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Myofascial pain, headache with SPONDYLITIS in neck . CONCOR.

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Good day Doctor ,

I was diagnosed with myofascial pain and headache .. I have a slight spondylitis in my neck Nr. 6/7 .
Due to stress and overwork , I got that bad headache and dizziness as well as heavy brain fog .
I had last Thursday trigger point injection but got worse on weekend . Yesterday I had more trigger point injections and the doctor said my neck muscles are hard and almost cramped up . He gave me Lyrica 0.25mg once in evening , Ativan 0.5 mg before sleep ....the problem is I don't sleep well since many month and need zolpidem ( I break off a bit of a 10mg tablet , sometimes 1/3 is enough sometimes 1/2 ) ... Now I need almost 1 tablet . Mornings I need to take a 400mg Celebrex. The headache is much better today , but I am feeling still the brain fog and feel hot all day as well as being kind like hangover . I guess is from the tranquilizers . He gave me as well some Concor 2.5 ( beta locker ) , said to take it if I am too stressed or have anxiety , but I did not take it .
Is it OK , to take the Lyrica at 8pm , Ativan at 10 pm and the zolpidem ( up to 10 mg ) at 11pm ?
What is the reasons for the beta locker ? Would that be better then the Ativan for stress and anxiety ?

I had the same problem 1 year ago , but much milder and went away after a few days after trigger points and some klonazepam . The doctor advised me to take every night a bit Klonazepam to sleep and less agitated . Is was bad , even i had the lowest dose I had big problems to get off with help of Valium . I stopped all Valium about 2 month ago , and had no issues . I did a good detox and hope I don't need to take any Benzo for longer then a week ever again .

Thanks and look forward to your reply . I am based in Thailand and good advice is difficult .

Category: Neurologist, Medical

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Category: Pediatric Neurologist
 22 Doctors Online

Thank you for posting your query at
I have noted your symptoms and current medications.
I feel part of your problem is medication related. Both ativan (lorazepam) and zolpidem have sedative effects and it is better to avoid one of them, or try coming off one of them as early as possible.
The dose of lyrica (pregabalin) is 75 mg once daily at night and it can be gradually increased to 150 mg two times daily. It is a very good drug for treating neuropathic pain and is quite safe. Some people may have dizziness in the first few days.
Beta blocker is generally given if the hear rate or blood pressure is high along with anxiety. Otherwise, it is not preferred. In stress or anxiety, ativan or clonazepam would be preferred.
I hope it helps.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist

Patient replied :

Hello doctor ,
thanks for the answer . I reduced the Ativan by half and I am much less hangover or groggy . i am still not well and continue to have tension in my neck , muscles around the neck and tight muscles on the head . Not reat pain just tightness . I still have some brain fog and easy irritated . The moment I have slight stress get slightly dizzy . Could something be wrong with the chemicals in my brain? Does the medicine (lyrica , Ativan ) fix this problem slowly ? Anything else I can do or just wait till it get better? I feel a bit better from day to day . Would some B12 shot be beneficial for me ?
Or anything else you would recommend ?
thanks and regards. Chris

Thank you for getting back.
I have noted the additional information and am glad to note that you are gradually improving. You would continue to improve over the next few days. No additional medications are needed. Yes, there would be an alteration of chemicals (neurotransmitters) in the brain, and you would improve slowly.
Vitamin B12 and alpha lipoic acid supplements would help you.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist

Patient replied :

Good day doctor, Last Friday I had a follow up visit at the doctor as planned. I had another round of trigger point injections because my left side neck muscles were still hard like rocks and still caused me tension headache and dizziness. I got additional Ativan 0.5mg, Concor 2.5mg and another slow release benzodiazepam to make me sleep. Even I prefer the Zolpidem; he could not prescribe it due to some internal regulation for medicine distribution. I still have a kind of pressure (I feel like it is around the brain stem), no pain, just this pressure that makes me often dizzy and anxious. My mind is still not “still” enough, but better at times. I don't have the mental fog anymore as 2 weeks ago. To be fair, I am not a good patient and never took the Concor and reduced the Ativan by half (0.25mg) before sleep.
Some days, I take10 mg of Zolpidem others 5 mg is enough. I take in parts and see now it goes. Some mornings I feel a bit hangover others is better , but I still have this kind of pressure ( I am is not something physical ) that continues to make me a2nxious and dizzy ( dizzy spell is mostly fast for a few seconds ) . Yesterday I play 1h Badminton and had no problems, except the pressure and dizziness, but did not feel bad during play, just annoying but I had to concentrate more. IN the office is worse, I keep thinking about the pressure and dizziness and that doesn’t help and gives me a bit headache. Really annoying. What should I do? Is it recommended to use the Concor or the other Benzo (to sleep instead of Zolpidem, this Benzo, and Bromazepam)? Should I increase the Ativan to 0.5mg? I don’t care the hang over feeling; I just need to get this pressure feeling and dizziness away. The anxiety I can handle like it in the past once I get better. Or is this all connected and my approach is wrong?
I read as well about Trazodone as alternative to Zolpidem with some antianxiety properties, could that be a solution for me once gets better? Look forward to your reply. Have a good day (sorry for the typos and font problem, writing with tablet)

I read as well about Trazodone as alternative to Zolpidem with some antianxiety properties , could that be a solution for me once get better ? Look forward to your reply . Have a good day ( sorry for the typos and font problem , writing with tablet )

Thank you for getting back.
I have noted the details of your consultation, symptoms and current medications.
I would feel that you increase the dose of Ativan to 0.5 mg and later 1 mg, if needed.
You can continue Zolpidem upto 10 mg per night, which is the safe limit.
Concor would not help much in this situation.
Yes, I agree, trazodone has both anti-depressant and sedative properties, and would be helpful in your case, if Ativan does not help.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist

Dr. Sudhir Kumar
Category: Pediatric Neurologist
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
Dr. Sudhir Kumar and 4 other Medical Specialists are ready to help you

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