I am Dr. Arun and will be helping you today.
I am sorry that your question was unanswered for long.
An hypertrophy is increase of tissue in size. Here the ligamentum flavum hypertrophy has occurred because of pressure of the disc which has prolapsed. Thus ligament is overworking, increasing in size. A circumferential bulge means that disc has come out of its space all around and thus causing pressure on the cord as well as the nerve roots. The central area of the disc bulge causes pressure on the spinal cord and side bulges causes pressure on the nerve roots.
This looks like what we term as cervicogenic headache. This headache is caused by referred pain from the upper neck (cervical) joints. The headache may be caused by neck movement or sustained awkward head positioning. So people who work long hours on computers are liable to have this kind of headache. Migraine and tension-type headache can be the other possibility, which can be concomitant to cervicogenic headache.
Physical therapy is the preferred initial treatment for cervicogenic headache. The other modalities employed for the treatment are done by pain management physician and are invasive modalities. These are;
1) Percutaneous radiofrequency neurotomy
2) Steroid injection
Your physician may consider a trial of Gabapentin or Pregabalin as an initial medical treatment to see the response with the physical therapy. Neck traction, acupuncture too can help.
Following measures would be helpful;
1) Neck care in the activities of daily living.
a) No working on computer for more than half an hour in a single stretch. Same for TV.
b) Monitors and televisions exactly in front (180 degrees).
c) Contour pillow: Should fill the hollow when lying on back or straight. Available over the counter.
2) Cervical Collar or Brace
3) Cervical traction
4) Anti-inflammatory analgesics like Ibuprofen
5) Some physicians do give oral steroids in severe radiculopathy cases, in whom pain / numbness / tingling is quite significant.
6) Physical therapy: gradually increasing exercises from passive stretching to active against resistance regime.
7) Electrotherapy in the form of TENS, interferential and laser and ultrasound.
8) Hot fomentation
9) Local analgesic patch / ointment / spray
You can consult following specialists;
c) MD in Physical medicine and rehabilitation
Please feel free for your follow up questions.
I would be happy to assist you further, if you need any more information.
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