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Neuro Doctor
Neuro Doctor, Neurologist (MD)
Category: Neurology
Satisfied Customers: 4625
Experience:  American Board Certified Neurologist, Internal Medicine
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I have a pain in the back left base of my skull that hurts

Customer Question

I have a pain in the back left base of my skull that hurts a lot at night occassionally. Sometimes, it's just a dull pain; but mostly, day and night, it's there and annoying. It's always the same spot, and lying on my back, or either side doesn't help. Sometimes, I don't go to sleep until 5am (and have to get up at 7am) I have tried to lay down during the day to see if it hurts as bad then, but it doesn't; I think the pain is the worst at night. Every now and then, during the day, I will feel like something is crawling inside there at the same spot, and other times, it will almost tickle. I have a pacemaker, so no MRI; CATScan, clear, sleep test says problems falling asleep consistent with pain. I'm 49 and never needed pacemaker; otherwise very healthy. I have taken asprin, tylenol, motrin, ekcedrin, and others through the years that I have had this problem. I have been to neurologist, head and neck, chiro, ...what would you do if you were me with this long undiagnosed problem that is wrecking my short term memory due to pain and lack of sleep.
Submitted: 5 years ago.
Category: Neurology
Expert:  Neuro Doctor replied 5 years ago.

Hi, Welcome to Just Answer!


I am an American Board Certified Neurologist (studied & worked in USA) with a vast neurology clinical practice experience. I am familiar with the condition that you have described and can help you with your questions/concerns.


After carefully reviewing all the available details I am considering the possibility of Occipital Neuralgia in you.


It is due to pinching or irritation of the occipital nerves (greater and/or lesser occipital nerves) that supply that area you mentioned and you can experience upper neck/base of the skull pain and/or headaches.


There are myriad causes although not always they are identified during investigations.


History of injuries to the neck area, whiplash, arthritis in the upper cervical spine, repetitive flexion & extension of the spine (the neck part) may trigger this condition, and there are more causes too. If CT of the neck was not done then you need that. Also as I said above investigations may not reveal anything sometime.


Regarding the management; if you haven't tried already the below options then it may be worth trying.


1) A muscle relaxant like Tab Baclofen .


2) Cap Gabapentin


These help with the nerve-pain, you can use ether alone or in combination.


3) TENS (Transcutaneous Electric Nerve Stimulation): With a small device and electrodes minor electrical impulses are applied to the painful area and this might relieve the pain too. TENS may be contraindicated with pacemakrs of certain types, so if you decide to use this please make sure it is compatible with your pacemaker.


4) If these above approaches do not help then you may see a pain specialist and they may try special interventions like occipital nerve blocks.


5) There are still more interventions like Rhizotomy but they are reserved only as last measures.


These are my recommendations and if you are seeking a more elaborative discussion or have additional concerns then please ask further questions.


All the best!


Best Regards,


Dr Sathya.

Neuro Doctor and other Neurology Specialists are ready to help you
Customer: replied 5 years ago.
thank you for your help. Would you rule out brain hemmorage completely? I have had several head injuries: thrown from horse, but didn't hit head; backstoke in pool, hit head; and hit head in closet a few years back. My eye dialation is the same in both eyes and normal. I do have some weird sensations in my left fingers and arm that feel like vein pain??? thank you for your comments. I will follow up on those recommendations.
Expert:  Neuro Doctor replied 5 years ago.

Thanks for these additional details. And Thanks for the payment & bonus too!


Yes, the brain hemorrhage possibility is not included at all. While there is no suspicion of a bleed in the brain, even if it was there the resorption of that blood must have taXXXXX XXXXX time ago and should not have any relevance with this headache what you are having now. The pupil equal size erases whatever tiny doubts one may have.


About the hand/arm pain; an EMG test will be very useful if not done already. A carpal tunnel syndrome or cubital tunnel syndrome is the possibility. If the neck pain radiates down the arm & fingers then pinched nerve in the spine is a possibility too. The CT you might consider for the base of the skull/upper neck pain may additionally shed light in to the cause of pinched nerve in the neck (if EMG indeed shows pinched nerve). If neurological conditions like above are ruled out then you may discuss with your family Dr about any circulation problems (like vein flow related etc).


I am reassuring you we are not dealing with any serious neurological conditions here. Please follow the recommendations for what appears to be a case of occipital neuralgia and I hope they will help you immensely.


Please ask if you have further questions until you clarify all your doubts.


All the Best!


Best Regards,


Dr Sathya.


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Customer: replied 5 years ago.
thank you!
Expert:  Neuro Doctor replied 5 years ago.

You are welcome and thanks very much for the payment & bonus. All the Best! Please follow up any time if you require my involvement in your care again. Best Regards, Dr Sathya.


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