Heard of Dural adhesions causing post crani headaches?

[Captain Deb]

Just a little confused here.  How can the manipulation of the dura, which is inside the skull, affect the occipital nerve, which is outside the skull.  Also the nerve blocks work on me, leading to the theory that my occiptial nerve was somehow affected during surgery. It is nowhere near the surgical field as I had middle fossa. I need one of those 3-D models of the skull with all the nerves and muscle to look at!  I really want to understand why I have this pain all the time.  It won't lessen it, but understanding it WOULD ease my mind if not my pain!

Capt Deb

[Soundy]

that is me since surgery...confused...

and I have different headaches that come on differently ,feel different and are relieved differently...
something I could never make my now song writing surgeon understand...

[bridgie]

Hi Capt!   and Buttinsky!    

I'm really appreciating your conversation and questions because I have the same questions really. I've been doing some research about dural adhesions, but frankly information is hard to come by. There is a condition called Arachnoiditis, which can occur in the cranium but its more prevalent in the spine from failed back surgery, myelograms, and epidural injections. It can be progressive. From what I can tell, and I maybe off, but this is called adhesive arachnoiditis.

Last week i finally had my brain MRI but didn't find it too helpful really. The radiologist was checking to see if I have a recurrent epidural abscess or some other type of brain abscess continuing on. (Scary thought) He was not trying to help me beyond simply accessing if I was in any sort of acute trouble. He compared my MRI from 2004 when I did have a epidural abscess to this imaging I had last week. From the imaging the epidural space does not enhance as much as before. Still its not normal, it still enhances between the temporal bone and the dura.

Anyway, I've forwarded my imaging to my Neurosurgeon. He will review the images likely along with a radiologist at his institution and then respond. I'm hoping he'll be more helpful. From what little I know about dural adhesions, its possible to perform a procedure called a cranioplasty.

[bridgie]

Capt Deb-
I think we're talking about two separate issues here. My son's oncologist was addressing me in the quote I posted. It's probably not going to apply  specifically to your situation. You have to look at it in general terms, which is why I quoted it. I didn't mean for people to take it literally but I can see how that could happen now.  Didn't mean to create confusion. Often we are comparing apples and oranges and its easy to forget.  I was specifically asking him about the dura, not the occipital nerve. You could however insert "occipital nerve" and remove dura and then for you it may or may not make sense. What I 'm saying is they probably didn't need to play around with your dura to get the neuralgia of your occipital nerve going. But I don't know. And I don't know why this happened to you since your surgery was temporal fossa like mine. You see for me there is a likelihood I could have dural pain from adhesions because I had an infection for months sitting in the dural space that surrounds the brain where all the surgeries happened. Also there was  alot of trauma to my head both superficial and within. I had 4 craniotomies with debridement and one mastoidectomy with debridement. Anyway, I can see how this quote set you off as you don't know why your occipital nerve is creating pain and it would appear from this quote the dura would have caused it somehow but for you it would have to be indirectly. I honestly don't know how that could happen. You'd have to ask your neurologist. I'm like you I want to know. I understand my anatomy is altered since all this happened to me, so I try hard to understand how I'm operating. It does help to know what you need to get worried about and what weird symptoms I need to simply adjust to.

[Janet]

I agree. 2 seperate issues.
Occipital nerves are outside the skull.
Dura is a membrane that covers the brain inside the skull. (The arachnoid and the pia are the 2 other membranes.) I have heard that the dura can get stuck to muscle through the skull incision. (My physical therapist gave me a print out on this, but I don't have the source.)

You might consider that the headclamps used in surgery could have damaged the occipital nerve. I think this is why my occipital nerve had a vessel piercing through it on the opposite side.   

The occipital nerve route goes over the head on the side like a ram's horn. Deb, is your incision close to this?

Janet

[Omaschwannoma]

   Really intrigued with this conversation ladies, thanks. 

Confused once again--sheesh, I don't think there are nerves in the dura, pia or arachnoid linings so where does the pain come from?  I know I had multiple arachnoid lesions removed and after reading article on them found out they can cause headaches and these little so and so spiders can return to same side or other side too!  Whoopee for me!  Seems they are formed by trauma so their return, as my new neurologists says I have a biggee in the surgical sight, is likely.  Wonderful! 

As for the "pain" thing, compromised nerves cause pain and the cranial nerves are on the outside of the bone/skull and intertwined with the muscles that are under the skin.  But, how on earth does the dura make it's way through the bone flap and attach itself to the muscles?  Wow there had to have been quite the hole for it to squeeze through no? 

