Spoke with a neurologist on here yesterday. Forgot to ask something else.HISTORY: Started having a bad headache last week and my doctor sent me for a Brain CT that came back completely normal. Is that standard practice to order this when a headache presents?Did or have the Cat Scan ruled out major stuff like tumors, etc?Also my Primary Care Providers plan of action is to send me for some kind of trigger point injection or some other type. He did not specify? Is that normal procedure?Is there any type of Chiropractic care of physical theraphy work for this type of head head.It feels like a dull ache that starts in my shoulders that creeps up both side of my neck into the back of my head!For now my doctor has me taking Zanaflex and Vicodin for this.Seems like the medications make it a little worse after they wear off and wonder why? I actually felt better not taking anything, ha??? That makes no sense to me?
Person's Gender: Male
Person's Age: 35
Got a Brain Cat Scan
waiting for you to come online
Hey your back
how are you today?
I wanted to ask a couple more things I forgot
head still hurts
back of the neck and up the back of the head correct?
Is there potential for me to got to chiropractic care
still in same spot
Would chiropractic do anything?
I have worked with chiropracters in the past
Or maybe some kind of physical theraphy
they are pros at fixing this type to problem as well
well PT is usually for cervical radiculopathy that is lower in the neck
you have it into your shoulders? as well?
truthfully it feels knotted from my upper shoulder on up, like crunchy feeling , knots etc
all the way to base of skull
so it could be generating from my upper shoulder as well
so the shoulders are C4 and C5 level, this is sounding more like fibromyaglic type pain
but it creates a dull headache in the back of my head
right, so there is a big muscle on your back called trapezius
and it comes up from the shoulders and into the back of your head
So that means I could have firbromalygia is what you are saying?
you have trapezius spasm
but neck seems tender too
well fibro is a multitude of things. you have to have tender points on examination, at least 14 of them on exam etc
I am assuming I could get injections all over in that area upon injection type
its really two points I feel
upper shoulder one spot is knotted bad and then base of skull upper neck
both are tender
so when you get your trigger points you will get those , and maybe others injected
Is it ok to take this Vicodin and Zanaflex as prescribed for this?
there is also medicine specifically for fibromyalgia
I forgot to ask you that
hydrocodone and tizanidine (generic names) are a ok approach for starters
you haven't had this for a long time
No a week
Since last Friday and not befoer
but you might need to switch to meds more specific if this becomes a chronic problem
I have had headaches before on and off but not continous daily like this past week
right, so the approach is correct for now
triggers and symptomatic treatment for the neck first and see if this goes away
then the possible botox after if that doesnt work right?
well botox if for the cervical problem specifically
Are more scans warranted? If my PCP wants to send me for another
if you end up with fibromyalgia, you will need to change meds to cymbalta, or Lyrica
the botox will not be enough if you have shoulder pain
I told my doc I had a Brain CT last August and he ordered another anyway
so you have had two? for headache?
No last year I fell and they order a Brain CT that was normal
Same month this year I have head ache so he orders another
I should be good for awhile, ha
so you could try some symptomatic chiro care or PT
If my headaches dont go away and my PCP wants to order another CT should I refuse?
no more CT scans
I have a friend that is an ortho surgeon that I told about this
and he said he probably did not need to order this one, haha
I had abdomen pains so he ordered an abdomen and pelvic CT that was completley normal
and after those normal results came back
he likes CT scanning
he wanted to do an abdominal ultrasound
that seems completety backwards
Ok mean time will try to do some chiropractic care
did you have a concussion when you fell?
This is a new thing, maybe pulled some muscles or something that is causing this
Not that I am aware of
Yes I would approach this as "cervical spasm"
But my doctor was afraid a tumor or something this time
From what I have been told tumors grow over time
and treat it as you are doing at this time give it a few weeks
My girlfriends dad had a tumor and his neuro told him he has probably had it for sometime
so it would have showed a year ago on the last scan
but I am no doc
guess he wanted to cover his butt to
I can understand that
well there are tumors in the CNS that grow quickly, in fact the most common the GBM grows fast
but all the others are pretty slow
But the Bran CT would have picked up any abnormailty corrct?
And assume would present with other symptoms then just a headache?
