Severe Headaches

Hello,

With back injuries there is a wide range in severity and a correspondingly sizable array of different treatments. Ideally, as much information is gather about the injury as possible and the proper course of treatment (from short-term pain relief to surgery) is assessed, usually starting more conservatively to avoid unnecessarily invasive (and expensive) treatments or procedures.

It seems like your GP approached the problem most conservatively, trying to treat your pain without directly addressing the physical trauma. Most disc displacement problems heal on their own within 6-12 weeks, so a more aggressive approach would most likely have not been appropriate (though I don't know why you had to go through three doctors before imaging studies were ordered).

Next you went to a chiropractor and didn't have much luck. I'll admit that I'm somewhat prejudiced against chiropractics in general--a large portion of practitioners rely on rather blunt techniques derived from pseudoscientific principles (not everything can be fixed by spinal manipulation!)--but I do believe that a good chiropractor (particularly with more modern training) can be very helpful. In your case, you report that he failed to resolve the issue and frequently made the pain worse. Again I wonder why you had not yet had an MRI study ordered. Trying to fix your back without actually knowing what was wrong with it, the chiropractor was probably as likely to cause a problem as to fix one.

But the important part is that you did find out that the likely culprit is a disc protrusion. Unfortunately the (cortisone?) injections didn't help but seeing a PT who does PM is a good step. I'm unclear as to whether you have tried PT for 3 months or 3 weeks. If it has been as long as three months and you haven't found relief, try talking to your therapist about your lack of progress and ask what sort of timetable they're looking at. PTs are trained to be very goal-oriented so this sort of discussion will hopefully be fruitful. If you and/or your PT don't feel like you're making progress you discuss a referral to an orthopedic specialist (given the nature of their work many PTs have relationships with good orthopedists).

An orthopedist will have the best resources at his or her disposal to find a solution to your problem. You might be advised to have corrective surgery. While it hopefully won't come to that, if conservative treatments have failed it may end up being a smart choice (especially considering how much you very understandably want it to just go away).

I wish you the best of luck. Having a painful back injury is a terrible thing but knowing the specific source of your headaches gives you greatly increased odds of finding a solution. Keep us posted on your progress.

Ben

Jen,

Well, a pain management specialist might not be the best person for the job in this case. I've been to a few pain specialists and they've honestly been great but I don't think that they provide the kind of treatment that you probably need right now. In the case of physical trauma a pain specialist typically, well, works to reign in chronic pain that comes from an injury that a patient is either recovering from or cannot recover from. In short they treat the symptoms but not the cause (generally).

It's good that the sharp pain has subsided but the abscence of pain proximal to your injury doesn't necessarily mean that the injury is no longer causing problems--I'm sure you know this and I don't mean to sound patronizing but it's an important point. Your protruding disc could be pinching or damaging a nerve or blood vessel; the shift in your spinal column may have changed the pressure of your cerebral spinal fluid; the accompanying muscle tension may be triggering headaches in a variety of ways--these are just purely speculative potential sources of your headaches. Your headaches might not even have any direct connection to your displaced disc (an MRI can only show some of the very many potential headache sources).

The point that I'm driving at is that, if your back injury is under control then your main problem is headache. With that in mind it may be wise to see someone with more experience in treating headaches. In most cases of chronic headpain I recommend seeing a headache specialist--they've simply the best equipped to help you. However, in this case a general neurologist with experience in treating headaches may do just fine (particularly considering how long you sometimes have to wait to see a headache specialist).

In any case I suggest that you discuss your prognosis with your PM. Ask him whether he thinks that he can treat the headaches. A good doctor will admit when he is not the best person to help you.

If you decide to see a headache specialist and need help finding one be sure to let us know. Keep us posted and best of luck!

Ben