The Closet Professor

I saw my neurologist yesterday at the Headache Clinic. She asked me a lot of questions about my pain and did an exam. She said that she did not believe it was shingles but was inflammation of my occipital nerve. These are nerves that run up the back of your head and are one of the primary nerves involved with migraines. She believes that when I had the abscessed tooth a couple of months ago and the subsequent root canal, it aggravated my occipital nerve causing a trigger migraine.

She told me that this could take months to clear up, but there were things they could do to improve the condition. She began by prescribing to me a six-day course of a Medrol Dosepak (methylprednisolone). I’ve taken this before. It’s not a pleasant treatment because it causes me to shake uncontrollably, but it is usually effective. However, I could not start the first dose until this morning before I eat breakfast. 

In the meantime, she gave me an occipital nerve block, i.e., injections of lidocaine in the back of my head. Almost immediately, the back of my head was numb. She told me that this should stop the pain for about four days giving the steroids time to work. Sadly, the pain came back within a few hours.

I sent her a message through their online portal to let her know that the pain was back. She told me that nerve blocks are not always successful and to put ice on it for twenty minutes every hour. She also said not to give up on the nerve block just yet; it could still provide some relief. The ice pack did help some and eased the pain for a time. If the nerve block does eventually help, then she can give me another one in two weeks, then once a month until this clears up. I’ll be going on March 8 for my next Botox injections, so that might also help.

I am praying that the Medrol Dosepak helps, even if I have to suffer through the shakes. The treatment for this whole thing is not pleasant, so I hope it works. The administration of the nerve block was very painful, and we shall see how my body reacts to the steroids this time. Hopefully, it won’t be as bad as the last time I had this treatment. I don’t usually say this, but please keep me in your prayers. This pain is not only wearing on me physically but mentally as well. I feel like it will never end, and I am destined for chronic pain for the rest of my life.

The nurse practitioner I saw on Monday discussed my condition with my regular doctor. They decided that because there were only a few bumps, that it probably wasn’t a rash like shingles would cause. My doctor believed it is an atypical migraine and told me to call my neurologist. They also lowered one of my diabetic medicines to help with the hypoglycemia.

I called my neurologist and was able to talk to one of the nurses eventually. I described what was going on, and she made me an appointment to see the headache clinic’s nurse practitioner today at 10:30 am. The nurse suggested that they may need to do a procedure to inject lidocaine into the back of my head, neck, and shoulders.

I hope it will help. I’m sure she will also check again for shingles, but unless more of a rash shows up, it is unlikely to be shingles. What I know at this point is that it’s the worst migraine/headache that I have had in years. When I was teaching, I’d have headaches that would make me cry myself to sleep; the pain was so severe. The only medicine I had that would help was a combination of a potent muscle relaxer (Flexeril) and a strong opioid (Lortab or Percocet). Lortab helped the most, but FDA took it off the market. Those medicines only helped because they put me to sleep and allowed the pain to subside eventually.

The worst headache I ever had was when I had one of these bad ones and took an Imitrex prescribed to me. Instead of helping, the Imitrex intensified the pain dramatically. I remember it being so bad I dropped to my knees, and all I could do was curl up in a ball and cry. I probably should have gone to the emergency room because I’ve never had pain that intense before, but I did not have any insurance at the time, so I just suffered through it.

The good thing about the Headache Clinic is that they understand just how painful and debilitating a migraine can be. Not all doctors understand the intensity of the pain associated with migraines. I’m appreciative that my regular doctor understood that I was in constant pain and could get me into the Headache Clinic. I pray they can help me today.

Since Friday, I have had a burning pain on the right side of the back of my head. The pain is accompanied by periods of intense shooting pain. It does not appear to be one of my typical migraines, though I’ve had an accompanying migraine on the right side of my face since this pain began. First thing Monday morning, I called to get an appointment with my doctor. Sadly, my doctor was out on Monday, so I had his nurse give me a call. I was also having some issues with hypoglycemia (low blood sugar), so I needed to see someone on Monday and not wait for my doctor to be back in the office. I describe my issues to the nurse, and she thought I should come in and see one of the nurse practitioners. She also suggested their PA, but I find that woman to be an idiot and refuse to ever see her again. So, I made an appointment with the nurse practitioner.

I told the nurse practitioner my issues, and she suggested that the head pain could be shingles, temporal arteritis (though unlikely), occipital neuralgia, or nothing more than an atypical migraine. She looked closely at my scalp and examined my shoulders, neck, and head. She didn’t see a rash to indicate shingles but told me that a rash from shingles could take up to five days to appear after the onset of the pain. She drew blood to run some tests and check for inflammation caused by temporal arteritis or occipital neuralgia and told me to check the area in 24 hours to see if a rash appeared. She also tested my A1C to see if my diabetes medications need to be changed because of the hypoglycemia.

Yesterday, I had my downstairs neighbor check my head for a rash. She did see a single bump, but we could not decide if it constituted the beginnings of a rash. Since she checked yesterday morning, a few more spots have appeared that I can feel but not see, and the pain continues. My neighbor will check for a rash again this morning. The nurse practitioner I saw was supposed to call me yesterday to discuss my lab results, but she never called. I’m not sure why she didn’t call, but I guess it could have been because of the snowstorm. However, we only got 3.5″ of snow the night before and only an additional 1-2″ during the day yesterday. I called the clinic towards the end of the day, but I never got an answer and had to leave a message, which she did not return before the end of the day. I’ll try calling back first thing this morning.

Whatever this pain in the back of my head is, I hope it ends soon. It is affecting my ability to work, and if the pain doesn’t improve, I’m going to have to take some sick leave. If I knew what it was, I’d feel a little better, even if it was shingles. At least shingles can be treated. I hate having medical mysteries. I seem to always have mysteries when it comes to health issues, and the tests they have to run can get expensive. I just want to be healthy or, at the very least, have some answers.