October 29th, 2014

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Mostly the neurologist appointment

Brain Doc

Saw the neurologist yesterday, and he says I'm still having two different kinds of headaches, though now they are related: muscle contraction headache and occipital neuralgia. (When I saw him previously, the headaches were complicated by cataracts and codeine, as well.) This "two kinds of headaches" diagnosis makes sense of a problem I'd been having with describing my headaches, because I have dull, pervasive pain—which I sometimes describe as feeling like my brain is too large for my skull—caused by the muscle contraction, but sharp, localized pain from the occipital neuralgia. So when people asked if my headaches were dull or sharp, I had trouble answering ... apparently because the answer is "both."

The muscle contraction headache is the one that is dull, almost constant, and not localized (though it is mostly in the front of my head). Its severity waxes and wanes, affected by fatigue, eye strain, overexertion, anxiety, stress, holding my head in one position for too long (e.g. when doing art, when at the computer, etc.), and possibly also pillow thickness (which I plan to experiment with). In addition to the headache, the muscle contraction also causes scalp sensitivity (most noticeable when I wash my hair) as well as numb places on my scalp. (Apparently, the sensitivity and numbness are related, as some nerves go hyperactive when others are dying. Yeah, Brain Doc referred to my nerves dying. Yay.) Muscle contraction headaches usually don't cause nausea.

The occipital neuralgia headache is the one that is sharp & narrowly localized in my temple. It's caused by pinched nerves in the back of my neck, which in turn are caused by the interaction of muscle contraction with the arthritis in my neck. The pain is not constant or consistent, but flares up frequently and varies in duration. (I believe this is usually when I walk around the house clutching my head and groaning, "JESUS CHRIST!") Like the muscle contraction, it can cause scalp sensitivity, so apparently I've got a double whammy there. Occipital neuralgia can also affect balance and coordination (which I've definitely seen & which is one of the reasons I haven't been biking) & often causes nausea (which I have definitely been seeing). This explains why the nausea is not consistent, since it probably only flares up when the occipital neuralgia flares up.

Old Body Syndrome

Brain Doc had another look at my x-rays from back in April, and commented that I have far more arthritis in my neck than would be usual at my age. Then his eyes got kind of big as he continued looking at the x-rays, and he repeated that it's really quite an extreme amount of arthritis.


I commented that I am extremely young for cataracts, too.


My body is prematurely old in multiple ways.


I wonder what causes this Old Body Syndrome, if it even has one single cause. I mean, Occam's Razor would seem to indicate that there's one cause, right? Hmm. Maybe I'm just lucky.

The Plan

So, anyway, here's what we're doing about the headaches:
  1. Pain Doc. This guy exists in my life only to assist me with the codeine withdrawal. He is not an expert in anything but pain management & therefore does not fully understand the causes of my headaches, which makes him not very well-suited to recommending treatment. (This makes perfect sense to me & is in accord with my own impressions of Pain Doc's approach, which seemed to focus only on the pain and not on the source.) So he is not going to send me to his colleague at Stanford or anything else complicated. He'll just help me reduce the Butrans dosage until I'm off it, nothing else, and I'll continue treatment per Brain Doc with the methods I'm listing here.
  2. Physical Therapy. This was what I assumed would be most helpful & would be recommended by Brain Doc. I'll return to PT to work on the muscular contraction problem, which in turn should help with the pinched nerves. This is our primary treatment focus, but it won't help immediately. I'm phoning today to set up an appointment to get started again, but in the meantime I'm returning to the exercises that were given to me previously, which I've only been doing sporadically since the gum graft surgery got me out of the habit (because I wasn't allowed to do any stretches for a couple weeks). PT will take time to really make a difference.
  3. Heat and Massage. I've already been using a heated pad on the back of my neck occasionally to help with the tension there, and Shannon has been massaging my neck when I ask him (and sometimes at his own instigation when I don't think to ask). Brain Doc suggests that I do this more often, experimenting with how much is helpful. I'm also going to try hot baths, which I've thus far been avoiding because I couldn't imagine just lying there with my head throbbing and nothing to distract me. But I'll listen to podfic or something. It's worth a try, anyway.
  4. Exercise. This is a hard one, with the severity of the headaches (and the plantar fasciitis) getting in my way. I'm applying for the health insurance extension that will allow me to go to Julia's gym & use the stationary bikes there, but that won't take effect until January (I think). I need to brainstorm the exercise thing. Ha. "Brainstorm."
  5. Relaxation. Brain Doc says that I might sometimes get some relief just from lying down so my neck muscles aren't supporting my head. I'm also going to try listening to my "relaxation tapes" (they're no longer tapes, but rather files in iTunes, but I still think of them as "relaxation tapes"), progressive relaxation, etc. I may not be able to do quiet stuff like this for very long when the headaches are really bad, but it's something I can try to add to my Headache Relief Regimen when possible. I'm also making sure to set alarms so that I stretch and move around every 20-30 minutes when I'm working on something.
  6. Acupuncture. Okayed by Brain Doc. See below for more about this.
  7. Nerve Block. If necessary in the future, Brain Doc (or Pain Doc) can give me a steroid injection into the pinched nerves to alleviate acute pain if it flares up badly.


