Good pic on how neck, scalp, occipital nerves, trigeminal nerves and face all impact on migraines and lady with nummular headache in posterior scalp ended up activating this convergence.
Arq. Neuro-Psiquiatr. vol.65 no.3a São Paulo Sept. 2007
http://dx.doi.org/10.1590/S0004-282X2007000400010
Massaging over the greater occipital nerve reduces the intensity of migraine attacks: evidence for inhibitory trigemino-cervical convergence mechanisms
Elcio Juliato PiovesanI, II; Fabrizio Di StaniIII; Pedro André KowacsI; Rogério Andrade MulinariII; Victor Hugo RadunzII; Marco UtiumiII; Eder B MurankaII; Mario Luiz GiublinI; Lineu César WerneckI, II
http://www.scielo.br/pdf/anp/v65n3a/10.pdf
- Have a lady with persistent severe headaches
- Had some normal pressure hydrocephalus when younger that had resolved. Diamox poorly tolerated so cannot tell if would help.
- Had some TMJ issues right which eventually got splint and therapy for – injected temporalis and lateral pteygoids at one point.
- Occipital nerves not tender but patch of nummular headache over area where parietal and occipital bones meet – where bones seem to surprisingly overlap. Botox to this area and elsewhere does not help.
- Neck fine
- 3 days of metoclopramide/dihydroergotamine/ some dexamethasone infusions failed to work on headaches because nummular patch persisted. – convergence at work
- Has tried all the usual meds, lidocaine infusions and even ketamine repeatedly
- Is being referred for occipital stimulator
Any suggestions? – Wondered if acupotomy (acupuncture micro-knifing) would help though semi-neurolytic 5% lidocaine injections just seemed to make things worse.