A literal pain in the neck at night.

December 11, 2010 8:04 AM

I am having neck pain that develops into a headache whenever I lay down. It started just over one week ago, and has progressively gotten worse. It goes away a few hours of waking up, though as it's gotten worse, it takes longer to go away. Yes, I've been to the doctor and we're working on a diagnosis; I'm looking for more insight.

It starts out feeling like my neck is weak and the pillows aren't supporting it correctly. Then moves on to a headache, with the pain radiating from the base of my skull to my forehead and face, and down the back of my neck radiating into my shoulders. The source of the pain seems to start at where my head and neck meet, but its hard to determine once the pain is full blown.

It wakes me up from sleep, and I have a hard time falling back to sleep. I have, over the past week tried several medications, including Ibuprofin, Cyclobenzaprine, Sumatriptan, and Percocet (not all in the same night!). The only thing that gave me relief was two Percocets. And then, I can feel a shadow of the pain but the pain itself is gone.

Which brings up another point, I just had surgery one month ago, I had my sinuses opened up, my deviated septum straightened, and turbinate reduction. My doctor said everything there is fine and not causing the pain - more on that shortly. (That's also why I have some Percocet laying around)

I frequently fall asleep before it gets bad, but then it wakes me in the middle of the night. At that point, I feel like someone is just squeezing my head and my brain wants to explode out. The most pain is in my forehead and the back of my neck, but its also all over. I think its worse than any migraine I've had, but its hard to do a side by side comparison. Putting a heat pack on my forehead helps a little bit, and does let me fall back asleep for a little. Same with a heating pad on my neck. Propping pillows so I'm sitting more upright does help a bit too but it doesn't solve it, just lessens it.

Thursday the pain was bad enough I had my husband drive me to the urgent care clinic. I threw up on the way there and then again in the doctor's office. I think it was due to the pain; I've vomited from pain before. The urgent care doctor diagnosed it as an atypical migraine caused by stress. This didn't sit well with me because I'm not particularly stressed, and I don't think laying down would trigger a migraine.

Later that day, I had a post op appointment with my ENT who preformed the sinus surgery so I kept it and asked him about it. He didn't see anything like a sinus infection or anything else out of the ordinary that would cause the symptoms I was experiencing. In fact, he said I was healing quite well though still a little swollen, which was to be expected.

I also made an appointment with my primary physician for the next day. She said the waking up at night in pain was a red flag, and there was no way it was a migraine based on my symptoms, ordered an MRI for next week and prescribed Prednisone, and told me to take it right away. So I did, and an hour later took a nap and slept like a baby, no neck pain or headache. Same with last night. Unlike the Percocet, there is no shadow of pain, it's just gone.

I have another appointment with her Monday to follow up, and the MRI is scheduled for Thursday for "head and brain" (that's what was written on the sheet given to me to call about scheduling it).

If you've managed to read this far, what can I expect? The Prednisone worked, is that a good sign or a bad sign? Should I be expecting the worst, a tumor? Encephalitis, meningitis, brain worms? Is there anything else I should be asking my doctor?

(Also, I'm kind of terrified of an MRI. Please tell me how its not going to tear any non-existent metal out of my body.)

posted by [insert clever name here] to health & fitness (14 answers total)

MRI - the problems that people have with them is that they're quite enclosed, and very noisy. You shouldn't experience anything at all from the magnetism (as long as you've taken out any piercings/removed all jewelry beforehand, of course).

As to the cause - IANAD and I don't know. The steroids are reducing an inflammatory response, but that could be anywhere in your head. Check if you need to discontinue the steroids before the MRI - if they are stopping inflammation, it may also stop the inflammation showing up when you get the MRI (so making it less informative).

Do you have any other symptoms, outside the pain? Brain problems often (but not always) involve issues elsewhere, like vision, speech, sensation and so on.
posted by Coobeastie at 8:20 AM on December 11, 2010

I can't help with your main concern, but the thing I'm wondering is if you can try to sleep in a recliner until you solve this.

