I have posted in PN section but this is the other issue.
Known issues degeneration c2/c3 c3/c4 c4/c5 it is worse in c4/c5.
I feel good lying down but shortly after getting up I get dull pain at base of my skull and around my eyes sometimes pain goes up back of head to eyes. The pain is not severe but there is a lot of pressure like something is squeezing my head the pounding in my head is only occasionally present. There is usually neck discomfort around c7/T1 like it needs adjustment. Eyes seem out of phase meaning i see ok just not like it use to be
I feel unbalanced but no trouble walking or driving
I take baclofen 30mg gabapentin 900 mg nortriptyline 20

Not sure if this migraine issue or neck issue

Any input appreciated

have you been checked for chiari malformation?

Two MRI's in 5 months with/without contrast both showed clear same with cat scan

There's nothing to say it can't be both (e.g. migraine brought on by neck issue or migraine and headache brought on by neck issue).

I have a tension-type/migraine complex. I can get either or both together, and either can present as the other. The two types respond to different kinds of meds, so determining/guessing which I have—and how to treat—can be problematic.

Have you had your eyes examined lately? Baclofen & gabapentin can affect vision, but there could be something else. I developed a slight astigmatism a few years ago. My vision is still 20-20, but it used to be better, and I need reading glasses.

Doc

My eyes have been examined by two different ophthalmologist. One repaired my torn retinas. He said my vision was better in october than my previous exam 4 months before. Pressure in eyes was normal. The other ophthalmologist said problem was neurological.

My pain doc wants to do ablation on my neck. Neurologist has not given a Dx yet

Ok here are my two cents, but I'm no expert on these things:

With the certainty of neck problems in the picture, my "first pick" would be Cervicogenic Headache:

http://ihs-classification.org/en/02_...1_cranial.html

If you have a history of migraines then the likelihood of there being a migraine component goes up. The other thing is pain type. The dull ache does not sound like migraine, but the throbbing pain does.

What leads me away from the migraine path is the fact that you've not mentioned other typical migraine symptoms.

Light and sound sensitivity are pretty typical of migraine. Nausea is frequent at some point during the attack. Technically, for a diagnosis of migraine, the International Headache Society (IHS) criteria require the presence of A) nausea, or B) both photophobia and phonophobia.

See: http://ihs-classification.org/en/02_..._migraine.html

There are other migraine types which you can browse if you go to that site. Migraine with Aura has several subtypes you might want to look at.

The dizziness and vision can be due to basilar migraine, which is a type of Migraine with Aura -- you would have to have some aura sx: http://ihs-classification.org/en/02_..._migraine.html

The IHS also has a diagnosis of probable migraine for those who meet all but one criteria for any migraine subtype.

You could indeed be getting mixed attacks. Are you mostly trying to treat these things, or more trying to figure out if the neck is the source of the headache, in order to decide about the ablation?

waves

IME, typical migraine symptoms typically present with typical migraines.

IOW, atypical migraines don't always present with typical migraine symptoms, e.g. not all migraines cause pain (these are sometimes known as silent or acephalgic migraine), and not all migraines are in the head (e.g. abdominal migraine).

The typical ones are easy; it's the atypicals that can slip through the cracks and go undiagnosed (and prove more difficult to treat).

The last time I changed PCPs, and the doctor was entering my various DXs into his computer, he stopped when he got to migraines.

"Hmmm," he said, "There are 30 different kinds of migraines here, and yours isn't listed. Ah, here it is... 'None of the above'."

Thanks for those links. I haven't had time to peruse them, but I've bookmarked them for later. Off hand they appear to be more comprehensive (albeit somewhat confusing) than the other sites I use. The litmus test will be if they have mine.

Doc

Right. To clarify, the "typical" sx I gave specifically refer to Migraine without Aura as defined by the IHS, as per the link following that paragraph. That is the simplest type of migraine-with-head-pain that they define, and many of their other diagnoses refer back to this headache type.

