Cervicogenic Headache

Cervicogenic headache is a common type of head pain that occurs in approximately 2.5% of the U.S. population. Occipital (back of the head) headaches generally occur from problems in the neck, especially the upper part of the neck. The pain originates in the neck, but it can radiate up to the head and cause head pain- called cervicogenic headache.

The headache usually radiates from the neck to the occipital area (back of the head), to the temples, or around the eyes. It can be on one side of the head (unilateral) or both sides (bilateral). The pain is often described as dull, aching, and is aggravated with head/neck movement . Poor posture, looking up, or looking down for long periods of time can trigger or worsen the head pain. Some people who have desk jobs or look up or down for long periods of time can have cervicogenic headache. Generalized muscle tension can also result in headaches that radiate from the neck up to the head.

The pain of cervicogenic headache can be due to problems in the neck, such as cervical discs disease, facet joint degeneration (arthritis), ligaments that become less stretchy, or from muscular spasm. The pain can come from any area of the neck, but commonly originates from the upper ( C2-3, C3-4) joints or discs.  Pain can also occur from unstable areas in the upper two joints (atlanto-occipital and atlanto-axial joints), and is called “atlanto-axial instability”.

Common causes of Cervicogenic headache can include:

Degenerative changes: or age-related changes in the cervical discs or joints

Kyhposis -reversal of cervical curvature

Whiplash injury

Nerve compression- typically from a herniated cervical disc that puts pressure on a neck nerve

If you think you have cervicogenic headache or other neck problems, the providers at the Neurosurgery Center of Colorado may be able to help. Call today for an appointment for evaluation.

Concussion

CONCUSSION- is a very common injury related to contact sports. Most athletes who participate in contact sports (such as football, soccer, rugby, etc) run the risk of concussion. A Concussion is a mild form of head injury that occurs from the brain being rapidly shifted back and forth within the skull. A concussion can range in severity from very mild to severe (with loss of consciousness). Symptoms of concussion can include dizziness, poor coordination, speech changes, memory and concentration difficulty, vision changes, nausea, confusion, and drowsiness. Anyone who sustains a head injury with loss of consciousness should be evaluated by a medical professional immediately after the event. In most cases, a CT scan or MRI will be done to rule out a blood clot. In some cases, the symptoms of concussion may take several days to appear. The effects of concussion (post-concussion syndrome) can last many months, and include memory problems, chronic headache, irritability, mood swings, dizziness, and lack of energy.              

  Take these precautions to help avoid concussion:

• Always wear appropriate head protection when playing football or contact sports
• Make sure the helmet fits well- get a new helmet if the old one is too small or too big
• Always wear a helmet when riding a bicycle or motorcycle, horseback riding, skating or skiing
• Always wear a batters helmet when playing baseball or softball
• Wear appropriate mouth/jaw/ear protection when wrestling or boxing
• Always wear your seat belt in the car and secure young children appropriately
• Avoid hitting the ball with your head while playing soccer

If you or someone you know is hit in the head and loses consciousness (passes out)- call 911 for emergency help immediately.

Wake Up

Caffeine is one of the most commonly consumed ingredients in world. It is estimated that >90% of adults worldwide consume caffeine daily. Caffeine, in its pure form is a very bitter white powder, and can be found in leaves and beans of over 60 different types of plants.

Caffeine is a psychostimulant that affects chemicals in the brain called Neurotransmitters. When these chemicals are over stimulated, the affects can be felt in many body organs. Caffeine is completely absorbed by the body in about 30-45 minutes, and lasts about 3 hours in the normal body system. Factors that can affect the metabolism of Caffeine are impaired kidney function, age, other chronic illnesses and some medications. Caffeine is excreted through the kidneys, so it is not stored in the body.  Caffeine use can cause dependence.

Caffeine decreases blood flow to the brain. People who consume too much caffeine can have symptoms such as nervousness, tremor, restlessness, sweating, irritability, urinary frequency and stomach upset. Many people find it hard to sleep if consuming caffeine less than 3 hours before bedtime.

