- NEURORADIOLOGY & PAIN SOLUTIONS OF OKLAHOMA -

Types of Headaches

Chronic daily headaches may present as different types of headaches and are usually classified as:
Short duration (less than 4 hours) CDH: rare and includes:
● Cluster headaches: intense pain from neck to temple and around the eye, on one side of the face, mostly at night.
Long duration (more than 4 hours) CDH: more common and includes:
● Chronic tension-type headaches: mild to moderate pain present on both sides of the head; develops from episodic tension-type headaches.● Chronic migraine headaches: throbbing pain on one side of the head with associated symptoms such as light sensitivity and nausea, but lacking aura symptoms.● Hemicrania continua: persistent pain that peaks in severity.● New daily persistent headache: mild to moderate pain present on both sides of the head, with no past history of headaches.

CAUSES

The cause of chronic daily headache is unknown but could be due to an abnormal development of low pain threshold or lack of pain suppression in the brain.

Treatment

In the absence of secondary causes, your doctor will focus treatment on preventing headaches. You may be prescribed antidepressants, anti-seizure medications, NSAIDs and blood pressure medication. Relaxation therapy may be recommended and botulinum toxin (Botox) injections may be given.
At Neuroradiology and Pain Solutions of Oklahoma, we offer a variety of treatments for this condition, including:
● Intra-Articular Joint Injection ● Trigger Point Injections ● Radiofrequency Ablation ● Facet injection, including C0-C1 and C1-C2 ● Peripheral Nerve Stimulation Treatment ● C2 Dorsal Root Ganglion (DRG) ● Epidural Blood/Fibrin Glue Patch ● Occipital ● Supraorbital

DIAGNOSIS

To diagnose your headache, your doctor will review your medical history and perform a physical examination to define the type of headache and possible causes. You may need to undergo CT and MRI testing to look for abnormalities, blood and urine tests, or electroencephalography to study the electrical activity of the brain.

CAUSES OF JOINT PAIN

Some of the common causes of joint pain include muscle and joint:
● Overuse.● Tension.● Injury.● Infection.● Inflammation.● Sprains and strains.

WHAT ARE THE SYMPTOMS COMMONLY ASSOCIATED WITH JOINT PAIN?

Symptoms that can be associated with joint pain include:
● Swelling.● Redness.● Tenderness.● Warm to touch.● Persistent pain.

HOW IS JOINT PAIN TREATED?

Some of the measures that can be employed to treat joint pain include:
● Using medications such as topical pain relievers and oral anti-inflammatory drugs.● Application of heat and ice on the affected area.● Adequate resting of the affected area.● Strengthening muscle function and maintaining a good range of motion with a regular exercise regimen.● Maintaining a proper body weight.● Engaging in stress-relieving activities such as meditation and yoga.● Lifestyle changes.

WHICH MEDICAL CONDITIONS CAN CAUSE JOINT PAIN?

● Bacterial and viral infections.
● Autoimmune disorders such as polymyositis, dermatomyositis, or lupus.
● Use of medications such as ACE inhibitors or statins.
● Fibromyalgia.
● Hypokalaemia.
● Hyperthyroidism or hypothyroidism.
● Osteoporosis.
● Chondromalacia.
● Gout.
● Tendinitis.
● Infectious diseases such as influenza, mumps, or hepatitis.
● Arthritis such as rheumatoid arthritis and osteoarthritis.
● Lyme disease.
● Polymyalgia rheumatica.

HOW IS THE UNDERLYING CAUSE OF YOUR JOINT PAIN?

Your doctor will review your symptoms and medical history and perform a physical examination. 
If necessary, your doctor will order certain diagnostic tests like X-rays to identify arthritis-specific joint damage, blood tests to screen for certain autoimmune diseases, complete blood count, sedimentation rate test to estimate the level of inflammation in the body, and other tests to narrow down the potential causes of joint pain.