Also, I have metal in my body, in the place where I get repeated MRI's (an implant at a surgery site) and all it does is tickle. Nonexistent metal in your body isn't a problem; it's okay. MRI's are very boring but mostly not something of which to be fearful :) ...although if you're claustrophobic get a script for an anti-anxiety pill from the referring doc and take it before you go in, it'll help.

As far as I can tell, "migraines caused by stress" is the first answer most docs have to serious, daily recurring headaches. It's extremely frustrating when the only source of stress is the damned headache, and you can't think straight because of the headache and lack of sleep, and all you want is for the doctors to make the headache GO AWAY, and they just tell you, "Oh, the headache is your own fault. Stop stressing and you'll be fine." It's good your primary doc is on it.

(I'm kind of wondering if that "swelling" the ENT doc mentioned could somehow be related to the headache, especially since the pred made it go away. Pred is killer on swelling.)
posted by galadriel at 8:24 AM on December 11, 2010

I feel like someone is just squeezing my head and my brain wants to explode out.

This. Especially at the base of the neck. I have this. I have a Chiari malformation, which can (or can not) cause a whole host of symptoms other than headache. I first noticed that I had problems with a very similar kind of headache (felt like someone had my brain stem in a vise grip).

You may have a Chiari malformation, you may not (its more likely that you don't), but the only way to know for sure is with an MRI of the head and cervical spine--on Monday bring it up with your doctor and ask for the neck to be included in your scan.

MRIs are no big thing. Unless you have been a victim of a bombing or building collapse and have shrapnel in you (or have really old fashioned broken bone pins), you have nothing to worry about. They are long, loud, and uncomfortable (if you like to squirm and not be enclosed), but they are by far the safest and best flavor of body scan. Since I'm kind of uptight about these things myself, I always give a quick dart around the MRI room to make sure the handyman from the night before didn't leave a screwdriver sitting around anywhere (much to the annoyance of the MRI tech), but it gives me peace of mind to give a cursory assessment of the room. If you're still terrified day-of, it might help relax you to just re-confirm that nothing there can hurt you.

Good luck!
posted by phunniemee at 8:24 AM on December 11, 2010

This sounds like EXACTLY what happens to me when my C1 and C2 vertebrae get locked up. Sometimes this happens when I sleep wrong, or am too stressed, or turn my head too abruptly while driving, etc.

I recommend that you see an osteopath. Osteopaths are sort of like a cross between a doctor and a chiropractor -- they can do spinal manipulations/adjustments like a chiropractor, but they are also "real doctors" and thus can write prescriptions, etc.

When I have this problem, the solution is usually to first loosen my muscles up as much as possible with a massage and/or muscle relaxant, then have the osteopath adjust my neck and pop the C1 and C2 back into place.

I am always shocked by what a world of difference this makes. Not only does the pain go away, but I can suddenly SEE better -- like all the light and colors in the world get 25% to 50% brighter. And one time I was so messed up that I was losing control of the grip in my right hand -- it immediately went back to normal after the adjustment. It's amazing how much a slightly pinched nerve in your neck can fuck you up!

After the adjustment it's important to take good care of your neck so you don't lock it up again. The osteopath can recommend a good neck pillow, and he/she will probably also show you some daily stretching exercises to do. One of the best ones for relieving/preventing the recurrence of this type of problem and headaches is to spend a few minutes a day lying on your back on your bed with your head dangling off the edge and just let the entire weight of your head hang there to stretch everything out. It feels really weird at the time (and may hurt a little afterward, like any other kind of stretch), but if you do this consistently for several days then you'll start to feel the difference.

