C6 incomplete quadriplegic with severe headaches

[stacy66]

My mom is a c6 incomplete quadriplegic. Her injury happened on Dec 4, 2014. She is home now and has been doing ok but in the recent days she has been having very severe headaches. Her blood pressure is fine and she has no other signs of the autonomic dysreflexia but we cannot get rid of the headaches. She went to the hospital last night due to the headache her brain scans are all fine her vitals are fine. Dr thinks it probably pressure head ache from the collar she still has to wear but my question is could the headache be caused by something going wrong with her neck where the injury occurred like the screws coming out ... Should we take her to a neurosurgeon and have that checked or have you heard if the pressure headaches are common and how can we get rid of them. She takes oxycodone 10 mg and tylenol, gabapentin at night and at the hospital they gave her morphine and none of that worked to get rid of the headache.

Thanks for your help

Stacy

[SCI-Nurse]

Most people should only wear the cervical collar after a cervical fracture or surgery for only a certain number of months afterwards. I would recommend that you follow-up with the Neurosurgeon.

pbr

[stacy66]

She is supposed to keep the collar on until August 4 and then she can start weaning herself off of it and take it off for good on Sep 4 and we do have a follow up appointment with him in November. Just worried about the headaches she is having now and wondering if they could be caused by the collar which is what her primary care dr thinks and if it is what we can do to ease her pain. Just looking for a second opinion and wondering if anyone else has had this problem.

[Jim]

I don't think you should wait until November. Not sure why the neck brace needs to be worn for 9 months. What hospital did she go to?

[stacy66]

Chandler Regional Medical Center in Chandler, AZ. My mom has had rheumatoid arthritis for 40 plus years and her bones take a while to heal. In April when we were there he said the screws were holding but that the bone hadn't fused yet. She has a bone stimulator that she wears all the time and they said she can get rid of that in August when she gets rid of the collar

[Wise Young]

My mom is a c6 incomplete quadriplegic. Her injury happened on Dec 4, 2014. She is home now and has been doing ok but in the recent days she has been having very severe headaches. Her blood pressure is fine and she has no other signs of the autonomic dysreflexia but we cannot get rid of the headaches. She went to the hospital last night due to the headache her brain scans are all fine her vitals are fine. Dr thinks it probably pressure head ache from the collar she still has to wear but my question is could the headache be caused by something going wrong with her neck where the injury occurred like the screws coming out ... Should we take her to a neurosurgeon and have that checked or have you heard if the pressure headaches are common and how can we get rid of them. She takes oxycodone 10 mg and tylenol, gabapentin at night and at the hospital they gave her morphine and none of that worked to get rid of the headache.

Stacy,

Severe headaches are uncommon in spinal cord injury. While screws, and plates may cause some irritation, they should not cause severe headaches. Collars should reduce neck and head pain. If the collar is causing the headaches, this should be relatively easy to test by removing the collar and seeing if the headaches go away. There is no reason why a collar need to be worn for longer than 6 months unless she had an unstable fracture despite the plates and screws. The fracture should have healed by 6 months. Did her doctor say anything about the possibility that she might have cervical stenosis (narrowing of the spinal canal)? Is your mother taking medication for her rheumatic arthritis?

Does your mother have a history of migraine? One possibility is that your mother may have migraine that is being triggered by muscle/ligament strain and the cervical injury. On the other hand, this should be getting better with time, not worse. About 50% of people who have had whiplash are fully recovered with no more pain by 3 months and 75% should be fully recovered in a year. Does your mother have neck pain? Does wearing the collar relieve that pain? Another possibility is that your mother may have had mild head injury at her accident. In 1991, Weiss, et al. reported that chronic migraine may be precipitated by minor head and neck trauma.

Post-traumatic migraine: chronic migraine precipitated by minor head or neck trauma.
Weiss HD1, Stern BJ, Goldberg J.
Headache. 1991 Jul;31(7):451-6.
Abstract
Minor trauma to the head or neck is occasionally followed by severe chronic headaches. We have evaluated 35 adults (27 women, 8 men) with no prior history of headaches, who developed recurrent episodic attacks typical of common or classic migraine following minor head or neck injuries ("post-traumatic migraine"-PTM). The median age of these patients was 38 years (range 17 to 63 years), which is older than the usual age at onset of idiopathic migraine. The trauma was relatively minor: 14 patients experienced head trauma with brief loss of consciousness, 14 patients sustained head trauma without loss of consciousness, and 7 patients had a "whiplash" neck injury with no documented head trauma. Headaches began immediately or within the first few days after the injury. PTM typically recurred several times per week and was often incapacitating. The patients had been unsuccessfully treated by other physicians, and there was a median delay of 4 months (range 1 to 30 months) before the diagnosis of PTM was suspected. The response to prophylactic anti-migraine medication (propranolol or amitriptyline used alone or in combination) was gratifying, with 21 of 30 adequately treated patients (70%) reporting dramatic reduction in the frequency and severity of their headaches. Improvement was noted in 18 of the 23 patients (78%) who were still involved in litigation at the time of treatment. The neurologic literature has placed excessive emphasis on compensation neurosis and psychological factors in the etiology of chronic headaches after minor trauma. Physicians must be aware of PTM, as it is both common and treatable.

