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Thursday, December 31, 2009

Headaches and Chiari Malformation

Headaches and Chiari Malformation

comments : I am 25 years old and am suffering from headaches. I have had a headache every second of every day for the past 11 months. I saw a neurosurgeon who diagnosed me with a small Chiari Malformation that was constricting the flow of my spinal fluid. He performed a decompression surgery with the hope that my headaches would be relieved. It has been almost 8 months since the surgery, and I have found no relief. He prescribed me a couple of different narcotics, but I experienced no pain relief.He had me make an appointment with a headache specialist whom I will not be able to see for another month. I have, however, been seeing a Nurse Practitioner in the neurologist's office who has placed me on several tryptan medications (I have tried four so far). I was placed on Topamax, but it had no effect, and I developed kidney stones (a known side effect). She also had me take muscle relaxers for a month to see if they would have an effect on the pain, but they did not. I am curre
ntly on Keppra (500 mg a day). I have only been on it two weeks, and the severity of my headaches has increased. I have ocular symptoms as well, shadows and spots in my field of vision, which an opthamalogist believes are a result of the headache. Since I was 11 years old, I have had difficulties with my left temporomandibular joint. I have pain if I open my mouth to far, as well as the common popping and scraping soulnds. My jaw has become increasingly stiff over the past several months. The constant pain is wearing me down and making it difficult to concentrate in school as well as perform my job at a daycare due to my sensitivity to sound. I do not know if there is any type of advice or information you can offer me, but I would appreciate your consideration. HEATHER

Dear Heather
While they found the Chiari malformation because they investigated your headache symptoms that does not mean that it was the cause of your pain initially. It is relatively common to have an assymptomatic Chiari malformation. Because that did not help your headache pain it probably was not the cause of the pain but rather a accidental finding. The malformation was not new, only the severity of the pain was new.

The majority of headaches are related to problems or disturbances of the trigeminal nervous system. With your history of jaw problems and I would tell you to consider trying a DIAGNOSTIC Neuromuscular Orthotic. It is rare for patients not to have significant relief from an orthotic. That does not mean 100% relief. I tell my patients that we initially seek 50-80% relief and then seek 50-80% reduction in residual pain. I frequently get out of town patients who come to Chicago but I will be glad to work with your Neuromuscular Dentist to help you through this difficult time. Frequently trigger point injections and or SPG nerve blocks can be helpful in treating pain problems similar to yours.

I am leaving the country for the next couple of weeks but please feel free to contact me again.

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posted by Dr Shapira at 8:37 PM

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