So, please consider asking your primary for a referral to a massage therapist and an osteopath (schedule the massage right before the osteopath appointment). The sooner the better -- it may turn out that this will fix things and you won't need that MRI or any more drugs!
posted by Jacqueline at 8:31 AM on December 11, 2010

I had headaches for years before finding out they were easily treatable by a chiropractor. I got an x-ray that showed that two of my vertebrae were out of place. A few months of weekly chiropractor treatments and I was fine. Now I only go back very rarely, and sleeping on a special pillow helps.
posted by davextreme at 8:37 AM on December 11, 2010

I am coming in to say the same as Jacqueline and davextreme. I was terrified I had a brain tumour when I experienced your symptoms. I had an x-ray which showed that I had a C1 and C2 problem that had been caused, it turns out, by a fall down some stairs 15 years previously [!] I saw a chiropractor for the first time in my life and got immediate relief. The headaches would return but less frequently or dramatically. I had a number of adjustments over several weeks, then over several months and I don't have any problems now after 2 years. I also agree with seeing an osteopath - I also had recommended an excellent pillow which I have used for several years. When I am traveling I find that my neck protests loudly without the right pillow. Voltaren gel is great for me too.
posted by honey-barbara at 8:49 AM on December 11, 2010

Not to discount other posters' experiences, but please, please, PLEASE do NOT go to anyone for a neck/spinal adjustment without an MRI and radiologist's diagnosis. If I were to let a chiropractor touch anything in the C1 C2 region, I would be in serious trouble. If it's something simple that can be fixed with a spinal manipulation that's one thing, but if it's not, that is a REALLY bad area to muck around in.
posted by phunniemee at 8:49 AM on December 11, 2010 [3 favorites]

(BTW, I recommend an osteopath over a chiropractor because too many chiropractors push a lot of woo-woo stuff about energy fields and claim that chiropractic adjustments can fix all sorts of nonsensical stuff like acne, liver problems, etc. Also, many chiropractors try to sell you on the idea that you will need regular adjustments for the rest of your life, etc. Not all chiropractors are like this but there are a lot of goofballs in the profession. It's also more likely that your insurance will cover an osteopath.)
posted by Jacqueline at 8:55 AM on December 11, 2010

I generally had no symptoms during the day. The first couple hours I still felt the headache/neck ache but it would resolve after a few hours. After that, I felt normal (but really tired, probably from the lack of sleep). If I really thought about it, I could kind of feel something at the base of my skull, but the something was nondescript. It wasn't pain, it was just there. With the Prednisone I don't even feel that.

Two other minor symptons - mild sound sensitivity, like certain sounds making me wince more than normal - I have a parrot and two dogs and normally I am not bothered by their screaming or barking, but find myself wincing just a little bit, as well as turning the tv down just a little bit more than normal. No light sensitivity, both the Urgent Care doctor and my regular doctor asked that, but lights seem fine to me. The only real anomaly is on Thursday, when it was really bad, the pain didn't seem to want to go away on its own during the day, but Friday it was back to going away after being awake a few hours.

I did develop a mild crick in my neck as of Friday, but I suspect it was due to all the different ways I was trying to sleep with pillows to relieve the pain. I mentioned that to my GP and agreed.

I do wonder about the neck issues, thanks to everyone that brought that up, I'll be checking with my doctor Monday. I regularly have neck and shoulder pain which I attribute to working at a computer. I see a massage therapist when it gets bad. It doesn't seem to hurt now and at night it's in the wrong spot but maybe its related somehow. I've also been to the massage therapist with no apparent pain in my neck and shoulder but she'll say that I'm really tight and be surprised I wasn't feeling any pain. So it's possible for me have some knotted, tight muscles and not even realize it.

I also have huge bags under my eyes. I attributed that to lack of sleep, but I did sleep well last night. Though maybe I'm still catching up on sleep.
posted by [insert clever name here] at 9:11 AM on December 11, 2010

Your regular doctor will likely discourage you from seeing a chiropractor -- M.D.'s have a longstanding professional beef with these alternative practitioners -- but that's what you should do. I have similar pain when C1 and/or C2 are out, and getting those vertebra back in place are the only thing that corrects it. You can drug yourself into oblivion with the regular MD's without correcting the problem. Good luck -- I'm feeling your pain.
posted by northernlightgardener at 12:36 PM on December 11, 2010

the MRI is fine. if you're claustrophobic, just close your eyes before you go in. they'll give you earplugs because it's loud--basically it'll sound like you're listening to the worst techno ever composed.

