Thank you for your query at DoctorSpring.com.
I have noted your history and will do my best to help you.
Your MRI of the brain is normal and MRI spinal cord shows only mild bulging of the discs. So major causes of concern have been ruled out, which is a good thing.
Since you do not seem to have any identifiable cause for a tension headache, migraine could be an alternate diagnosis. As you do not seem to have any preceding aura, it can be Migraine without aura. This is more common than the classical migraine with aura.
The fact that your headache is unilateral, diffuse, and associated with scalp tenderness; goes in favor of migraine. Migraine is by far the most common cause of headaches in the general population. This is a benign (harmless) condition. So there is nothing to worry.
The pinched nerve could be responsible for the additional neck and shoulder pain. However, this should subside with the same treatment as for migraine.
Analgesics like Ibuprofen or Acetaminophen are the first line therapy and provide good pain relief. Ibuprofen is better for you since it has additional anti-inflammatory action. This will work for the nerve inflammation as well.
I would recommend that you take Ibuprofen 400 mg, twice a day after food, for a week.
In case symptoms persist, you can consult your doctor for the next line of management.
I hope this was helpful. Feel free to ask queries.
Patient replied :
I have been taking Ibuprofen. It doesn't seem to have any effect.
Hello. Thank you for posting the follow up.
The pain on the left side of your head and the dull headache can be attributed to your mucosal thickening of the sinuses. Sometimes in order to treat the other mor serious causes of headache, the sinuses are completely ignored and they can also present with similar symptoms like yours. Since there is mucosal thickening already, it shows that you have had recurrent sinus infections in the past, and it is better to consult an ENT doctor regarding the same. Blocked sinuses can cause repeated infections too, leading to a lot of nasal block and other cold related symptoms.
The dull pain on the left side of the neck and shoulder can be attributed to the pinched nerve. The first-line management in with Ibuprofen but if it doesn't settle with that, then corticosteroid injections can be advised to the patient, or depending on the level of compression even surgical decompression is done in some cases. Because chronic compression of the nerve can canuse permanent damage. It is better to review your reports with an Orthopaedic Surgeon who can decide on the further line of management, since Ibuprofen has not been helpful. Certain other measures like weight loss, in case the patient is overweight and maintaining good posture coupled with stretch exercises are advised in cases of pinched nerve.
Hope this was helpful,
Feel free to discuss further,
Patient replied :
I am sharing with you results of a brain MRI from 5/2013, and then a brain MRI done in 7/2014. Also included is a spine MRI done in 7/2014.
Can you help me with some of the technical language? Does it indicate I might have a sinus infection (from both old and new brain MRI)?
Also, any indication the spine MRI shows the cause of neck pain?
My next step is to see an ENT.
I have gone through both your old and the new MRI scans.
MRI brain is largely normal. There is an incidental finding, which can be seen in migraine sufferers. Nothing to worry about. The sinuses seem to be mild-moderately inflamed (sinusitis) in both the old and the new MRIs. The new MRI shows the lining of the sinus cavity is not only thickened, but also has small cysts.
All of this can be cleared with appropriate treatment.
MRI spine shows mild spondylosis (vertebral bony problem) but spinal cord is completely normal and there is no compression of either the cord or the nerve roots.
Spondylosis, a common condition, can result in neck pain. Treatment is with physical therapy and painkillers, if unbearable.
The next logical step, as you have said, is to consult an ENT specialist.
Patient replied :
Thank you for your response. I have made an appointment with an ENT specialist. I have found the neck pain goes away by changing the way I sit at work (I sit at a computer), and this is a relatively new job since I started about 4 months ago (the symptoms started 3-1/2 months ago). So I think we found the culprit for the neck pain.
There is another pain however that goes from the left nostril to the brain. It is sometimes a sharp, jabbing pain, but usually it is a dull ache. This second pain cannot be alleviated with Ibuprofen, or massage, or posture. I believe it has something to do with my sinuses. The imaging shows my sinuses are so blocked, the doctor asked "How can you breathe?" I have had chronic congestion throughout my life. I think this may be due to sphenoid sinus infection, since it is more interior in the head. Some of the symptoms - pain/pressure behind the left, pain at back of neck, pain at various spots on head (top, left, etc) - do coincide with this type of sinus infection? What do you think? Of course, this is why I am seeing an ENT specialist to confirm.
Thak you for the follow up.
Yes the symptoms you mentioned, and i strongly believe are due to the sinus layer thickening. Due to constant irritation at the layer of the sinus mucosa, there is a good possibility that the nerves are getting irritated too and hence you're manifesting all these pains. The pain at the back of the neck can be attributed to your posture, or the mild sponsylosis caught in your MRI.
It is better you discuss the possibility of removal of the sinuses through surgery or by FESS ( Functional Endoscopic Sinus Surgery ) which is the latest method.
Hope this is helpful,