TREATMENTS

At Neuroradiology and Pain Solutions of Oklahoma, we offer a variety of treatments for this condition, including:
● Intra-Articular Joint Injection ● Peripheral Nerve Blocks ● Radiofrequency Ablation ● Peripheral Nerve Stimulation Treatment

CERVICAL ANATOMY

The first 7 vertebral bones of the spinal column form the cervical spine in the neck region. The neck bears the weight of the head, allows a significant amount of movement, and is less protected than other parts of the spine. All these factors make the neck more susceptible to injury or other painful disorders.

CAUSES

The most common cause of neck pain is injury to the soft tissues (muscles, ligaments or nerves) or prolonged wear and tear. Traumatic accidents or falls and contact sports can cause severe neck injuries and pain. Neck pain can also occur from infections, tumours or congenital abnormalities of the vertebrae. The common conditions producing neck pain include:
● Rheumatoid arthritis: It is an autoimmune disease in which the body's immune system attacks healthy joints, tissues, and organs. The condition occurs most often in the upper neck area, causing inflammation of the lining (or synovium) of joints, and resulting in neck pain, stiffness, swelling, and loss of function.
● Cervical disc herniation: disc herniation is the bulging or rupture of the soft fibrous disc that cushions the vertebrae. The soft central portion called nucleus pulposus bulges out through the tear in the capsule. Cervical disc herniation refers to the herniation of the discs in the cervical spine region or neck region. The condition can be caused by normal ageing or by traumatic injury to the spine. The condition results in painful, burning, tingling or numbing sensations in the neck.
● Cervical spondylosis: Cervical spondylosis refers to the abnormal degeneration of the cartilage and bones in the neck region. The condition results in neck pain radiating to arms or shoulder and neck stiffness that gets worse over time.
● Cervical stenosis: Cervical stenosis refers to the narrowing of the spinal canal that protects the spinal cord and its branching nerves. The condition causes neck pain radiating to your arms and hands.
● Degenerative disc disease: Degenerative disc disease refers to the gradual deterioration of the disc between the vertebrae and is caused due to ageing. As people age, intervertebral discs lose their flexibility, elasticity and shock absorbing characteristics, resulting in neck pain.

DIAGNOSIS OF NECK PAIN

The diagnosis of neck pain is made with a review of your history, physical examination and other imaging techniques including electromyography (EMG), X-ray, MRI scan, CT scan, blood tests, and bone density assessment.

Prevention of Neck Pain

The following steps may help you prevent or improve your neck pain:
● Practice relaxation exercises to prevent undesirable stress and tension to the neck muscles.● Perform stretching exercises for your neck before and after exercise.● Maintain good posture if you work at a computer and adjust the monitor to your eye level. Stretch your neck frequently.● If you use the telephone a lot, use a headset.● Use a pillow that keeps your neck straight.● Wear seat belts and use bike helmets to reduce injuries.

treatments

At Neuroradiology and Pain Solutions of Oklahoma, we offer a variety of treatments for this condition, including:
● Epidural Injection ● Facet injection ● Spinal Cord Stimulator ● Sympathetic Nerve Block ● Medial Branch Block ● Stellate ● CT guided Biopsy ● Radiofrequency Ablation

Causes

Nerve pain can be caused by injury to the central or peripheral nerves.
● Central nerve pain: This is caused due to damage to the nerves of the central nervous system by the presence of lesions or diseases such as stroke, spinal cord injury, or multiple sclerosis.
● Peripheral nerve pain: This arises due to dysfunction or injury to the peripheral nerves (nerves that carry senses and motor signals from the brain and spinal cord to the entire body). Diabetes, trauma, vitamin deficiency, kidney disease, certain medications, and alcoholism can cause peripheral nerve pain.

Diagnosis & Options Available

Nerve pain is diagnosed with a detailed review of your medical history and a thorough physical examination. A grading system is used to determine the cause of pain as neuropathic.
● Ablative therapy.● Spinal Cord, Dorsal Root Ganglion Stimulation, and Peripheral Nerve Stimulation.
Early treatment is important to manage nerve pain as nerve damage is progressive. Nerve damage cannot be cured completely. Treatment is centered around relieving symptoms.
The first line of treatment is to manage your underlying condition such as diabetes and changing medication that may be causing nerve damage. Surgery may be indicated to remove tumours.
Your doctor may prescribe anti-epileptic analgesic drugs, antidepressants, opioids, opioid-like drugs, topical anesthetic, and analgesic medications to relieve symptoms. 
Electrical nerve stimulation such as TENS may be performed to relieve pain. Alternate treatments such as meditation, acupuncture, hypnosis, and biofeedback may be ordered to help you cope with pain.

