Have you been evaluated for TOS? My advice would be to seek out a vascular surgeon with TOS experience for such an eval. Your pain doc can do diagnostic injections but should know immediately if they have effect (even if only temporary). I experienced excruciating headaches and earaches for months (I initially thought I had ear infections) that baffled my primary and pain doc (I eventually had to stop working). We eventually suspected nuerogenic TOS (I had a previous neurologist suspect this in the past). I sought out some vascular surgeons and they found that I had both vascular and neurogenic TOS contributing to the symptoms. Raising my arms was compressing the thoracic outlet and the PT I was doing was making me worse. I had to train myself to drive and sleep with my elbows at my side (not near my head) and wore Intelliskin postural garments to get the aches under control (I still required rib resection surgery).

Try keeping your elbows at your sides at all times (especially driving and sleeping) and see if it helps.

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