View Full Version : OA and Rhizotomy for Cervicogenic Headaches, Rhizotomy Failure

03-28-2007, 09:54 PM
Anyone have Rhizotomy for cervicogenic headache and have it fail? (Sorry this is going to be long.)

It lasted only a little over a month. I had Rhizotomies done at the C-spine. I am not sure which levels were done as he runs out of the room too fast and it's impossible to talk to him when he is sticking needles in my neck. And he only did as far as I can tell one level, 2 injections in one appointment. I know this because they don't use any pre-meds just lidocaine for local and I know because of the test for postion; 1 and zap, 2 and zap. Clean, bandaids and done. You can go to work tomorrow, normal activities. If any neurologists or pain guys read this consider next day stay home, rest, relax, ice and then go back to work. My boss thought ok, everything is good, you are here so go unpack the boxes of files from recent office relocation. Really not the best to do normal activities the next day.

Last one done February 5th and last Tuesday I woke at around 4 am with such a full blown migraine I could manage only to call work, leave a message and then I could not get out of bed. My head felt like it would explode, something in my neck, c-spine, was jumping like crazy and it felt like something was actually twisting around. I was nauseous which I had not had with these headaches in the past. I could take no meds because I knew they would come right back up. I woke at noon, neighbor in the apt. building was cooking onions, I woke up gagging. Then I woke at about 10 to 5:00 pm nausea was over and the first thing I did was swallow 3 Tylenol 3s and 1 Napoxen 500mg. I knew I had to get them in. I then quickly ate some applesauce because I knew the meds would make me sick on empty stomache and because I had taken no food or drink all day I knew I was dehydrated and would be hypoglycemic which causes another bad headache and shaking. Understand that these headaches are waking me up from sound sleep.

I was not able to call the neurologist all day and by the time I could call the office was closed and I did not think this was emergency by then. Weds. I went to work (should not have) Thursday woke with headache again at 4:00 am but it was not as bad as Tuesday. I called the neurologist (pain guy) who did the procedure. He added Gabapentin (300mg 2 x's a day). When I asked if the rhizotomy had failed or if the lesions were only partial or were the nerves already regenerating he said "you are asking too many questions". "You have a follow up scheduled for April 6th we will talk about it then just take the Gabapentin it is neuropathic pain." Well I went to get the Gabapentin and he had also called in a script for Tylenol 3 which I had not asked for nor did I need I still had a script with a refill left. And now I didn't know if I should take them together but I knew I had to get the Gabapentin started. Friday I went to work and by mid afternoon the pain and weird neck stuff was starting back up again. I had not started the Gabapentin as I had only been able to pick it up Friday morning and did not want to take it at work. I took it at 5:00 pm as soon as I got home and by then had a full blown headache. It worked wonderfully, after about 1 and 1/2 hour I got this weird numbing sensation up the back of my neck and up an over the top of my head, it followed the exact track of my headache (which I refer to as head pain, because that is what it really is). Boom headache gone. Not for long. I woke up Saturday morning at 7:00 am to headache, took the Gabapentin and bingo about an hour and 1/2 same thing. Wonderful. But not for long, awoke Sunday morning, headache, took Gabapentin, and hour and 1/2 same thing weird numbing following the track of headache. But not so good, same on Monday morning, so I could not go to work (not to mention the side effects, dizziness, spatial relationship off, hands feeling weird, legs too but the benefit far, far outweighs the little annoyances). Call neurologist, explain that I think that there is no overlap with the Gabapentin and I am having breakthrough head/neck pain, I explain the weird neck stuff, jumping and twisting feeling, I ask again did the procedure fail, was there partial lesions, were the nerves regenerating? He says to take the Gabapentin every 8 hours, and again I am asking too many questions he will see me in a couple of weeks and we will talk about it then. Oh, in the meantime, I also woke Saturday with very, very bad LBP (I have moderate to severe Facet Joint degeneration of the lumbar spine, the only normal level lumbar is L1-L2, otherwise it's a mess). He will not address the LBP at all, we will talk about it in two weeks, take your pain meds. I made appointment with my GP, saw him yesterday, Tuesday (should not have driven myself but I had to go). GP agrees with Gabapentin, there are others newer with less side effects, try it for a couple more days it might level out. The script for Tylenol 3 from pain guy is "1 Tablet every 8 hours as needed". Now this is like throwing a glass of water on a burning house, what's the point? GP says take as manufacturer recommends 1 to 2 tablets every 4 to 6 hours as needed. What a difference that has made. Although this has slowed me down, the pain is finally subsiding and today is the first day in 5 that I can actually stand upright and I can now lift a gallon of milk.)

Oh, I take Naproxen 500mg 2 xs a day, Naproxen and Neurontin, I read it in the package insert on-line, you need to adjust dose of both because in animal studies the Naproxen increased the effects of Neurontin by about 14% at doses much lower than intended for human therapy. So I did switch to OTC Aleve. Still it might be increasing the side effects even at 220 mg 2xs a day. I know I read too much, but you have to these days. Some day I will tell you about the adverse effects/interactions of taking Elavil and Tramadol, it's not pretty and I asked both the neurologist and pharmacist and they said "No problem". So I read.

Ok everyone, who knows about Rhizotomies and the failure rate and the regeneration of nerves and is it possible that another set of nerves has been "lite up"? All the literature I have read (work for pharma company have access to literature) doesn't really address anything other than partial lesioning of the nerves. Is it possible it failed both on the left level and the right level of the C-spine at the same time? I don't know if he used any steroids at the time (some do this) he didn't say, could it have failed entirely?
I am now out of work all week, I don't see that I am going to be in any shape tommorrow for work, I cannot really drive like this and the back while better is probably only better because I have increased the Tylenol 3s. My GP wanted me to try and add muscle relaxer Orpehnadrine (neuro took me off of Flexeril: over medicated not the same neuro as pain guy, works in same office and referred me to pain guy for epidurals and rhizotomies). I can't find much about the interaction between orphenadrine and neurontin/gabapentin. But I suspect that it might not be good that's too many CNS meds. And the Orphenadrine is time released 100 mg, can't break in half.

I would love some information if just on the failure of rhizotomies.

03-30-2007, 03:36 AM
Howdy :).

I've had the procedure done for occipital neuralgia/headaches.

Yours sounds like it was done quite a bit different than how my doctor does procedures. I'm consciously sedated (Versed) and (most generally) don't remember a thing that happens once la-la land time happens.

In addition, the doc uses fluoroscope - every procedure; the "f" word is live-guided x-ray for precise needle placement.

Also, the pre- and post-op instructions are to rest the day of and days following a procedure. No driving and no work.

I don't know whether your neurologist might have mentioned it, yet... in everything I've been told and read about Rhizotomies there can be a temporary worsening of symptoms - which, for some, may persist for a couple of weeks (before the effects of the procedure kick-in).

I don't know about possible adverse interactions with medications you mentioned. If you feel up to it, though, you may want to ask your pharmacist. That's what I'd do :).

About the "failure" rates: Again, I don't know. I used to have all kinds of info. at my fingertips. I'll see if I can find some of the stats later today.