What could cause these symptoms?

December 21, 2020 4:51 AM

YANMHD but my husband's doctors have not figured out what the problem is. He has had pressure/pain on his head and neck for about two months. He says sometimes it feels like a headache, sometimes just as though his head/face/neck muscles are tense. He also has some TMJ issues.

This started when school did, and he is teaching on Zoom all day every day, so that is probably one of the causes--unfortunately not one he can change.

We have tried, with limited to no success:
* new desk chair
* hot compresses on his neck and jaw
* Tylenol/Ibuprofen alternating
* massages, professional and amateur

He did go to the ER for these symptoms combined with severe dizziness last month and they did an MRI and blood tests--nothing out of the ordinary. That doctor thought it might be a type of migraines but the neurologist we were referred to refused to see him because he didn't think it sounded neurological.

I know that we are just going to have to keep squeaky wheeling his doctors until they help us. But I was hoping having some more ideas about his symptoms/treatment might help us push in the right direction. Thanks all!

posted by chaiminda to Health & Fitness (15 answers total)

Dumb question is dumb, but has he been looked at for a sinus infection or even just sinusitis? It would explain the pressure, pain, and dizziness. Referred tooth pain is more common but apparently referred neck pain is also a possibility.

With respect to sinusitis, look at possible allergy exposures. Is he doing Zoom teaching in a new room he doesn't normally spend time in, e.g. a basement that could have mold issues?

Also, what's the pattern of the headaches? Is there a particular time of day they're worse? (If they're bad when he wakes up, sleep issues could be involved.) If he isn't already, I'd start keeping a headache journal with level and type of pain, weather, sleep quality and duration, food, etc. all logged. That may let you find patterns.
posted by pie ninja at 5:19 AM on December 21, 2020 [4 favorites]

Did you adjust monitor height so he is not craning his neck? He should be able to look straight ahead towards the monitor, with his head balanced on his neck. The further you deviate from that, the more the neck muscles have to work to hold up the head, and the more musculoskeletal issues can arise--including TMJD. Often, the monitor needs to be raised. If he's using a laptop, he should raise it and use a separate keyboard.
posted by Flock of Cynthiabirds at 5:25 AM on December 21, 2020

One possible cause for tension headaches is stress. I would recommend trying yoga or gentle stretching, particularly this stretch, and trying to think of other ways to reduce stress.
posted by pinochiette at 5:32 AM on December 21, 2020 [2 favorites]

Since he already knows he has TMJ issues, could it be a particularly bad bout of that? When mine first started I had a month+ of pain not just in my jaw but the entire side of my face, my ear, my head, down into one particular muscle or something in my neck that hurt most when I moved, even my teeth seemed to hurt. I saw multiple doctors before an ENT figured it out & sent me to a TMJ dentist. It only stopped after about a week of muscle relaxers.
posted by The AhForgetIt Tendency at 6:10 AM on December 21, 2020 [2 favorites]

i have 'cervicogenic migraine'. see if these images are informative. when i saw them, i was all, "yep." yoga seems to help, as does very concious monitor-posture. but, when it's on, it's on. i have a tiny rx for vicodin i get filled a few times a year when it's bad.

what with all the restrictions in the last years, i bet it's tough to get a new doc to go along with that - I've had my pcp for 15 yrs.
posted by j_curiouser at 6:23 AM on December 21, 2020 [2 favorites]

I second taking two Sudafed and seeing if it helps. It's not going to hurt and this sounds like sinus issues are plausible.
posted by DarlingBri at 6:27 AM on December 21, 2020 [1 favorite]

You mention that your husband has seen a professional massage therapist, but has he seen a physical therapist? I have issues similar to your husband’s, and they are 100% caused/exacerbated by WFH/RSI issues. I started seeing a talented physical therapist last year who specializes in sports performance (I am not an athlete), and he has used a variety of techniques to help reduce the nerve impingement that causes burning pain and dizziness. I went every couple of weeks at first, then once a month, and during the pandemic I’ve only gone twice. Might be worth exploring since it sounds like everything other than musculoskeletal causes have been ruled out for your husband. Will also second the idea that stress makes this kind of pain worse, for obvious reasons. Hope your husband gets some relief!
posted by little mouth at 6:42 AM on December 21, 2020 [5 favorites]

See if you can find a neurologist who specializes in headaches. Mine does and she is phenomenal. Sometimes I have neck pain/slight head pain and think it's muscular, but then I take a triptan (rescue med for migraine) and the neck pain disappears. He may be able to get an rx for triptans. Feel free to memail me with any migraine questions. IANAD, TINMA, just a migraine sufferer.
posted by bookworm4125 at 6:47 AM on December 21, 2020 [1 favorite]

I had something similar form sitting at my desk job with bad posture for months/years. Not sure if this was the cause but in the end I had severe headaches by the end of the work week, so much that one day I couldn't even turn my head to the sides. I was diagnosed, after a neck xray, with Cervical Radiculopathy. I'm not saying this is what your husband has but just that I had similar symptoms and I was treating them with Ibuprofen/Tylenol and heat.

