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Suggest Treatment For Constant Headache And Stiffness In Neck And Back Area
Question: I am witting in the case of my 17 y/o son XXXXXXX XXXXXXX is special needs and non verbal and does not understand what is going on nor can he communicate what is actually bothering him so its only by my own observation that I have been able to try and seek help. XXXXXXX has been suffering from a near constant headache, stiff neck and back , not eating well, slower/shorter gait than normal and will grunt from pain more worse it seems in the late afternoon into the evening until he goes to bed.. These symptoms have been on going but in late January , they really seemed to become more profound or debilitating and acute in doing so. That is to say, sometimes while eating, he would place his hand to his head but he was able to do most of his daily activities with little or no signs of discomfort. NOW.. Around mid January, when returning from his mothers house as we split custody, he had a noticeably stiff neck. I felt he may have just slept on it wrong and had a "crick" .. I gave him 200-400 mg IBF and alternated with 350 mg tylenol.. after a few days and no improvement, I took him to his pediatric office for a visit. They did not think it was serious as in meningitis but had us do a cervical x-ray. results were NEGATIVE, and prescribed him 800mg Ibf. after another week , NO IMPROVEMENT. I then took him to my Chiropractor who did some deep massaging and said he found some knots that he worked out one being a dorsal muscle behind his left shoulder blade. He did an adjustment on "popping his back while standing" We did two visits but still NO IMPROVEMENT.. I then called his Neurologist. and they ordered an MRI (cervical) and a Medrol dose pack.. At the same time, and due to his being special needs and not very tolerant of blood work or urinalysis. I had the Neurologist order blood work and U/A to be done since they were sedating him. The MRI came back negative and his neurologist said his neck and brain were fine," NOTHING WRONG" on the MRI but his white blood cell count was elevated and U/A was positive. I then had to call his Urologist to get a script for Keflex 500mg BID x7 days. and also Xanaflex 2mg which we give at bed time. He finished the abt Friday 3/20/15 am dose. We also started a second Medrol dose pk as the neurologist said it could take a couple rounds of the Medrol to be effective. We are in the 3rd day of the second Medrol pack. Still , we have no improvement in the headaches although he seems to get the most comfort from our deep massaging his head and constantly will place our hands to his head . The headaches originally were in the back of his head and neck as that is where he would place your hand to massage him, they progressed to the top or crown of his head and towards the frontal lobe area where he will now place my hands to massage him. While walking, he keeps his back straight up with his left arm extended at times... and prefers to turn his entire trunk rather than turn his neck unless your massaging his neck, this seems to ease the pain and gives him more mobility in his neck but only while massaging are these results positive. He seems to also find some comfort by getting into a fetal position on his knees and leaning forward into the bed while we massage him. I am at a complete loss and not sure what to do or who to turn to. Im sorry if this letter is lenghty but Im trying to give everything we have done as sooner or later , this has got to ring a bell with someone and its killing me to see him hurt like this. especially with his not being able to give any feed back on whats helps, what doesn't and when or where he is actually hurting.. 3/22/15 4pm central
Brief Answer:
Consider dental x-rays
Detailed Answer:
Good evening. My name is Dr. Saghafi and I am a Neurologist and Headache Specialist from the XXXXXXX OH region of the world. I'm so sorry your child is having what appear to be headaches. It is very tough to be attentive to the needs of children with special communication problems which make it difficult to know how much or where pain could be in the body.
I agree that holding the head is usually a sign of headaches. Here are a few suggestions to think of while trying to deal with this challenging and frustrating problems.
1. In order to try and corroborate if he is having headaches or not one trick I tell my parents with special needs to do is use either an icepack or if that doesn't work, heating pad..or warm water bottle over the forehead or even behind the head if he hunches forward to see if he comes down with either of those approaches. If he does then, the idea of a headache is more likely.
2. Avoid giving him TOO MUCH over the counter medication since that in and of itself can lead to WORSENING OF HEADACHES....known as MEDICATION OVERUSE HEADACHE (MOH) or Analgesic Rebound headaches. I realize that he had these headaches BEFORE getting any medications for his headaches, however, consider that MOH is known to be a significant risk of contracting by any patient who takes MORE THAN 10-15 days per month (or even episodes) of some acute abortive medication such as ibuprofen, naproxen, Tylenol, aspirin, etc.
3. Consider getting a PANOREX or full dental films to make sure he doesn't have a cavity or loose filling that may be to blame for his headaches (very common problem which is not always thought about).
4. I know he has a urinary tract infection which looks pretty aggressive and so that COULD be a cause of headaches but more than the infection...how about any medications he may be taking which could cause headaches as a side effect?