as for what it could be, i have similar headaches, and it may be that you have lost some of your core neck strength and are unconsciously recruiting other muscles to compensate (even in your sleep). i discovered this while doing physical therapy for a slipped disc.

try this: lying on your back on the floor (no pillow), tuck your chin and lift your head just barely off the floor (no more than an inch). see how long you can hold it. someone with normal strength can go about 30 seconds. when i first started PT, i was only able to hold it up for 5. now that i've built up that strength, i haven't had as many headaches. in the short term, you might try a firmer pillow for more support.
posted by thinkingwoman at 12:45 PM on December 11, 2010

While you're getting it figured out, may want to try a cervical support collar and see if that gives you any relief.

As my chiropractor said, "Sure, you'll feel silly. Unfortunately they've become associated with sitcom characters who are faking an injury, but you don't have to wear it in public. Just wear it around the house and when you're sleeping to give your neck muscles a chance to relax."

It did seem to help when I had arm/neck pain and headaches due to an impinged nerve. Cheap and harmless anyway.

Adding to the chiropractor anecdata.

Every chiropractor I've seen (at 5 different practices in 4 different towns in my lifetime) has been focused on what chiropractic can do to eliminate headaches, neck & back pain, and such. No woo woo "energy" or "chiropractic can cure endometriosis" B.S.

I also have not experienced chiropractors charging ahead recklessly and discouraging other medical treatment. As an example, when I was treated for the impinged nerve, the chiropractor:
1) examined and interrogated me looking for symptoms that would indicate an injury that should not be treated by chiropractic
2) had x-rays taken and examined by a radiologist to ensure there were no hairline fractures or bone density issues
3) indicated if my symptoms did not respond to chiropractic within 6 weeks time, an MRI and referral to an MD would be in order

Maybe I'm just lucky, or we have great chiropractors in MN because there's a major chiropractic college in the Twin Cities.
posted by superna at 4:28 PM on December 11, 2010

hi, i came in to say that your neck should definitely be included in the MRI. If there's something in your neck causing the pain, a head and brain scan isn't going to catch it. i can leave out the personal story that goes along with this.

the fact that this is happening right after the surgery seems really suspect, and you are smart to make this link. a few different things could be happening here, including:
a) during the surgery, maybe they put your head in a weird position, or used force in a strange way, causing your cervical spine to behave strangely, to pinch a nerve, to herniate a disk, etc.
b) maybe your pharyngo-basilar fascia (which is connected in your throat and up into your sinuses) is responding to the tension from the scarring and adherences that happen after surgeries. it's tensing up, causing you pain.
c) your sinuses are right around your ethmoid bone (kind of on top of your nose), which is a super important attachment of your dura mater and cranial meninges. they ALSO attach at C0-C1-C2, which is EXACTLY where you are complaining of pain - from the back of your neck to the front! any problems with your ethmoid bone are likely to give you these symptoms.

as well as going for an MRI, i think an experienced osteopath would be a great idea for you to see. any osteopath that you tell about your headaches should be wise enough not to perform any spinal manipulations (these should definitely NOT be done until you know what you're dealing with). they can also correct any ethmoid lesions or meningeal torsions, as well as the fascia that could be causing the trouble here. they'll be able to tell you where the tension is coming from and how to fix it.

are you in canada? you can memail me and i'll be glad to give you a recommendation for an osteopath here. i kind of assume you must be in the states, given the speed at which you're able to get an MRI.

good luck!
posted by andreapandrea at 4:38 PM on December 11, 2010

I agree Superna - there was no 'woo' with my chiropractor just efficient diagnosis after detailed xray work, after liaising with my GP. There was also contact with a personal trainer to start rehabilitation exercises to strengthen the area. These people have a lot of training. My chiropractor is a trained physician, and a trained specialist, as is generally the case I believe.
And OP, having an easier time during the day was also my experience. Bedtimes were the worst.
posted by honey-barbara at 10:35 PM on December 11, 2010