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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suffering From Constant Headache & Neck Pain

Hello, 30 year old female with 3.5 years of constant, 24/7 headaches and neck pain. After taking an Xray with my mouth open and my neck tilted to the left and right, a doctor diagnosed me with a torn alar ligament, both left and right side. Can you please help me understand treatment options?
Thu, 3 Aug 2017
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Neurologist, Surgical,  's  Response
Hi, thanks for asking from HCM.


I can understand your concern. As per your history, you are having symptomatic craniovertebral junction disease (CVJ). The alar ligaments are present between skull base (clivus) and dens (uppermost spine C1 and C2). Torn alar ligaments mean the dens (a bony structure) is unstable.

This unstable bone and its damage can be confirmed on CT and MRI of CVJ. You must consult neurosurgeon or spine surgeon. The above investigation will tell you about your spinal cord compression, bony structure at CVJ and is there any need of surgery. Usually spine is fixed with instruments. Don't worry about it. First you need complete evaluation.

Till then, you should follow few steps

- Avoid extreme neck movement

- Use hard cervical collar to prevent sudden jerk.

- For headache and neck pain, you can take combination of paracetamol and diclofenac after proper prescription. If pain is radicular, take tablet pregabaline after proper prescription.

- For vertigo, you can take betahistine after proper prescription.

Hope it will help you. If still in doubt, do let me know.
Thanks. Take care.
Dr Ishu Bishnoi
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Suffering From Constant Headache & Neck Pain

Hi, thanks for asking from HCM. I can understand your concern. As per your history, you are having symptomatic craniovertebral junction disease (CVJ). The alar ligaments are present between skull base (clivus) and dens (uppermost spine C1 and C2). Torn alar ligaments mean the dens (a bony structure) is unstable. This unstable bone and its damage can be confirmed on CT and MRI of CVJ. You must consult neurosurgeon or spine surgeon. The above investigation will tell you about your spinal cord compression, bony structure at CVJ and is there any need of surgery. Usually spine is fixed with instruments. Don t worry about it. First you need complete evaluation. Till then, you should follow few steps - Avoid extreme neck movement - Use hard cervical collar to prevent sudden jerk. - For headache and neck pain, you can take combination of paracetamol and diclofenac after proper prescription. If pain is radicular, take tablet pregabaline after proper prescription. - For vertigo, you can take betahistine after proper prescription. Hope it will help you. If still in doubt, do let me know. Thanks. Take care. Dr Ishu Bishnoi