In 2009. Theeler & Erickson erported that 41% of soldiers evaluated for headaches reported a history of head or neck trauma while deployed to Iraq. Did your mother have even transient loss of consciousness or concussion without loss of consciousness (confusion or amnesia) at the time of her accident?

Headache. 2009 Apr;49(4):529-34. doi: 10.1111/j.1526-4610.2009.01345.x. Epub 2009 Feb 11.
Mild head trauma and chronic headaches in returning US soldiers.
Theeler BJ1, Erickson JC.
Author information
Abstract
OBJECTIVE:
To determine the incidence and types of head or neck trauma and headache characteristics among US Army soldiers evaluated for chronic headaches at a military neurology clinic following a combat tour in Iraq.
BACKGROUND:
Head or neck trauma and headaches are common in US soldiers deployed to Iraq. The temporal association between mild head trauma and headaches, as well as the clinical characteristics of headaches associated with mild head trauma, has not been systematically studied in US soldiers returning from Iraq.
METHODS:
A retrospective cohort study was conducted with 81 US Army soldiers from the same brigade who were evaluated at a single military neurology clinic for recurrent headaches after a 1-year combat tour in Iraq. All subjects underwent a standardized interview and evaluation to determine the occurrence of head or neck trauma during deployment, mechanism and type of trauma, headache type, and headache characteristics.
RESULTS:
In total, 33 of 81 (41%) soldiers evaluated for headaches reported a history of head or neck trauma while deployed to Iraq. A total of 18 (22%) subjects had concussion without loss of consciousness and 15 (19%) had concussion with loss of consciousness. Ten subjects also had an accompanying traumatic neck injury. No subjects had moderate or severe traumatic brain injury. Exposure to blasts was the most common cause of trauma, accounting for 67% of head and neck injuries. Headaches began within one week after trauma in 12 of 33 (36%) soldiers with head or neck injury. Another 12 (36%) reported worsening of pre-existing headaches after trauma. Headaches were classified as migraine type in 78% of soldiers with head or neck trauma. Headache types, frequency, severity, duration, and disability were similar for soldiers with and without a history of head or neck trauma.
CONCLUSION:
A history of mild head trauma, usually caused by exposure to blasts, is found in almost half of returning US combat troops who receive specialized care for headaches. In many cases, head trauma was temporally associated with either the onset of headaches or the worsening of pre-existing headaches, implicating trauma as a precipitating or exacerbating factor, respectively. Headaches in head trauma-exposed soldiers are usually migraine type and are similar to nontraumatic headaches encountered at a military specialty clinic.

Finally, does your mother have a history of migraine headaches or have any of the signs of migraine? Is your mother at or close to menopause? If not, has the spinal cord injury interrupted her menses? Spinal cord injury may affect hormones. Fluctuating levels of hormones and premenstrual syndrome may trigger headaches. Has she been assessed for her hormonal levels, including estrogen, progesterone, thyroid, parathyroid, etc. In any case, if her headaches do not get better and problems with her neck have been ruled out, she should probably see a headache specialist.

Wise.

[stacy66]

Thank you that has relieved some of my worry. My mom is 70 so she has been in menopause for some time. She does not have a history of migraines. She takes 5 mg of prednisone for the arthritis and they just added methotrexate 3 weeks ago. Her accident was so weird. She tripped in the living room and fell into the couch a soft leather couch and broke her neck so I am not sure that she would have had any brain trauma. It helps to know that her neck should be healed so she can feel comfortable to remove the collar to see if that will help the headache. Right now she is very scared to remove the collar for fear of it causing damage to her neck if she takes it off before the Dr said to. She does not complain of any neck pain. She has pain in her shoulders at times and she does have a pressure sore on her backside right now that they are treating with a wound vac. Until we started having trouble with the pressure sore she had hardly been taking any medication for pain, usually a few tylenol and maybe one oxycodone a day.
Thanks again for your help.
Stacy

[SCI-Nurse]

Does she have a complete spinal cord injury? or incomplete with some upper and lower extremity movement (arms and legs)?

What is her prognosis?

So sorry about this accident to your mother. With a history of arthritis it is not uncommon to find it in the spine. Falling is a rising cause of spinal cord injuries in people with arthritis in the spine. Falling in general is a risk for anyone with anyone as they age and have any co-moridities (other medical conditions like osteoporosis, high blood pressure, dementia, etc).

I hope you are able to get ahold of the neurosurgeon. The arthritis medication will need to be re-evaluated for effectiveness with her new spinal cord injury diagnosis.

Please keep us posted.

pbr

[backwoodsrider]

I have migraines and I believe they are caused by my SCI. Doctor in Craig said many people with SCI get headaches when the barometric pressure is rising. That was 25 year ago and still check. About 75% of my migraines happen when there is high pressure in the atmosphere. Good luck with your mother