Neck Pain with Headaches: When to See a Neurologist?

Neck pain accompanied by headache?

My girlfriend initially experienced sudden pain in her upper body along with chest tightness.
Later, she developed sharp pain in the back of her neck accompanied by headaches.
Despite visiting the hospital outpatient department, no clear diagnosis was made, and pain relief medications have not been very effective.
This has been ongoing for a week.
In the past two days, the pain has become concentrated in her neck, and the chest tightness has subsided.
She is almost unable to sleep, and the pain has spread to her upper chest and both arms.
Additionally, she cannot turn her neck without experiencing sharp, knife-like pain.
With the recent holidays, we are unsure how to proceed.
Could you please advise if it would be better to see a neurologist? Previously, she consulted a family medicine physician and a rheumatologist based on the emergency physician's recommendation.
Thank you.

Otto, 40~49 year old female. Ask Date: 2016/02/28

Dr. Gao Chunde reply Neurology

If the rheumatology department confirms that there are no related issues, consideration should be given to neurological causes such as cervical spinal cord lesions, whether they are due to inflammation, hemorrhage, intervertebral disc problems, or other reasons.
The on-site physician should conduct a detailed examination to determine the need for further diagnostic tests.

Reply Date: 2016/02/28

More Info

When experiencing neck pain accompanied by headaches, chest tightness, and other symptoms, it is crucial to seek medical attention, particularly from a neurologist or a specialist in neurology. Your girlfriend's symptoms, which include sudden onset pain in the upper body, neck, and head, as well as chest tightness and pain radiating to the arms, warrant a thorough evaluation.
Given that her symptoms have persisted for a week and have not improved with over-the-counter pain medications, it is essential to consider several potential underlying causes. The combination of neck pain and headaches can be indicative of various conditions, including cervical spine issues, nerve compression, or even more serious conditions such as vascular problems or neurological disorders.

1. Cervical Spine Issues: The cervical spine consists of vertebrae that can become misaligned or degenerate over time. This can lead to nerve compression, resulting in pain that radiates to the head, shoulders, and arms. Conditions such as cervical spondylosis, herniated discs, or cervical radiculopathy may be responsible for her symptoms.

2. Nerve Compression: If a nerve in the neck is compressed, it can lead to pain, tingling, or weakness in the arms. This could explain the pain radiating to her upper chest and arms. A neurologist can perform specific tests to determine if nerve compression is present.

3. Muscle Strain or Tension: Sometimes, muscle tension or strain in the neck can lead to headaches and discomfort. Stress, poor posture, or sudden movements can contribute to muscle tightness, which can be exacerbated by anxiety or lack of sleep.

4. Vascular Issues: Although less common, vascular issues such as vertebral artery dissection or other vascular problems can present with neck pain and headaches. These conditions can be serious and require immediate medical attention.

5. Neurological Evaluation: A neurologist can conduct a comprehensive evaluation, including a physical examination and possibly imaging studies such as MRI or CT scans, to assess the cervical spine and brain. They may also perform nerve conduction studies or electromyography (EMG) to evaluate nerve function.

6. Referral to Other Specialists: Depending on the findings, the neurologist may refer your girlfriend to other specialists, such as an orthopedic surgeon or a pain management specialist, for further evaluation and treatment.

In summary, given the severity and persistence of your girlfriend's symptoms, it is advisable to see a neurologist. They can provide a more specialized assessment of her condition and determine the most appropriate course of action. Additionally, if she is experiencing significant pain that affects her ability to sleep or perform daily activities, it is important to address this promptly to prevent further complications and improve her quality of life.
Encourage her to keep a detailed record of her symptoms, including when they occur, their intensity, and any factors that seem to alleviate or exacerbate them. This information can be invaluable for the healthcare provider in diagnosing and treating her condition effectively.

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