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

There are so many types of headaches and migraines.........(which I never new_. I have cervical migraines due to arthritis in my neck. I have degeneration in every level. I have no cartilage anymore (10 yrs now I was 27). I didn't know that til a yr ago. I suffered 9 yrs. All I do is take Excedrin (like today) and that stops the pain from crawling up the back of my neck and would eventually (if I didn't take excedrin) engolf my entire head/face.

With degeneration on those discs it can see why you would have throbbing in the base of your head. When you sit up all of a sudden your neck is supporting your head and if you don't have the proper support in your neck it's not gonna feel to good. I say this because i have another neck pain. I have so many I can tell the difference between them......Sometimes my neck can't support the weight of my head and I wear a neck brace. It holds my head up so my neck doesn't have to do the work. Then the pain lessens.

I have no idea if this has anything to do with your pain but I wanted to say it just in case.

Hope u feel better soon.
Heather

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

Hi Heather, welcome.

Would strengthening the core neck muscles help? I would think a neck brace would weaken those muscles.

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