You note an “SNRB at c5 root that has helped with the vast majority of symptoms”. You then state “symptoms to include the one my doctor seemingly puzzled by: pre injection being right neck pain and bilateral shoulder pain”.
You then note “neck pain that without warning would migrate into my head and cause me to be bed ridden nausea and vomiting on occasion and would last days at a time, all either coincidentally or not we’re improved w my SNRB”. Finally you state “Though I’m told cervicigenic head pain is upper level related he’s mentioned soondylosis, retrolisthesis, nerve compression etc c5 radiculopathy”.
FIrst, let me assume that the most problematic level is at C4-5 where you have some root compresssion. This would be the C5 nerve root. This nerve will cause pain that radiates into the shoulders and down the upper arm but not below the elbow. Nerve compression or even disc degeneration can cause neck pain so all your neck and shoulder symptoms fit with C5 nerve irritability (radiculopathy).
Your headaches could be caused by C4-5 degenerative changes but C4-5 generally does not cause headaches in 90% of patients. Nonetheless, that means 10% of patients can have C4-5 generated headaches. Typically, neck pain generated headaches are caused by C1-3.
If you received a nerve block (SNRB) that immediately gave you headache pain relief (see pain diary) along with neck and shoulder pain relief, there is some evidence that this level is also producing the headache. I will state that if you developed relief-not immediately but after at least 12 hours, this could be the steroid effect and not related to pain generation at that level of injection. This effect can cause pain generators not near the local injection to be relieved and a false-positive test (relief leading to a false conclusion that the area injected is the area of pain generation).
Dr. Corenman
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.