Expert: Dr. J. Shawn Leatherman - 2/21/2007

Question
Dear doctor,

I have been suffering from pressure near/around the temporal bone for about 6 months now.At times it feels like tight bands around my head.  When I press down on the bone it hurts as if I got hurt. The crown of my scalp hurts when I touch it or when I wash my hair. Also I noticed that the back of my head hurts slightly as well. At first I thought it may of been a sinus problem, but a ct scan showed mild-chronic sinusitis. Can you please tell me, whether or not this is related to sinusitis, or if may be nerve demage.  I have visited a chiropractor and he stated that my symptoms are related to greater occipital nerve. Also do you recommend a cervical spine MRI? Thank you

Answer
Dear Maria,

What you have described does not sound like nerve damage, rather irritation. In relation to the greater occipital nerve, yes it can cause the symptoms you are complaining of as it traverses from the back of the skull over the back of the head, but you likely have involvement of the lesser occipital nerve as well which supplies information up the sides of the head behind the ears.  Now supply to the head in front of the ear up to the temples is supplied by branches of the Trigeminal nerve which is a cranial nerve, but has a major ganglion (group of nerve cells)that can be affected by input from peripheral nerves in the neck. The ganglion is like a train station with nerve tracks entering and exiting.  The branches are called the Zygomaticotemporal, and the auriculotemporal nerves...in case you want to look them up. All of these nerves can be affected by adjustments of the Occiput, C1, and C2 vertebra, and chiropractic care should help.  Conversely, the nerves that affect the top of the head originate from other branches of the trigeminal nerve called the Supraorbital and supratrochlear nerves.  I know, big names, but the bottom line is that these nerves can be stimulated by spinal adjustments and it should help reduce your pain and symptoms.

Other things you need to consider:  do you pull your hair back into a pony tail or other type of tie...affects the scalp and nerve supply; do you have high stress and tight facial muscles, tight upper neck musculature;  do you grind your teeth or clench them tightly...affect the temporal and masseter muscles which can create headache pain;  any other factors that may be contributory.

Mild chronic sinusitis of the nasal cavities tells me that you have continual low level inflammation of the membranes inside of the sinus cavity.  This can also aggravate some of the Trigeminal nerves due to their proximity to the nasal cavities.  Sinus pain is often felt in the face around the eyes, upper cheeks, and the forehead.  If does not commonly go over the head, but this is still a possibility.  you may need to be medically managed in conjunction with the chiropractic care to help alleviate the sinusitis.  Antibiotics can often be affective in reducing the inflammation if there is a bacterial infection, but an upper respitory tract culture should be taken to determine this, otherwise anti-inflammatories may help...just consult with your M.D. on these matters.

Concerning the MRI of the neck, this is not something I would do right away.  There is no clinical reason to do so.  MRI's are utilized to visualize the soft tissue such as disks, nerves, nerve roots, ligaments and muscles.  We usually order MRI's of the neck if we suspect significant swelling, bleeding, or for radiating symptoms into the shoulders, arms, and hands, not the head.  After a course of treatment, say two weeks, if your symptoms have not improved, then you should discuss the possibility of a brain or neck MRI at that time with your treating physician, but they may be hesitant to order it.  It is an expensive test, and should be utilized only with clinical correlations.   

Good Luck Maria.  Feel free to write back if you have any further comments or questions.

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