Expert: Dr. J. Shawn Leatherman - 5/2/2007

Question
For the last three years I've been having chronic severe headaches that radiate from back of the left side of my head where the head and neck meet. They are painful through my left eye and left temples. The veins in my head are actually painful to the touch. The pain does radiate throughout my head. The pain is also down the left side of my neck and I have general muscle tension on upper left back (shoulder blade) and down my left arm. On my left arm there are two painful areas: on the outside of my upper arm - if I press against the bone, it causes a shooting pain and numbness. Also just below my elbow where it meets the forearm (funny bone) and down to my pinky finger.

Any type of lifting (yes, I have two small children that I carry on my left side), desk sitting, exercise like pilates or lifting, etc. exacerbates it and when it flairs up, it lasts for weeks on end. The headache pain is about a 7/8/9 on a 1-10 scale - migraine status. OTC pain relievers barely make a dent.

Other symptoms:
- congestion (no, I don't have a sinus infection)
- vision impairment (strained eye sight, blurriness. I wear glasses when looking at the computer at work)
-dizziness and lightheadedness
- nausea
- severe sleepiness
-tinnitus: pulsating and a constant hum in my head. This makes sleeping and hearing difficult.

I've been told "it's stress" so many times I think I'll scream if I hear that again. I tried Cymbalta for 5 mos and went off when I got pregnant this last time. While pregnant, I had to stop any heavy lifting and exercise and my oldest was old enough to walk and get in the car, etc. This seemed to help but now I am back at work (same desk) and lifting an infant and it's back in full force.

I had an MRI about a year ago and it came back normal. I saw a chiropractor for about 8 sessions and the exercises seemed to also exacerbate it.

What do you think?

Answer
Dear Sarah,

You have a strange presentation of symptoms that overlap, but may have separate causative factors.  From the initial description of headaches that radiate from the base of the skull to the front of the head and behind the eye indicated musculoskeletal dysfunction in the upper neck and upper back.  Especially with the description of radiating pain into the shoulder blade areas and left arm.

An MRI that is "negative" means that there was no nerve root compression/encroachment found and that the disks are all within normal limits which is a good sign. Moreover, if there were any brainstem or cerebellar tonsil involvement, that would have been found on MRI.  So again this points to musculoskeletal dysfunction and or structural dysfunction of the spine.  Structural dysfunction can only be quantified with upright x-rays taken of their neck in neutral position, these can be measured and compared to the normal states as described in the clinical literature if the doctor is aware of these values and understand how to mark the films.  Medical doctors are not trained in this technique, and many chiropractors aren't either.  For more information about this aspect of correction please check out this website:  www.idealspine.com.

A few questions:  Are you left handed?  Does your job require long hours of desk and computer work?  Do you perform repetitive tasks on a daily basis that would place stress on your neck and left side?  Are you on the phone a lot throughout the day?  Any increased physical demands that are asymmetrical can cause these symptoms due to cumulative micro-injury.  Have you had normal blood tests checking for inflammation? Do you have x-rays of the neck?
Has anyone tried to address the muscular component with deep tissue massage or active and passive stretching techniques to reduce physical and gravitational stress to the neck and left side?  

A specific technique for addressing the muscle and fascia (coverings of soft tissue) would be helpful.  As muscle spasm are frequently responsible for intense local pain and headaches, while trigger points will actually cause referred pain.  Check out www.grastontechnique.com  and  www.activerelease.com  for more information on good mobilization techniques for the soft tissue, adhesions, muscle spasms, and scar tissue.

The other associated symptoms you have spoke of can be associated with the above, or separate.  They just seem to be all over the place.  I would work on the soft tissue component first, and then see what residual symptoms are left.  Give this a try and research the above options, and feel free to write back with any additional concerns or questions in relation to any ongoing problems.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net