If too much caffeine is consumed, there may be an abnormal rise in heart rate and blood pressure. Caffeine can decrease the amount of blood that flows to the brain tissue, resulting in reduced intracranial pressure. There is one case report in the literature of death from a fatal dose of caffeine (more than 10 gms).

There is much controversy over how much Caffeine is too much. Although this is still under debate, the following guidelines (from www.medicinenet.com/caffeine/article.htm ) may be helpful:

• Low-mod intake= 130-300mg/day
• moderate intake=200-300mg/day
• High intake= >400mg/day
• Heavy consumption > 6000mg/day

Nurse Practitioner – in specialty care

A Nurse Practitioner (or NP) is a registered professional nurse with advanced education and training who evaluates and treats patients as an independent health care provider.  The first formal Nurse Practitioner program was developed at the University of Colorado in 1965, and the educational programs have continued to grow throughout the United States and abroad. There are currently over 140,000 licensed NP’s practicing in the US.

All NP’s have a basic degree (Bachelor’s degree in Nursing) and a Masters Degree, which prepares them with specialized knowledge in the evaluation and treatment of patients in a wide variety of clinical settings. Some NP’s have earned a Doctor of Nursing (ND) or Doctor of Nursing Practice (DNP) degree which requires additional education of approximately 4 years.

All Nurse Practitioners must have certification from a national board, such as the American Nurses Credentialing Center. The license to practice as a NP is granted from the individual’s State Board of Nursing in which the NP practices. Some Nurse Practitioners practice in primary care, while others specialize in areas such as pediatrics, gerontology, oncology, women’s health, orthopaedics, neurosurgery, neurology, cardiology, psychiatry, etc.

Nurse Practitioners practice in a variety of settings, including rural clinics, offices, acute care hospitals, emergency department, urgent care, nursing homes, rehab facilities, schools and academic facilities.

Some of the services that NP’s provide include:

• Evaluate and treat acute and chronic illnesses
• Ordering and interpreting diagnostic tests
• Evaluate and treat various specialty disorders
• Prescribe medications
• Prescribe treatments
• Health education and health counseling

Choose a Nurse Practitioner for your health care provider!

What is my responsibility as a patient?

Most individuals will need to seek medical evaluation and care at some point in life. This can be a very tense and frightening experience, especially if the individual is very ill. Interactions with health care providers can be intimidating. Whether you are healthy and just in for a yearly check-up, or you have an urgent medical problem, there are some ways that can help to reduce the stress and make the appointment more productive.  Your responsibility is to become an active participant in your health care. It is our pleasure to evaluate and care for you. This process helps us better meet your needs.

Here are some tips to help you interact with your provider and have a successful appointment:

