JeremyC

Dear Dr. Corenman,
I hope you are doing well since our last exchanges last year. Following these exchanges, I proceeded to have Occipital nerve blocks and pulse radio frequency procedures on left side of neck (C2 to C4 I believe). Unfortunately this has not made any significant difference in my problems. Furthermore, in addition to my neck pains and strong pressure sensation (base of head/upper neck area), I continue to be severely affected by a condition that has not been identified. I understand you must be extremely busy and will get straight to my questions if I may:

– When lying on my back (head on pillow), I often feel significantly worse (malaise, nausea, and also tingling in back and arms). The tension/pressure sensation felt in the upper cervical area is strongest in this position. I am wondering if this could help provide a clue as to the cause of my suffering.

– I have come across the myodural bridge connection and was wondering if you had an opinion about this being a possible cause of neck pain and other symptoms. Perhaps the “bridge” was ruptured during my sports injury 3 years ago.

– As I am suffering from many symptoms without a clear cause found, I have been diagnosed with ME/CFS, although I feel this is a label I have been given by process of elimination (despite that I really don’t feel this diagnosis is correct). Have you heard of Jennifer Brea’s story? She was a “famous” woman diagnosed with ME/CFS, who did a Ted talk and also directed the Netflix Documentary on ME/CFS “Unrest”. Ultimately, it turned out she did not have ME/CFS but some form of upper cervical instability and a cervical fusion resolved nearly all her symptoms. Naturally, I question whether a similar condition could be causing my suffering. Are you aware of her story and do you have an opinion on her case? According to her, there are only 4 neurosurgeons worldwide which diagnose her condition and do the procedure. From memory 2 of them are Dr Gilete in Barcelona and Dr Bolognaise in the USA.

– I have had more physiotherapy sessions than I can count, with no significant improvement. I have so far avoided seeing a chiropractor here in Europe as this has been strongly advised against by most of my doctors including neurologists. In your opinion, who best could I see short of a neurosurgeon? Osteopaths?

Once again, I thank you for the incredible work and support you provide so many desperate people. If you have the time to read and reply to my message I would very much appreciate it.

Kind regards,
Jeremy

Thank you. You have answered most of the questions.

If you don’t mind, could I get your thought on these points:

– One of the only things I can do to relieve the neck and back of head pressure feeling (only very temporarily) is to hang my head over bead (lying on front side). This really pulls/stretches areas that seem to be so tight. Could this be a bad idea if my problems are linked to stretched ligaments? I don’t want to do anymore dammage (obviously).

– In your opinion, could a disorder in the neck area affect sensations in the pallet and cheekbone areas (both sides)?

– “Patients with O-C1 or C1-2 disorders have base of the skull pain that can radiate over the back of the skull.”. I do have base of skull pain (the suboccipital muscles are always tight and painful), and I have abnormal sensations like mild numbness, tingling, and tension/pressure at the back of the skull, but not acute pain or back of head ache. I have an appointment with a pain specialiste on July 11th and will ask him about facet joint blocks for diagnosis purpose as per your recommendation from earlier message.

– “Generally, the most common cause of greater occipital neuralgia is facet disease at C2-3 and C3-4. Facet disease at C1-2 does occur but it is rare. O-C1 disease is even more rare.”. According to the area I feel the pain in, I believe the pinched nerve is the lesser occipital nerve, rather than the greater. Does this fact change your comment?

Thank you.

What type of symptoms would a person have if there was injury (tear, stretch, etc) to a ligament/membrane connecting C0/C1 or C1/C2? I have pain when pressing deep centrally above C2 spinous process.

As described previously, 6 weeks after my fall in 2016, and continuing until this day, I get very acute pain when tilting head right and backward. This really feels like the occipital nerve is being pinched as the pain goes over and side of had up to behind eye. Fortunately it is not a movement I do frequently. What damage could have occurred when falling that would explain that I now have “something” pinching this nerve? What is likely to actually be pinching this nerve (muscle? Tendon? Ligament? Bone?). I assume something must be displaced for the nerve to get pinched.

Thank you