringing this up to both your ophthalmologist in your primary care physician. In our area of the country, we have pain management specialist who are pretty familiar with doing these nerve blocks. In some cases it actually serves as a diagnostic test if the symptoms are significantly reduced by these nerve blocks. Does that make sense to you?

Customer :

I did look up this condition, but it didn't seem like the symptoms didn't track to what I was experiencing. Sorry, I have forgotten the specifics. Does my pattern seem to fit this in your view?

Dr. Tom :

Well, as you can imagine these things are extremely variable. And by no means does everyone with occipital neuralgia experience the type of ocular issues you have described. But there is definitely a subset of patients who do have referred pain and to the orbital area from cervical conditions. In most conditions that seem vague and difficult to find a specific diagnosis, one eventually turns up. And from what you and I have discussed tonight, I would certainly put occipital neuralgia syndrome on your diagnostic list to be ruled out. I wish that I could help you by giving you something very specific but I have a feeling that you are pretty intuitive about these things and realize that as your doctors rule out more and more problems that, both they and you, will get a handle on this. I certainly wish you the best and am standing by if you have any other specific questions with which I might be able to help.

Customer :

No. Thanks.

Dr. Tom :

Well thank you for allowing me to help you with this tonight. I really hope that you get it sorted out as soon as possible. It's part of my job to ask you to rate our conversation and to ask you to click one of the big smiling faces before you checkout about compensation. Thank you

Dr. Tom :

That was not compensation, rather conversation. Sorry

Expert:  Dr. Tom replied 1 year ago.

Dear Bill,

 

Again best wishes as you work through your complex problem. Please take a minute to rate our conversation. My objective was to be as helpful to you as possible. I hope I was able to satisfy you with some additional information. Before you completely check out, please rate our conversation with one of those big smiling faces. Thanks again

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