Interesting about the growing fast thing
I learn something new
yes it is really bad. like the one Ed Kennedy had
I am very proud of what you do and how your field of medicince is advancing sir!
survival is 19 months
well thanks we try
but you don't have to worry about neoplasms or arterial malformations, etc.
My girlfriends dad and a cancerous Brain tumor that he had 95 % cut out and the Doctor and MD Anderson in Houston gave him 24 months to live afterwards
That was 15 years ago and he is still here and getting clear scans
wow that is fantastic
Changed his lifestyle and food he eats completelty
so the pathology must have changed
all by itself
Yeah he has all these anti cancer books and cds
very interesting as i have read them all
he eats all fresh stuff no preservates etc
the thing is that we don't understand all the issues here
what turns on the tumors or turns them off
I mean he does do traditional medicine but incorporated all these other things into it
and it worked obviously
Unlike Steve Jobs which I read caught his cancer early and could have survived yet decided to take the herbal approach
How long have you been in practice if you dont mind me asking sir?
right, that is the story, they found it extremely early on an ERCP test, and he didn't want the chemo
well thanks for taking time to come on here to answer questions for people like me
no problem have a nice saturday
take care come back anytime
Dr Frank T
Do you think the problem with society is they wait to long for stuff like this
Just last question
as in people go months years before they go to the doc when they could have caught something early on?
well everyone has their own approach to their health and it should be respected
I find that in a lot of people
sure, some feel they are invincible
But i always hear people could have caught it early, etc but they waited to long
Jobs was like that
well good luck to you ok?
Alright sir thanks again and have a good weekend.
Thanks you take care of yourself as well
let me know if the pain doesn't quit
what would be a next step
General Adult Neurologist. Board Certified. Experimental Neuroimaging and Neurodiagnostics
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information. What happens now? If you haven’t already done so, please rate your answer above. Or, you can reply to me using the box below.
HI sorry didn't see you had another question?
You there sir?
Hello yes, I am here how are you?
I am not sure if I posted my exam results before but wanted to post them.
EXAM: Head CT without contrast performed
SCANNER: GE 16 Slice BrightSpeed
EXAM DATE: August 7, 2012
COMPARISON: Comparison Exam August 09, 2011- Head CT
SCANNER: GE VCT 64 Slice
TECHNIQUE: Multiple thin-section contiguous helically-acquired, axially-displayed computed tomograhic imagaes of the brain were obtained from the posterior fossa continued through the supratentorial structures, with images reviewed at brain, intermediate, and bone windows.
FINDINGS: The ventricular system is normal. No focal parenchymal areas of abnormal density or mass; there is no midline shift. No extra-axial masses or collections are present. The pituitray gland is unremarkable to the extent visualized. The orbits and sella are normal and the visible paranasal sinuses, middle ear and mastoid air cells are clear.
Examination of the skull on bone windows shows no additional abnormality.
IMPRESSION: Normal CT of the brain. No hemorrhage, mass or mass effect or CT evidence of infarction. No questionable areas of further examination. There is no change from the prior CT exam of the brain.
My question is, if my headaches get worse does these finding mean its not coming from something in my brain, etc?
My doctor gave me vicodin for the headaches and wondering if taking these meds are making the headaches worse?
Also I have been on vicodin since 4 months ago for a lower back injury. I was taken 1-2 a day. Could the continous use of such meds cause this in the first place?
Also is this something that I can count on my internist to treat?
Continuous use of vicoden can cause nausea/vomiting if allergic to codiene. they can also give you headaches. Your CT is normal So this excludes the intercerebral causes of headache as relates to increased pressure in the brain from tumor or stroke or bleeding. Most headache has nothing really to do with brain changes. Headache comes from irritation of the coverings of the brain, or the scalp and muscles around the skull. Your story was suggestive of cervical spasm, or irritation of the muscles in the back of the skull. So are you going to stay with the gameplan, PT GON blocks? botox if needed? You should get a neurologist as this is our bread and butter, as opposed to treating urinary track infections, etc. as an internist. Those guys are great but this is more specialized. let me know if you need anything else. Dr Frank T.
Was planning on sticking with that gameplan. Yes
I just need to find a neuro here in Albuquerque, NM that deals in a lot of headache stuff. Most here have sub specialties like MS etc.
Would you recommend a nom narcotic instead like tramadol.