Julia is a genius and—when I told her about my bad experience at AIMC—she suggested that I look into local acupuncture clinics where licensed acupuncturists (NOT "junior level interns") provide treatment on a sliding scale. I did so, and found one that has excellent reviews on Yelp and has staff grounded in a more well-rounded approach to medicine (i.e., not likely to dismiss a nephrologist's kidney disease diagnosis). You can get acupuncture treatments there for free, if necessary (though you are, of course, encouraged to pay what you can, depending on your resources and how you value the services—hence the term "sliding scale").

So I'm going to try out Berkeley Community Acupuncture. I'll give them a call today to make an appointment. I'm very enthusiastic about it! I'm hoping this will help with the immediate headache pain while I work on the PT.

Edited to Add: Another element of Old Body Syndrome: my reduced kidney function, though that one was obviously triggered by an outside influence (lithium). So I've got old kidneys & old arthritis & had my old eyes replaced. I grow old, I grow old, I shall wear the bottoms of my trousers rolled. But really that part's just because I'm short.
hide, headache

Technical stuff re: my headaches

Notes to self re: technical terms & locations of online info for some of the stuff Brain Doc says I have, because I like to understand things, especially when they're about me:

  • occipital neuralgia (a.k.a. C2 neuralgia): pinched nerve in the neck between the C1 and C2 vertebrae (see greater and lesser occipital nerve definitions below for confusion re: which vertebrae are involved), which causes chronic intense headache pain
  • C2: the second cervical vertebra (a.k.a. axis or epistropheus), the pivot upon which the first cervical vertebra, which carries the head, rotates
  • greater occipital nerve: one of the nerves being pinched in occipital neuralgia, originating between the 1st and 2nd cervical vertebrae (many sites say 2nd and 3rd vertebrae—confusing)
  • lesser occipital nerve: one of the nerves being pinched, originating between the 2nd and 3rd cervical vertebrae (some sites say 1st and 2nd vertebrae—confusing)
  • cervical spondylosis: arthritis affecting the spinal disks of the neck
  • arthritis: usually (though not in my case) "age-related" wear and tear causing inflammation of joints, causing cartilage to break down, subsequently causing (in my case) bone grinding directly on bone, which can lead to bone spurs
  • osteophyte: bone spur, a bony projection that develops along the edges of bones, often where bones meet each other, usually caused by arthritis
  • cervical osteophyte: bone spur in the neck, which can narrow the space that contains your spinal cord & pinch the spinal cord or its nerve roots
  • muscle contraction: I wasn't able to find a useful, non-technical definition of this, but there are numerous videos illustrating it & this page was somewhat useful (though largely above my head in my current intellectually-impaired state)
  • muscle contraction headache: headache caused by sustained muscle contraction (duh), sometimes called "tension headache" (though my neurologist says that term is not really accurate in my case), usually characterized by steady pain, sometimes accompanied by nausea