Please take these initial suggestions and let me know what you find and perhaps in the follow up answer you give me I can think of several other suggestions or thoughts.
Consider dental x-rays
Detailed Answer:
Good evening. My name is Dr. Saghafi and I am a Neurologist and Headache Specialist from the XXXXXXX OH region of the world. I'm so sorry your child is having what appear to be headaches. It is very tough to be attentive to the needs of children with special communication problems which make it difficult to know how much or where pain could be in the body.
I agree that holding the head is usually a sign of headaches. Here are a few suggestions to think of while trying to deal with this challenging and frustrating problems.
1. In order to try and corroborate if he is having headaches or not one trick I tell my parents with special needs to do is use either an icepack or if that doesn't work, heating pad..or warm water bottle over the forehead or even behind the head if he hunches forward to see if he comes down with either of those approaches. If he does then, the idea of a headache is more likely.
2. Avoid giving him TOO MUCH over the counter medication since that in and of itself can lead to WORSENING OF HEADACHES....known as MEDICATION OVERUSE HEADACHE (MOH) or Analgesic Rebound headaches. I realize that he had these headaches BEFORE getting any medications for his headaches, however, consider that MOH is known to be a significant risk of contracting by any patient who takes MORE THAN 10-15 days per month (or even episodes) of some acute abortive medication such as ibuprofen, naproxen, Tylenol, aspirin, etc.
3. Consider getting a PANOREX or full dental films to make sure he doesn't have a cavity or loose filling that may be to blame for his headaches (very common problem which is not always thought about).
4. I know he has a urinary tract infection which looks pretty aggressive and so that COULD be a cause of headaches but more than the infection...how about any medications he may be taking which could cause headaches as a side effect?
Please take these initial suggestions and let me know what you find and perhaps in the follow up answer you give me I can think of several other suggestions or thoughts.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr for your timely reply. I have done some research into some medication interactions and found this and hoping this is our culprit!! Cephalexin and Zanaflex together: in males. common symptoms: Anxiety, Stiff/ and or back ache, migraines, loss of appetite,Asthenia, All of which he has! Remembering that this all started with trying to treat neck pain. I can remember thinking that the pain had transferred into his head but certainly after we started all of these both OTC Nsaids,tylenol, moving into Xanaflex to ease muscle tension in order for him to sleep., and the Keflex for the UTI, and further into 800mg IBF. I have noticed that at times when he would hold on to me or even push against me for a reason, I could feel him shake under the tension or effort so to speak. At the moment, we have stopped everything except tylenol and IBF. The Keflex was completed this past Friday so we are done with it anyways. Should we also stop the IBF, and Tylenol ? Should I or can we even look at maybe Narcan to reverse the Xanaflex ? or do we simply wait this out a few days. I have scheduled a dental appt for this Thursday in case it was maybe his wisdom teeth or anything else that may show up on an x ray, We are only about 2 months from his scheduled check up anyway but I did consider the fact that he could have dental issues.
We have tried the hot and cold packs and he does seem to get some relief from either but he does not understand their use and is a bit hard to keep them on him.
We have tried the hot and cold packs and he does seem to get some relief from either but he does not understand their use and is a bit hard to keep them on him.
Brief Answer:
Good work Gumshoe
Detailed Answer:
Nice updates there XXX....I think you're on to somebody old man! HA! Medications either alone or in combination with other drugs can often times cause SEVERE headache reactions. They can interact with over the counter drugs....taking OTC's too frequently or too much in quantity is also a COMMON CAUSE of uncontrolled and severe headaches. This is referred to as MEDICATION OVERUSE HEADACHE.
My philosophy is always, "Less is More." I would reduce or delete as many UNNECESSARY medications as possible. And that means all medications for pain as well (YES- YES-YES, discontinue Ibuprofen and Tylenol). It may be a bit rough to begin with but as everything slowly washes out there should be resolution of symptoms. Give him lots of fluids to flush his system.
It's good that the hot/cold packs help but if he's not able to be totally compliant you may need to sit there with him and handle the pack yourself. You can sort of play a game with him or offer some type of reward if he will keep the pack on....perhaps, you can fix the pack to the head using an Ace Bandage or tying it to the forehead using a towel or something. Or simply sit there with him and place it on and take it off when he gets tired, give him a couple minute rest and then, back on until he seems to be doing better.
I would not give Narcan since it does not sound as if he is TOXIC on the Zanaflex. It'll wash out in a few days if you simply withdraw it from him. I would recommend a taper of the muscle relaxant as opposed to abrupt withdrawal....reduce by 1 tablet every 3-4 days.