Is it common for a temple to be sensative when pressed? My left one is.
tramadol is an synthetic opiate. a similar medicine in its class that I like is Nucynta, or tapentadol. Like tramadol, you can get it in an extended release form. I will leave you with a webpage on this drug
I am leaving you another webpage, the american headache society, they are pretty big, and have a provider network search engine, so you might find one there. ok? get back to me for questions. dr
Oh yeah what about the temple pain you did not comment on that?
Would you be confident with the Radiologist findings with continuing headaches?
HI. temple pain? that can also be muscular contraction headache pain, there is a muscle on the side, superficial temporal muscle that contracts and gives you headache. Would I be confident on a radiologist finding on a CT scan, absolutely. CT has been around since the early 80's, I've been looking at them for 30 years, but only sporadically as MRI has really cornered the market in neurology. But a radiologist? that is all they do day in and day out, 30 or so a day, for 30 years? CT has its limitations, I wouldn't try to diagnose a CNS vasculitis or MS, but tumors, bleeding in the brain from whatever source, CT is fantastic.
And you have had 2 correct? good luck in finding a good headache specialist in Alburquerque. Dr Frank T.
I have had two CT Scans. Not knowing much about the quality and how far they can see in the brain, I know one scanner was a GE Bright Speed 16 Slice and the other was a GE VCT 64 Slice. Both scans were done one year apart and had no changes from one to the other. Thats just what I read on the report. I had 3 radiologist look at both scans and all 3 agreed on findings.
Is that standard protocol for Neurologist to order a Brain CT or do some do MRI first for headaches?
Should I ask my Internist to prescribe fiorcet for the time being until I get my injection in middle September?
Also should I exercise in the mean time? Would that make symptoms better or worse by increasing blood flow?
One last thing as you have put me at ease. I am searching this ACHE site for local docs and it ask me do I want one that is UCNS certified. What is that?
My anxiety is probably not helping either!
CT scans are fine for headache, Neurologists will order an MRI for other diseases, like MS/vasculitis, metabolic problems like encephalopathy, dementias , but for common headache, the concern is a bleed or neoplasm (rare).
You could try fioricet, you really have to wait for that injection?
you can exercise, but I would not run or pound and have that be reflected into your neck, and no heavy squats, or benching. Aerobics increases blood flow, how about a stationary bike?
you do seem anxious to me online, that is probably not helping your cervical spasm either, although we all are different, maybe you work better on the edge so to speak.
I do not work better on the edge. I am the type of person that when I get an uncommon sympXXX XXke this since I know my body so I think the worst.
Do these injections typically include lidocaine and steriods? Or is it a simple lidocaine shot?
By the way i searched the ACHE site and none come up within 50 miles of me! No headache docs here unfortunately.
if you do not have a contraindication for steroids, I usually use them in cervical spasm as there is an inflammatory nature to the muscles in this condition. Some use just lidocaine or lidocaine and prilocaine, which is a longer anesthetic effect.
Dr. Frank T,
Hope everything is good with you. Pertaining to our previous discussion, do you think it would be a good idea to go to a chiropractor? I have an appt tomorrow. I cant not get in for my injections until Sept 27 so I have lots of time to experiment with other things until then.
absolutely. I am a proponent of chiropractic, some neurologists don't believe in them. But I see them as useful when you have tremendous cervical spasm (which I feel you do have, based on your story) so I would let them work on you. The will try to manipulate your atlantoaxial junction and get those muscles to relax. Try it out and let me know ok? Dr Frank T
Thank you sir. I figured it was worth a shot since my injection appt is so far out.
Hopefully my chiro appt goes well today. I have a question about these so called tension/cervogenic headaches. Can they go all over your head? Typical definitions I see online says a tight band feeling and mine is not that at all. It starts in my back neck and moves up. Or just now had like a 1-2 second pain in the top of my head and nothing else about 1 finger length from my left ear or sometimes I will feel pressure behind my eyes. The headaches seems very elusive.
Tim, no golden rules with these headaches, certainly the symptoms you describe can be seen in tension headaches. Cervico genic means they just start in the neck, from known pathologic changes, but have a primarily tension like picture. The muscles that surround your skull are all connected by a tight aponeurosis or band layer in the scalp, covering the vertex, and you can get pain as part of tension in that part of your scalp.