• If you are a new patient to the practice, arrive to the office about 15-20 minutes before your scheduled appointment time to complete paperwork. Some offices will mail new patient forms ahead of time for you to complete at home- always ask if this is available.
• Always arrive on time to the appointment.  If you are running late, call as soon as possible to let the office know- you may need to reschedule.
• If you need to reschedule, please call the office as soon as you know. Do not just “no-show’ for your appointment- this wastes valuable time for another person who might need to be seen.
• Ask the receptionist if your health care provider is on schedule- Sometimes in a specialty practice (such as a surgical or specialty) the provider may be delayed in the operating room or hospital. If your provider is late, ask for a time-frame, and if you are unable to wait, reschedule your appointment.
• Bring your insurance card and a photo ID to the appointment. If you do not have these, the appointment may need to be rescheduled.
• Bring your co-pay. Most insurance policies require some amount of co-pay- if you are not sure, ask when you schedule the appointment.
• Bring a complete list of ALL of your current medications- including over the counter meds such as Tylenol, vitamins, supplements, etc. The provider will review your medications with you during the appointment.
• Bring a list of all of your medication allergies- it is vitally important for your provider to understand your previous reactions to any/all medications/latex or tape.
• If you have had scans (MRI, CT, x-rays) from a different facility, have that facility transfer the images to a CD and hand-carry them with you for your appointment. DO NOT rely on the imaging center to mail the images to the provider. In most cases, a radiology report is not sufficient- the provider must see the actual pictures on the CD.
• Be completely HONEST with your provider. If you smoke- tell him/her. If you drink alcohol or use drugs- be honest about the amount and type. Your provider cannot help you unless he/she understands all of your health issues.
• If you are receiving prescription medications- especially narcotics- from another provider, tell your provider at the time of your appointment. Some medications can interact and result in life-threatening problems- your provider needs to know exactly what/how much you are taking.
• Be aware that if you are given a prescription for a controlled substance (such as a narcotic), the prescription information will be entered into the Colorado Prescription Drug Monitoring Program (PDMP) database.
• ASK–Write down all of your questions ahead of time so you are sure all of your concerns are discussed.
• If you do not understand what your health care provider is telling you- speak up and ask for clarification.
• If you do not speak or understand English, bring someone with you who does. If you do not have someone to accompany you, ask for an interpreter when you schedule your appointment
• Bring a family member or close friend with you to the appointment to help remember what was discussed.
• HIPPA laws require that your health care provider have written permission from you to talk with ANYONE else about your health care. The providers are NOT allowed to speak to anyone (including a family member) without your written permission.
• Bring a pen and paper to write notes- especially if this is the first time you visit with a provider.
• If the provider orders a test, such as MRI, CT scan, colonoscopy, etc, make sure you ask the specific requirements of the test (such as food/water/medications prior to the test) and if you will need a driver
• Do not expect to leave with all of the answers- more often than not, the provider will need to order or review tests to make conclusions
• If you schedule a follow-up or return appointment, have the receptionist give you an appointment card with the date and time.
• If you call the provider’s office, make sure to leave a working phone number to receive a return call. If you are unavailable during specific times of the day, make sure the office is aware.

Sun Time

Just about everyone enjoys a bright sunny day, but did you know that the sun can cause damage that you can’t even see? Ultraviolet rays are energy that comes from the sun that can cause damage in many ways. Everyone’s skin ages at a different rate, but most people will begin to see age-related changes at around age 28. At that age, the epidermis (outermost layer of the skin) begins to thin and the normal renewal capacity of the dermis (next layer) becomes less elastic. The effects of the sun on aging skin can show up as brown spots, areas of redness, wrinkles, and thinner appearing skin. The sun is one of the main culprits for accelerating these age-related changes.

 

There are 2 types of ultraviolet rays that can cause damage:

1. UVA- these are the rays that are the longest, and most powerful, and can come through even on a cloudy day. UVA rays are about the same year-round, so there is always risk of over-exposure. Exposure to UVA rays reduces the amount of collagen (elastic portion) in the skin, and results in wrinkles, thinning of the skin layers, and dilation of the tiny surface blood vessels. The UVA rays cause the most damage, as they can penetrate auto glass, some clothing and even office/home windows. If you commute a long distance in your car, you might notice brown spots on your hands- that may be due to UVA exposure of your hands on the steering wheel. Tanning beds are especially dangerous, as they emit UVA rays and can increase the risk of skin cancers.
2. UVB- these are the rays that most commonly cause sunburn, age spots and freckles, as they penetrate the outer layer of the skin more easily.  Because UVB rays typically penetrate the outer skin layer, they are also more dangerous and are more often associated with the development of skin cancers. UVB rays are typically stronger in the summer, in higher elevations and in locations closest to the equator, however, they do not penetrate glass as easily as UVA rays.  Both UVA and UVB rays can accelerate the development of cataracts and eye damage.

High risk individuals

• Those who work out in the sun (construction/roofers/street workers/landscapers)
• Those who have fair or light colored skin
• Anyone with a family history of skin cancer
• Anyone with a family history of cataracts
• Anyone who lives in high elevations or near the equator
• Persons who take certain medications (always review the medication insert for precautions)
• Elderly individuals, infants and small children
• Persons with illnesses that suppress the immune system

 

Syringomyelia

Normally, cerebrospinal fluid (CSF) flows from the ventricles (fluid pockets) of the brain down the spinal canal and back to the brain. Spinal fluid pulsates in this manner with every beat of the heart- over 100,000 times per day. When there is a blockage in the flow of spinal fluid, an abnormal CSF pathway forms, resulting in a syrinx or syringomyelia. Syringomyelia (or syrinx) is an abnormal fluid cavity that forms inside the spinal cord.