I'd appreciate the favor of your providing a STAR RATING and some brief written feedback if your questions have been satisfactorily answered. In addition, CLOSING THE QUERY on your end will also be most helpful.
Don't forget that my webpage to keep me abreast as to how you're doing is:
bit.ly/drdariushsaghafi
All the Best
This query has required a total of 63 minutes of physician specific time to read, research, and compile the return to the patient.
Good work Gumshoe
Detailed Answer:
Nice updates there XXX....I think you're on to somebody old man! HA! Medications either alone or in combination with other drugs can often times cause SEVERE headache reactions. They can interact with over the counter drugs....taking OTC's too frequently or too much in quantity is also a COMMON CAUSE of uncontrolled and severe headaches. This is referred to as MEDICATION OVERUSE HEADACHE.
My philosophy is always, "Less is More." I would reduce or delete as many UNNECESSARY medications as possible. And that means all medications for pain as well (YES- YES-YES, discontinue Ibuprofen and Tylenol). It may be a bit rough to begin with but as everything slowly washes out there should be resolution of symptoms. Give him lots of fluids to flush his system.
It's good that the hot/cold packs help but if he's not able to be totally compliant you may need to sit there with him and handle the pack yourself. You can sort of play a game with him or offer some type of reward if he will keep the pack on....perhaps, you can fix the pack to the head using an Ace Bandage or tying it to the forehead using a towel or something. Or simply sit there with him and place it on and take it off when he gets tired, give him a couple minute rest and then, back on until he seems to be doing better.
I would not give Narcan since it does not sound as if he is TOXIC on the Zanaflex. It'll wash out in a few days if you simply withdraw it from him. I would recommend a taper of the muscle relaxant as opposed to abrupt withdrawal....reduce by 1 tablet every 3-4 days.
I'd appreciate the favor of your providing a STAR RATING and some brief written feedback if your questions have been satisfactorily answered. In addition, CLOSING THE QUERY on your end will also be most helpful.
Don't forget that my webpage to keep me abreast as to how you're doing is:
bit.ly/drdariushsaghafi
All the Best
This query has required a total of 63 minutes of physician specific time to read, research, and compile the return to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Ok, Will do, thank you again and ill keep you updated ... Thank you again and i will gladly go and do your review !! Fingers crossed..
Brief Answer:
Lots of luck to you and your son
Detailed Answer:
Thanks for the updates again and just keep in mind that when retiring medications such as the ones you will be taking down that slow and steady is the way to go. Another rule of the road is when someone has been on several medications for pain for a while or on high doses for a few weeks that when these are withdrawn in headache patients, things tend to get a little worse before they get better. Don't let that put temptation out there in front of you to not be able to stick to the plan of withdrawing the medication.
Once the medications have been withdrawn completely it can sometimes take up to several weeks longer for headaches to level off. If at that there are still problems then, we are able to look at the baseline that has been created and based upon that along with a headache log that you will fill out we can make intelligent and medically sound choices of medications or other interventions (e.g. the Sootheaway device- www.sootheaway.com) in order to knock the headaches out.
Thank you for the opportunity to help you in this situation. Perhaps, one of the best ways we can gauge improvement in your son's headaches is by your taking pictures of him as you did before. I thought the ones you took were very effective in depicting what appeared to be his discomfort and pain compared to when he was normal and happy.
This query has required a total of 19 minutes of physician specific time to read, research, and compile the return to the patient.
Lots of luck to you and your son
Detailed Answer:
Thanks for the updates again and just keep in mind that when retiring medications such as the ones you will be taking down that slow and steady is the way to go. Another rule of the road is when someone has been on several medications for pain for a while or on high doses for a few weeks that when these are withdrawn in headache patients, things tend to get a little worse before they get better. Don't let that put temptation out there in front of you to not be able to stick to the plan of withdrawing the medication.
Once the medications have been withdrawn completely it can sometimes take up to several weeks longer for headaches to level off. If at that there are still problems then, we are able to look at the baseline that has been created and based upon that along with a headache log that you will fill out we can make intelligent and medically sound choices of medications or other interventions (e.g. the Sootheaway device- www.sootheaway.com) in order to knock the headaches out.
Thank you for the opportunity to help you in this situation. Perhaps, one of the best ways we can gauge improvement in your son's headaches is by your taking pictures of him as you did before. I thought the ones you took were very effective in depicting what appeared to be his discomfort and pain compared to when he was normal and happy.
