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headache type? treatment?
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lizard_lady_nm posted:
Hi, my name is Natalie. I had an anterior cervical discectomy and fusion C5-7 using the ROI-C cervical cage and artificial bone-seeded sealer of some sort in 2011. I used a bone-growth stimulator post-surgically for about 3 months. At first I thought my recovery was going well but then the back and neck spasms returned, and these blinding headaches started with shooting pain in my skull and eyes. I was trying to return to work but after about 6 months of progressively worsening condition and short term disability exhaustion I had to leave on medical disability, which kills me - I hate not working. Anyway, sorry for rambling, I've never done this before...

I'm still at home 2.5 years later with chronic headaches. My fusion failed - I quit smoking about 2 years before the surgery, so maybe that history contributed to the failure - I'm now 46. Most of my pain feels like it's in the bones of my skull and face and in my eyes. I get these lightning bolts of pain and intense surges of pain into my temples, eyes, right side of my skull, and sometimes this one spot on the crown of my head and/or behind my ears. My cheekbones, eye sockets, eyes, forehead and brows get this deep persistent ache. I also get pain in the back of my skull (deep ache), neck and down my spine to my shoulder blades (burn). Sometimes my scalp is hypersensitive and tender on the right upper side. The pain in the late afternoon until bedtime is often the worst which clusters of shooting/surges of pain with lasting residual pain.

I have a couple of pain management physicians for medication management and injections. I'm on gabapentin (600 mg 3x/day), tizanadine (8 mg 3x/day - a LIFE saver for me), amitriptyline (20 mg 3x/day) and now hydromorphone (2mg per dose, up to 4 doses/day). Trigger point injections almost always cause me to flare up rather than reduce the pain. I've had cervical nerve ablation, occipital nerve blocks, facet and epidural injections, acupuncture, myotherapy, PT, deep relaxation training, and nothing has helped much. My brain MRI is normal. The cervical spine MRI (Dec. 2012) is pretty normal just noting reversal of normal lordosis and some minor osteophytes. The last X-Ray I had in Sept. 2013 notes the reversal as well and 2mm of anterior subluxation of C2 on C3 and of C4 on C5; a mild narrowing of C3-4 and C4-5 interspace, and small anterior and posterior osteophytes in the endplates at those levels. My surgeon believes that micromotion in the fusion space is causing the headaches and that to fix the fusion we'd have to go through my back and the likelihood that it would improve my pain is 50%; having no impact or making it worse also 50%. I don't think another fusion surgery through the back is a good idea.

My medications usually work pretty well when I'm at home, i.e. I get 2-4 flare ups during the day, but with medication can limit the pain to maybe 4 hours, on a good day, on a bad day it's more like 10-12 hours of not excruciating, but pretty awful, pain (on a scale of 1-10, level 8, rarely 9 (lightning bolts only, not lingering)), and that's when I'm not moving around a lot. But when I go out, the bouncing down the road in the car, walking, turning my head a lot, etc. starts the flares of pain, which then linger so I sometimes have to abort my errands, come home and medicate.

I found a web site that offers "hardware injections" - diagnostic blocks into the failed fusion site. Has anyone heard of that? Is it widely practiced? I'm hoping to locate the origin of the pain so maybe I could get an implant (electrical stimulation or morphine pump?) and go back to work. Does anyone know of any other treatments I might try?

Thank you for reading all of this. Any suggestions you might have are greatly appreciated.
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An_256249 responded:
This probably will not be the answer but it helps me with the pain in my neck, use lots of lidocaine cream. It is available on amazon in a tube, I believe it is 5% cream.

Good luck!


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