I was sent to physical therapy which did help a bit. What helped more was getting enough and good rest at night. Also... what was exacerbating my pain and delaying my recovery was the use of heat on my neck and back. Heated blanket, hot showers etc..

My physical therapist directed me to use icing my neck instead of heat. Heat was making everything worse. Icing helped. I want to suggest using ice but I would want him to get properly diagnosed first.

Good luck.
posted by eatcake at 7:04 AM on December 21, 2020

If your original doctor thought it was serious enough to refer you, is there any chance they’d refer you again to someone who will take this seriously?
posted by showbiz_liz at 7:12 AM on December 21, 2020 [2 favorites]

Because I am a Dentist, i will second the recommendation the he see one. I have seen so much of this in the past 9 months.
I would likely ask him to show me the pattern of his headaches, if he can. Muscle related headaches typically occur over the temples and down the back of the head into the neck, or in the jaw muscles themselves, just under the cheekbone; whereas sinus headaches begin above the eyes. Muscle headaches less frequently have the aura or nausea that vascular headaches create.

I would ask if his teeth come together the way they should, and if he has any limitation to the way his jaw moves or can open.

There are treatments for acute episodes, and therapies for chronic myofacial pain that a dentist can provide.

Massage is good and he can do quite a bit himself, just working his thumbs or fingers into the jaw and neck muscles. little harm will come of this, and it feels good.

I like ice more than heat.

He might simply get some relief from an over-the-counter bite guard.

We're all more stressed because of this, so even if he gets a diagnosis of something else, recognizing that stress is there and underlying it all, can help build a strategy for relief.

I'm not his dentist of course.
posted by OHenryPacey at 7:28 AM on December 21, 2020 [5 favorites]

It's worth ruling out eye strain - I had weird, persistent headaches for months that no one could track down, and in the end it turned out I needed a new eye prescription.

Make sure his ergonomics are okay too, and maybe try varying his working positions if possible (standing part of the time, etc.) to see if that makes any difference.
posted by trig at 7:47 AM on December 21, 2020

Low-hanging fruit test would definitely be several days of sinus treatment. My personal regimen is Sudafed (the real shit you have to show ID for, but only the 4-hour duration) at bedtime and another in the night if pain/congestion wakes him up, and then 12-hour Mucinex in the day.

Plus electrolytes (I use these flavorless drops that go in water/whatever). Magnesium deficiency can cause muscle tension and headaches (including migraine - a lot of neurologists are prescribing it now), potassium deficiency can also cause muscle tightness/cramps, and of course dehydration will cause headaches and can exacerbate sinus congestion.

I was also advised to stop using heat on my face, ears, and back of head for sinus pain. Particularly in the case of my ears (but not just my ears - the swollen lymph nodes next to the ear and under the jaw, which not only will ache when swollen but can swell enough to cause jaw joint pain): heat = expansion, not a thing you want your Eustachian tubes and lymph nodes doing. Normal warm showers once a day were fine, but otherwise I was told to use cool* compresses on facial/neck skin and then I could use a protectively-wrapped ice pack on the back of my head and neck. (I love these old-school-type bags because they squish to fit all the weird angles and do not leak even under a moderate amount of abuse, but are kind of troublesome if you don't have an ice maker.)

*My doctor was okay with gel freezer packs if they were in a thick cover and then wrapped in at least one layer of fabric, to prevent frostbite, but suggested frozen washcloths or dishtowels put into a ziploc and then wrapped in two layers as a cheaper more-easily-renewable cool pack.
posted by Lyn Never at 11:52 AM on December 21, 2020 [1 favorite]

but the neurologist we were referred to refused to see him because he didn't think it sounded neurological.

In my personal experience, and amongst the migraine crowd, neurologists are known for being fairly useless unless they are headache specialists. If you want to pursue the migraine route, you should look for a neurologist who specializes in headaches.
posted by See you tomorrow, saguaro at 7:32 AM on December 22, 2020 [1 favorite]

I had similar symptoms including dizziness and ear pain. The doc did a lot of exploration then pressed on my neck - when I helped he said it's most likely that I have very tense and aggravated muscles including the teeny tiny ones that go around the jaw and if swollen enough, press into the ear canal/nerves around it.

Symptoms abated with a course of anti-inflammatory (not 'as needed' but consistently for a few days) and wearing my mouthguard/doing jaw PT. It still flares up now and again, but for me it is jaw related.
posted by geek anachronism at 3:12 PM on December 22, 2020