This query has required a total of 19 minutes of physician specific time to read, research, and compile the return to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hey Dr. I am writting in response to my son XXXXXXX and his condition. ok, we have had some improvement but not out of the woods just yet. XXXXXXX has done some better but still having a stiff neck and headaches. He is more active in his daily routine but still comes over to lie his head on my shoulder and will place my hand on his head to massage it as well, he is eating a little better but needs much presuading to both chew and swallow his food. We took him to the Dentist and while all 4 Wisdom teeth are coming in, they have not ruptured and the Dentist said she did not think they would be bothering him, although, he will not eat much at all so Im suspect of her initial conclusion. She said that the "teeth were not in the canal to put pressure on a root?" Greek to me. Overall she siad his teeth were fine with 0 cavities.. Any ideas on what I may need to seek out next ?
Brief Answer:
Glad to hear that XXXXXXX is improving
Detailed Answer:
Thank you for the update from several days ago. As my last note mentions headaches due to side effects from medications, and let us be clear that under the circumstances it really is difficult to be 100% sure that in fact that's EXACTLY what we're dealing with since XXXXXXX can't relay things to us aside through behaviors...but if headaches were from interactions or side effects from the medications and those have now been stopped we are still looking at a full washout period of another 10-14 days before we should be expecting that they be fully gone away. How much have you been able to persuade him to use either ice packs across his forehead or to the back of the neck to see his response or the opposite (warm packs?). I've found these 2 options an excellent way of making people's headaches better (along with massage or gentle pressure on the temples or forehead, when the person is not able to respond verbally for some reason, etc.
As far as the dentist's comments are concerned I'm not getting the sense that she's saying that any headache is due to wisdom teeth erupting. Perhaps, she is implying that his somewhat lethargic behavior could be due to the actual teeth erupting but usually that in fact, is a painful experience and I do not believe that any pain he is experiencing now or in the past 2 weeks was due to a tooth eruption phenomenon.
I believe he is still in the convalescent stages of either the UTI you mentioned he was detected of having and its treatment which is only about 2 weeks down the road....or headaches precipitated as a result of drug to drug interactions vs. side effects of the individual medications on his activity levels, combined with headaches, etc. A little more tincture of patience right now will result in a very happy XXXXXXX soon enough.
I'm hesitant to begin recommending using anything for the headache at this point since the temptation may be to use and then, overuse the substance until he's completed the washout period. That is why I've suggested the hot and cold compresses. There is an automated device that does the same thing which actually wraps around the head and he might find "interesting" called a Sootheaway device. You can look it up online at www.sootheaway.com and is something we prescribe at the XXXXXXX VA all the time to veterans suffering from chronic daily headaches as a result of medication overuse or other phenomenon where taking pharmaceutical relief is contraindicated for some reason. Of course, there is one difference and that is, at the VA we can prescribe that machine to the patients at no cost to them because it is picked up by their health care insurance.
On the outside, I don't know how that works in Taylor's situation since this is considered durable hardware and would depend on the type of insurance that he has as to whether they would pay for the machine or not. It's not terribly expensive as medical equipment goes but you'd have to call the manufacturer and find out the details from them. Of course, it's the type of thing that is so good for these types of situations since the head band that you get with the equipment (there are different options that have to be purchased separately) can be kept on for long periods of time and even causes a massaging action so the patient can literally sleep with it such that I highly recommend it.
Look it up on the internet and see what you think..... www.sootheaway.com. Then, have your doctor consider prescribing it as a medically necessary piece of equipment and see if the manufacturer's have any way of putting your insurance through on it for either purchase or rental of the device. You may even have a medical supply house in your area that carries the device and they'd be able to go through the paperwork shuffle for you or even just rent the device for you.....I don't think you'd need it at this point any more than another 10-14 days anyways...but it's an AWESOME machine to have around...kind of like a vaporizer...never know when it's gonna come in handy!
Other than that I would still work on AVOIDING analgesic compounds or medications for at least a few more days or even 1 week to give everything a chance to "wash out" and after that perhaps slowly and carefully consider giving things such as Tylenol ES (without codeine) at the rate of 2 tablets every 8-12 hrs. for when you think his head is hurting...look at the labels which have had their indications changed since Tylenol overdosing can injure the liver.
Another medication shown to be useful in "gentle" headache therapy and reduction over a period of time is Vitamin B2 (riboflavin) at 400mg. twice daily. No real down sides to using this medications since it doesn't interact with any prescription medications and doesn't really have side effects to speak of...this is over the counter and does not require prescription. You may wish to try him on this regimen for about 30 days. If nothing else it's a nutritional supplement which could be good for him anyways if he's not eating as fully as he should due to lethargy or just not feeling well.
I'm happy to continue working on this problem but this being the 4th answered question in the set would suggest that you would want to consider reopening this question under a new set of questions that can be reopened at any time after having rated this group which I thank you for doing along perhaps with a STAR RATING and some relevant written feedback.
