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Q: I have been under various doctors' care for over 13 years for headaches, which are almost constant. I have been diagnosed with tension headaches, vascular headaches and migraines. They are getting worse. I have three bulging cervical disks: C4-5, C5-6, C6- 7. And my neck hurts.
I have also been on various medications, had epidurals (three weeks' relief), trigger-point injections, myofacial release, physical therapy and traction (which helped slightly). Could the bulging disks be causing the headaches? Are there any treatments you might suggest?
A: I'm sorry to hear that you have experienced 13 years of pain and frustration.
Based on the information you've provided, especially those treatments that have had some success, my guess is that seeing a neurologist or neurosurgeon about your neck problem would be a good next step.
Both chronic and recurring headaches can be painful and distressing. That's bad enough, but sometimes headaches are merely signals of more serious medical problems. Indeed, they are more often symptoms or warning signs than disorders in and of themselves.
This is especially true if there's a change in the pattern or nature of the headaches, e.g., progression from rare to frequent or mild to severe.
Headaches are among the most common medical problems reported to doctors and have a broad range of possible causes. Identifying the cause can be difficult.
Medical history and a thorough examination are important. The intensity, quality and site of pain, and especially the duration and presence of associated nerve-related symptoms, may provide clues to the underlying cause. In addition to the history and exam, it may be necessary to do MRI or CT scans, electroencephalograms and spinal- fluid analysis.
The major types of headaches are tension, migraine and cluster. They are easily identifiable as different disorders, but have much in common.
Tension headaches are the most common form, characterized by mild to moderate intermittent dull pain, often brought on by stress, fatigue or depression. They are caused by muscle tension in the neck, shoulders and head.
Cluster headaches are defined as multiple recurrent attacks of severe, usually unilateral (one side of the head) pain. They occur most often in middle-aged men, but are the least common of the three types.
By contrast, migraine headaches occur most commonly in young women, are of moderate to severe intensity, and are often accompanied by nausea and increased sensitivity to light and sound.
Headaches are also associated with trauma, eye problems, sinus problems, brain tumors and infections, and hemorrhage in the brain.
As you might suspect, it would be impossible for me to diagnose the cause of your headaches. But bulging disks in the cervical spine are certainly a reasonable explanation and should been dealt with even if you didn't have headaches.
Although you haven't presented any evidence of this, it's also important for people to understand the symptoms of stroke, one of which is headache, so that treatment will be started as early as possible.
Write to Dr. Allen Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1500, Chicago, Ill. 60611; or contact him at DRFamily@aol.com. This column is not intended to take the place of consultation with a health-care provider.
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