SYMPTOMS

Nerve pain can be differentiated from normal pain symptoms as follows:

● The normal symptoms of pain are altered and present as prickling or tingling sensations to a stabbing, shooting, or burning pain, similar to an electric shock.
● Allodynia or pain that occurs from a stimulus that does not normally cause pain sensations.
● Hyperalgesia or increased pain caused by a stimulus that usually causes pain.
● Anaesthesia Dolorosa or pain that is felt in a numb region.

NEUROPATHIC PAIN CONDITIONS

THERE ARE SEVERAL CONDITIONS THAT CAN LEAD TO NERVE PAIN. SOME OF THE MOST COMMON INCLUDE:
● Diabetic peripheral neuropathy: This is a common condition if you have diabetes. It is characterized by a stabbing or burning pain and numbness in the legs and feet.
● Trigeminal neuralgia: This is a frequently occurring condition that arises due to multiple sclerosis or from a tumour compressing the trigeminal nerve, which carries signals of sensation to the face and motor functions such as chewing and biting. Typical symptoms include sudden facial pain lasting for several seconds to minutes and intense burning pain, usually accompanied by involuntary spasms or facial twitches.
● Chemotherapy-induced peripheral neuropathy: As the name indicates, this type of nerve pain is commonly seen while undergoing chemotherapy, due to sensory nerve damage in the dorsal root of the spinal nerves. Common symptoms include pain and numbness, which may aggravate as the therapy continues.
● HIV-associated sensory peripheral neuropathy (HIV-SN): This condition affects HIV patients either due to the attack of the HIV virus on the peripheral nerves or the effect of the medicine, which is neurotoxic. Advancing age, malnutrition, genetics, and associated diseases such as diabetes further increase the risk of HIV-SN.
● Post-herpetic neuralgia: This condition occurs if you have previously suffered from herpes zoster infection. Reactivation of the herpes zoster virus where it resides in the dorsal root ganglion can lead to pain typically along the spine and around the eyes.

treatments

At Neuroradiology and Pain Solutions of Oklahoma, we offer a variety of treatments for this condition, including:
● Epidural Injection ● Selective Nerve Root Block ● Peripheral Nerve Stimulation Treatment ● Spinal Cord Stimulator ● Intrathecal Pump Placement

types of Trigeminal Neuralgia

The typical or "classic" form of the disorder (Type 1) causes episodes of severe, sharp, stabbing, electric shock-like pain in one side of the face that lasts from seconds to a few minutes. These attacks may occur several times a day or week and can be triggered by chewing, talking, brushing teeth, or exposure to wind. Some people with classic TN have constant pain and not relieved by medication.
A less common form of the disorder (Type 2) causes dull, aching pain in one side of the face that is continuous and usually not relieved by medication.

Causes

The cause of trigeminal neuralgia is not fully understood. In many cases, the disorder appears to be due to compression of the trigeminal nerve by a blood vessel. This type of compression is more common in people over age 50.

Other possible causes include damage to the nerve from inflammation or injury, tumors, and certain diseases such as multiple sclerosis.

Symptoms

The most common symptom of trigeminal neuralgia is intermittent, severe, sharp, stabbing pain in one side of the face. The pain usually lasts for seconds to a few minutes. It may be triggered by activities such as chewing, talking, or brushing teeth.

The pain of trigeminal neuralgia is usually worse with touch, cold, heat, or wind on the side of the face where the pain occurs. Some people have constant pain that is not relieved by medication.

TREATMENTS

At Neuroradiology and Pain Solutions of Oklahoma, we offer a variety of treatments for this condition, including:
● Peripheral Nerve Blocks ● Radiofrequency Ablation ● Peripheral Nerve Stimulation Treatment ● Spinal Cord Stimulator