I wish you the best with XXXXXXX and would love to hear about his progress and seeing some of his pics again when he is back to his usual self.
This query has required a total of 127 minutes of physician specific time to read, research, and compile with return to the patient.
Glad to hear that XXXXXXX is improving
Detailed Answer:
Thank you for the update from several days ago. As my last note mentions headaches due to side effects from medications, and let us be clear that under the circumstances it really is difficult to be 100% sure that in fact that's EXACTLY what we're dealing with since XXXXXXX can't relay things to us aside through behaviors...but if headaches were from interactions or side effects from the medications and those have now been stopped we are still looking at a full washout period of another 10-14 days before we should be expecting that they be fully gone away. How much have you been able to persuade him to use either ice packs across his forehead or to the back of the neck to see his response or the opposite (warm packs?). I've found these 2 options an excellent way of making people's headaches better (along with massage or gentle pressure on the temples or forehead, when the person is not able to respond verbally for some reason, etc.
As far as the dentist's comments are concerned I'm not getting the sense that she's saying that any headache is due to wisdom teeth erupting. Perhaps, she is implying that his somewhat lethargic behavior could be due to the actual teeth erupting but usually that in fact, is a painful experience and I do not believe that any pain he is experiencing now or in the past 2 weeks was due to a tooth eruption phenomenon.
I believe he is still in the convalescent stages of either the UTI you mentioned he was detected of having and its treatment which is only about 2 weeks down the road....or headaches precipitated as a result of drug to drug interactions vs. side effects of the individual medications on his activity levels, combined with headaches, etc. A little more tincture of patience right now will result in a very happy XXXXXXX soon enough.
I'm hesitant to begin recommending using anything for the headache at this point since the temptation may be to use and then, overuse the substance until he's completed the washout period. That is why I've suggested the hot and cold compresses. There is an automated device that does the same thing which actually wraps around the head and he might find "interesting" called a Sootheaway device. You can look it up online at www.sootheaway.com and is something we prescribe at the XXXXXXX VA all the time to veterans suffering from chronic daily headaches as a result of medication overuse or other phenomenon where taking pharmaceutical relief is contraindicated for some reason. Of course, there is one difference and that is, at the VA we can prescribe that machine to the patients at no cost to them because it is picked up by their health care insurance.
On the outside, I don't know how that works in Taylor's situation since this is considered durable hardware and would depend on the type of insurance that he has as to whether they would pay for the machine or not. It's not terribly expensive as medical equipment goes but you'd have to call the manufacturer and find out the details from them. Of course, it's the type of thing that is so good for these types of situations since the head band that you get with the equipment (there are different options that have to be purchased separately) can be kept on for long periods of time and even causes a massaging action so the patient can literally sleep with it such that I highly recommend it.
Look it up on the internet and see what you think..... www.sootheaway.com. Then, have your doctor consider prescribing it as a medically necessary piece of equipment and see if the manufacturer's have any way of putting your insurance through on it for either purchase or rental of the device. You may even have a medical supply house in your area that carries the device and they'd be able to go through the paperwork shuffle for you or even just rent the device for you.....I don't think you'd need it at this point any more than another 10-14 days anyways...but it's an AWESOME machine to have around...kind of like a vaporizer...never know when it's gonna come in handy!
Other than that I would still work on AVOIDING analgesic compounds or medications for at least a few more days or even 1 week to give everything a chance to "wash out" and after that perhaps slowly and carefully consider giving things such as Tylenol ES (without codeine) at the rate of 2 tablets every 8-12 hrs. for when you think his head is hurting...look at the labels which have had their indications changed since Tylenol overdosing can injure the liver.
Another medication shown to be useful in "gentle" headache therapy and reduction over a period of time is Vitamin B2 (riboflavin) at 400mg. twice daily. No real down sides to using this medications since it doesn't interact with any prescription medications and doesn't really have side effects to speak of...this is over the counter and does not require prescription. You may wish to try him on this regimen for about 30 days. If nothing else it's a nutritional supplement which could be good for him anyways if he's not eating as fully as he should due to lethargy or just not feeling well.
I'm happy to continue working on this problem but this being the 4th answered question in the set would suggest that you would want to consider reopening this question under a new set of questions that can be reopened at any time after having rated this group which I thank you for doing along perhaps with a STAR RATING and some relevant written feedback.
I wish you the best with XXXXXXX and would love to hear about his progress and seeing some of his pics again when he is back to his usual self.
This query has required a total of 127 minutes of physician specific time to read, research, and compile with return to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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