The most common cause of Syringomyelia is the Chiari I malformation which causes obstruction of spinal fluid at the base of the skull.  Other causes can be trauma, tumor, or arachnoiditis. Syringomyelia  can cause pressure on the nerves that control pain, sensation and strength.

Symptoms of syringomyelia include (but are not limited to) pain in the neck or back, pain in the arms/hands, numbness, tingling, and sometimes weakness of the arms/hands/lower extremities.

The test of choice for diagnosis of syringomyelia is an MRI of the cervical (neck) and/or thoracic (middle back) spine.

Treatments for Syringomyelia include medications for nerve pain, or in some cases surgery. If the cause of syringomyelia is the Chiari malformation, the treatment is often decompression surgery to make more space at the base of the skull.

Neuro-monitoring

Neuro-monitoring, or Intra-operative monitoring is a procedure that involves placing small electrodes (wires) on various places (such as hands/arms/feet/scalp, etc). The electrodes are generally placed while the patient is asleep (under general anesthesia), but the person may notice a small tender area where the needle electrode was. There may also be an electrode placed in the ear canal, much like the microphones used with a music player. Impulses are sent through the electrodes to stimulate various nerves, and the response is monitored on the computer screen.

The technician is in the operating room during the surgical procedure and monitors the nerve activity via computer. The nerve activity is sent by computer to a specialist (usually a Neurologist), who will monitor your sensory and motor function continuously during the surgical procedure.  If any changes occur during the procedure, the specialist notifies the technician, who notifies the surgeon immediately.

Intraoperative monitoring can help ensure that if there is any abnormal activity in the system being monitored, the surgeon will be notified immediately. Though not needed in all neurological surgeries, this additional safeguard may help reduce the risk of nerve injury in some cases.

Ulnar Tunnel Syndrome

A common cause of arm pain, tingling, numbness and hand weakness is Ulnar Tunnel Syndrome. There is a nerve that runs through the small groove in the elbow, called the Ulnar Nerve. When that groove narrows, there can be pressure on the nerve, resulting in pain that radiates from the inside of the elbow to the little finger or palm of the hand. Ulnar Tunnel Syndrome occurs more often in women than men, and is typically more common in the 30-40 year old.

Common causes of Ulnar Tunnel Syndrome include obesity, activities that cause pressure in the area, resting the elbow on the desk or arm rest, injury to the elbow or arthritis. Some women note Ulnar nerve pain or numbness during pregnancy, which often resolves after delivery.

The test of choice for diagnosis of Ulnar Tunnel Syndrome is a nerve conduction test- called EMG

There are several treatments for Ulnar Tunnel Syndrome. The providers at the Neurosurgery Center of Colorado can evaluate and treat this disorder.

Trigeminal Neuralgia

Some people experience severe, intermittent pain in the face that could be related to the facial nerve. There are 12 nerves (called cranial nerves) deep within the brain. The fifth cranial is responsible for sending messages to the face, including pain, temperature, and sensation. In some people, there is pressure or sensitivity of the 5^th cranial nerve that results in severe, intermittent pain in the cheeks/forehead or behind the eye- this is commonly referred to as trigeminal neuralgia.

Trigeminal neuralgia occurs more often in women than men, and is more commonly diagnosed after the fourth or fifth decade of live (though it can occur in younger persons).

The pain is often described as sharp/sudden/severe/stabbing or electric shock. The pain can occur at any time, but is often triggered by cold wind/brushing teeth/chewing/ or talking. Some people report pain when swallowing.

Treatment for trigeminal neuralgia can include medications, injections or surgery.

The specialists at the Neurosurgery Center of Colorado can help to diagnose and treat Trigeminal Neuralgia.