I do not know if the IHS criteria are those used in the US. Any diagnostic criteria, however, serve as minimal guidelines; they are not intended as descriptive references and cannot cover every possible experience.

Yes, I myself get acephalgic migraines sometimes. The IHS codes these as a form of Migraine with Aura. Abdominal migraines are coded under childhood syndromes, but the text specifies that they occur mainly in children, suggesting that an adult can also receive the dx.

Haha. I've seen these catch-all diagnoses for other illnesses too. They are provided precisely so physicians can decide if an individual warrants a certain diagnosis even though he or she does not fit nicely into one of the specific diagnostic buckets, as there will never be enough diagnostic buckets to fit each singular case.

Enjoy!

Not sure what your defining sx are... I'd be curious if you find yours. In regard to the mixed/tension aspect, though, I'm pretty sure that is not coded specifically. I believe the working definition of such is a headache which meets criteria for both migraine and tension type.

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On another note, You've mentioned you have difficulty peeling apart the tension/migraine headaches and treating accordingly. You've probably tried lots of things so I don't know if my experience can be of any use to you:

For clearly mixed headaches, I treat both the tension and the migraine.

Sometimes, I get severe, unilateral tension in certain back/shoulder/neck muscles and after about 12 hours of that I get a headache whose pain quality varies. The neck/back pain persists, sometimes to the point of causing neuralgia right the way down my arm. These caused me a lot of confusion. Thinking that there was mostly a tension issue, I would take myorelaxants, wind up with a wicked headache, and end up having to take huge amounts of NSAIDs. For a while I just took less NSAID to try to cover my bases, but this is undesirable. At some point I discovered that, most of the time, zolmitriptan will not only kill the migraine but also relieve the tension. If I take the Zomig early at the first hint that some stiffness is producing a headache, I don't usually need other medications. YTMV (Your Triptan May Vary ....if indeed you use them for your type of headache.)

BTW, is your back doing better (recalling the herniated disc)?

waves

All I meant was that I'm not necessarily lead away from suspecting some kind of migraine.

My headach Dx doesn't show up anywhere (that I've been able to find via simple search) on goggle except one chiropractic site.

In that case I'd agree; there's no choice. As you know, the sooner we treat correctly, the easier to defeat the headache with less medication. But guessing wrong can lead down a path of 2-8 hours of taking the wrong medication, allowing the headache to gain momentum/steam, requiring more of the correct medication (than if I'd guessed correctly), which may not mix well and leave me overmedicated and out of commission for 1-2 days. It happens, but it's not my preference.

My back is mostly better; it's a recurring injury, and with little/no disc left in some places, I don't know what the future will bring. I'm told I'm not a candidate for surgery (unless paralysis threatens) because my arthritis is too severe. Right now, I'm told my spine is "stable", so status quo.

Doc

Hi Doc,

I think you are saying that in your mind, the absence of 'typical symptoms' does not lead you away from migraine. Just FWIW, when I said I was led away from migraine by the abscence of these sx, I didn't mean I was ruling out migraine, only that I felt it was less likely than if the presentation were typical -- less likely, not non-existent, nor even insigificant. I hope that is a bit clearer.

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My comment on treating clearly mixed type headaches was more of a preface; yes, those suck but they are a nobrainer to treat, and the sooner the better, as with anything.

The type of attack I described afterwards is not the kind I'd call "clearly mixed". It surprised me to find out that a triptan would resolve tension/stiffness, moreover in places other than my head. I guess I sometimes get that as part of prodrome. I wondered if perhaps some of your tricky-to-distinguish attacks might have similar sorts of features.

It still happens now and then, that I fail to catch whatever is truly happening and wind up out of commission for 1-2 days d/t medication and/or intractable pain. I don't know if we can hope to make the right call 100% of the time, you know? We can only hope to get better and better at it.


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I am glad your back is better for the moment. Perhaps they will make some medical advances that will give you more hopeful options for treatment.

Take care.

waves