Sudden Neck and Head Pain: When to Seek Neurology Help

Q: Sudden Neck and Head Pain: When to Seek Neurology Help

Hello, Miss： You mentioned wanting to know if this is a sign of a blood clot. <br>A： If a blood clot is present, you can check the D-dimer to see if the clotting index has risen. <br>In the case of vertebral artery embolism, it is usually accompanied by symptoms of loss of motor

Headache and neck pain, with the size and intensity of the pain points being consistent?

Hello Doctor, thank you for taking the time to address my concerns amidst your busy schedule.
Two days ago, while standing and working on a report, I suddenly experienced severe pain below my left ear and behind my earlobe.
Additionally, I have been feeling a slight numbness in the sole of my right foot.
The neck pain is more intense than my usual muscle strain or headaches from staying up late, and the painful area feels like a circular spot about the size of a fingertip.
Applying muscle relaxants and menthol ointments has not been effective, and doing neck relaxation exercises recommended by online physical therapists has made the pain worse.
Later, after taking muscle relaxants and pain relief medication (Dolan Tab.
35mg) prescribed by a neurologist, along with a blood circulation medication (GINKGOCENTRATE TAB.
9.6mg), I felt some improvement, but it did not completely resolve the pain.
After having hot soup for dinner and walking briskly on a treadmill, I gradually felt better.
However, yesterday, after being informed by a gastroenterologist that I needed to undergo a sigmoidoscopy, I became anxious and started crying, which triggered the pain in the same area again.
I noticed that taking the blood circulation medication helped more than the muscle relaxant and pain relief medication.
Unexpectedly, while washing my hair today, I suddenly felt a similar pain in the left back of my head, with the same intensity and area as before, and it worsened with warm water.
I hurriedly finished my shower, and surprisingly, the pain subsided afterward.

Later in the afternoon, while standing and working on my report again, I suddenly felt a similar pain near my left buttock close to the anus, but it disappeared after I pressed on it.
Today, I occasionally feel a sensation like ants crawling on my nose and cheeks, but it doesn’t last long.
The commonality in these pain episodes is that the painful areas are roughly the same size and the pain comes on suddenly, but the duration varies from a few hours to a few minutes or even seconds.
I would like to ask if this could be a sign of a blood clot.
If so, should I continue seeing a neurologist or consult a cardiologist? Would I need to pay out of pocket for an angiogram or other tests? (A few months ago, I had blood tests done, and aside from a slightly elevated white blood cell count (which has been at the borderline in previous tests), everything else was normal.) I previously consulted a doctor due to persistent cold sensations from the back of my head to the top, which occur during prolonged sitting or exposure to cold air; only hot showers and brisk walking seem to help, although there have been times when medication, hot showers, and brisk walking did not alleviate the symptoms.
I had a carotid ultrasound, which revealed a congenital narrowing in the upper part of the right carotid artery, and a cervical spine X-ray showed normal cervical vertebrae.
Thank you for taking the time to answer my questions! I greatly appreciate it!

C, 20~29 year old female. Ask Date: 2021/06/22

Dr. Jiang Junyi reply Neurology

Hello, Miss: You mentioned wanting to know if this is a sign of a blood clot.
A: If a blood clot is present, you can check the D-dimer to see if the clotting index has risen.
In the case of vertebral artery embolism, it is usually accompanied by symptoms of loss of motor function.
It seems that you are primarily experiencing sensations.
If that is the case, should you continue to see a neurologist or go to a cardiologist? Would you need to pay out of pocket for an angiogram or other tests? A: It is recommended that you first consult a neurologist for nerve conduction studies or arrange for a full spine MRI at your own expense.
During the day, you can supplement with B vitamins.
I suggest you visit the neurology outpatient clinic for follow-up, but due to the recent tight COVID-19 situation, it is advisable to wait until the situation stabilizes before going to the hospital for examinations.
Please implement self-protection measures, including cleaning and disinfection, and adhere to the new pandemic prevention guidelines before and after your medical visits.
Thank you for your inquiry, and feel free to discuss any related questions! Wishing you good health and peace.
Dr.
Jiang Junyi, Taoyuan Hospital, cares about you.

Reply Date: 2021/06/22

More Info

Understanding sudden neck and head pain can be complex, especially when accompanied by other symptoms like tingling or numbness. Based on your description, it seems that you are experiencing a range of symptoms that could be related to several underlying issues, including muscular tension, nerve irritation, or vascular concerns. Here’s a breakdown of your symptoms and some guidance on when to seek further medical help.

Symptoms Overview
1. Neck Pain: The sudden onset of pain in the neck, particularly near the left ear and the area behind the ear, could indicate muscle strain, nerve irritation, or even a vascular issue. The pain being more intense than typical muscle strain suggests that it may not just be a simple muscle issue.

2. Tingling Sensation: The tingling in your right foot and the "ants crawling" sensation in your face and nose could indicate nerve involvement. This might suggest that a nerve is being compressed or irritated, possibly due to muscle tension or a structural issue in the neck.

3. Pain Triggered by Activities: The fact that certain activities, like washing your hair or standing while working, exacerbate your pain could indicate that specific positions or movements are aggravating your condition.
4. Response to Medication: You mentioned that muscle relaxants and pain medications provided some relief, but not complete resolution. This could suggest that while muscle tension is a factor, there may be other underlying issues that need to be addressed.

When to Seek Neurology Help
Given the complexity of your symptoms, it is advisable to consult with a neurologist, especially since you are experiencing neurological symptoms such as tingling and sudden pain. Here are some specific indicators that warrant a visit to a neurologist:
- Persistent or Worsening Symptoms: If your symptoms persist or worsen despite treatment, it’s essential to seek further evaluation.

- Neurological Symptoms: The presence of tingling, numbness, or any changes in sensation should be evaluated by a specialist to rule out conditions like multiple sclerosis, peripheral neuropathy, or other neurological disorders.

- Unexplained Pain: Sudden, severe pain that does not respond to typical pain relief methods should be investigated to rule out serious conditions such as vascular issues or nerve compression.

- History of Vascular Issues: Given your history of carotid artery narrowing, it’s crucial to monitor for any signs of vascular complications, including blood clots or transient ischemic attacks (TIAs).

Diagnostic Considerations
- Imaging Studies: If you haven’t already, consider discussing the need for imaging studies such as an MRI of the cervical spine or a CT angiogram to evaluate the blood vessels in your neck and brain. These tests can help identify any structural issues or vascular abnormalities.

- Blood Tests: Regular blood tests to monitor your white blood cell count and other parameters can help rule out underlying infections or inflammatory conditions.

Conclusion
In summary, your symptoms suggest a multifactorial issue that may involve muscular, neurological, and possibly vascular components. Given the complexity and the potential seriousness of your symptoms, it is advisable to continue following up with a neurologist. They can provide a comprehensive evaluation and determine if further imaging or tests are necessary. Additionally, maintaining a healthy lifestyle, managing stress, and practicing relaxation techniques may help alleviate some of your symptoms. Always prioritize your health and seek immediate medical attention if you experience any new or worsening symptoms.

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