I don't know ladies I'm just thinking here and bouncing my brain off on to you.  I'm not the expert just one of you who try many things to prevent the pain and in so doing must figure out what causes the pain.  As for what Janet says I know mine to be occipital neuralgia, but don't know why it's firing.  Guess I don't need to know as I'm able to handle it with what's in the kitchen.  If the day comes where stuff here doesn't work then we will have take a closer look into opening me up and releasing the nerve. 

[Janet]

Interesting discussion!

I have a hard time picturing the dura coming through the skull and attaching to the muscle too. Maybe this is a theory? Maybe closure techniques prevent this now but earlier techniques made it possible? I don't know.

The scalp nerves, I know to be more than a theory. They cause headaches behind the eye, head, neck and shoulder.

[bridgie]

Arushi-
The dura is not likely going to travel outside my skull or your skull and attach to a nerve and cause a pain syndrome.  The dura itself has pain fibers. Therefore, if the dura is attached to adhesions we may get pain. See note below from article I posted earlier within this thread. My surgeon removed my bone flap and the titanium plate when I became infected. Now all I've got is skin, muscle and scar tissue between my scalp and brain in the temporal area of my head. Pinned on top of this are nerves that likely grew back funny in the course of healing. Does your doctor say you have arachnoiditis?

"The pathogenesis of chronic headache after craniotomy is unclear but may involve meningeal inflammation, nerve entrapment, adhesion of muscle to dura or other mechanisms. Modifications in the operative procedure, including the use of osteoplastic cranioplasty, may lead to a reduction in the incidence of post-craniotomy headache by preventing adhesion of muscle and fascia to the underlying dura." 

[Omaschwannoma]

Bridgie,

Haven't been back to see my "new" neurologist since my first and last visit to her.  She wanted me to go for another MRI, I thought this too soon since the previous one and told her office assistant to have doc call me if she felt it urgent I repeat MRI so soon after.  I have not received phone call either way, so have opted to wait until December (another year) so don't know if the dx is arachnoiditis or what.  At the time of my visit with her I saw her open up my MRI on her puter and she said "oh yes, there is arachnoid on side where operated and it's big."  The fact I haven't gotten phone call from doc makes me wonder about her professionalism and has got me thinking if I'm with another "winner" specialist in my home town.  Either way I'm waiting until December's MRI with Antonelli and will pass on copy to new neurologist to compare with one year ago. 

Thanks for the "update" info on dura seems if you don't have a bone flap and dura sits next to muscle is where the pain comes from.  Am I understanding now?  Thanks again.  Oh yes, then those of us that have the bone flap or flap made out of another material the dura isn't involved but rather it's a muscle, occipital or trigeminal neuralgia--yes?

[staypoz]

Arushi, one of the headache presenters at the ANA conference in Philadelphia last year talked about a syndrome, and explained that those of us who suffer from head pain may experience different kinds of pain from different sources, sometimes all at the same time.  I have been doing some reading up on post head-trauma pain, and what we experience sounds very similar. 

staypoz

[bridgie]

Good to see you posting "staypoz." I appreciate that you go to some wonderful sources to understand this type of head pain. Arushi, its true what Staypoz is saying. I've mentioned I also likely experience "scar neuroma" pain which is probably coming from the auricular nerve. I could even have an entrapped nerve to boot! Our anatomy has been altered. I don't think you could say that because you Do have a bone flap doesn't rule out a issue with the dura. I'm simply saying that in my particular situation its more likely--at least in my opinion. 

Staypoz, I called Dr Ducic office and left a message and emailed him about my situation. His staff called and said he was out of the country. This was about 6 weeks ago. Now I'm thinking he's not interested in helping me figure this out. Still, I'm hpeful my NS will help me in some way at least find answers.

[Captain Deb]

Arushi, one of the headache presenters at the ANA conference in Philadelphia last year talked about a syndrome, and explained that those of us who suffer from head pain may experience different kinds of pain from different sources, sometimes all at the same time.  I have been doing some reading up on post head-trauma pain, and what we experience sounds very similar. 

staypoz

Hey staypoz! I missed that workshop. I had a screaming headache on that Sunday.  I think I'll order the CD transcript.

Capt Deb

[staypoz]

Bridgie, I'd call his office again.  I got frustrated with his staff and what I experienced as real disorganization. 

Capt Deb, I remember that you were nursing a brainwreck and missed the presentation.  Of all the docs I've talked to and heard talk about our pain experience, his explanation made the most sense.  I would definitely order the CD. 

staypoz

[bridgie]

Thanks for the advice regarding Dr D. I keep running into head trama as a parallel as well.  Just from my own experience and observations, minus the cognitive impairments, I feel like I go thru the same type of experiences the soldiers coming home from Iraq go thru with tramatic brain injury. Not just the symptoms but the experience of finding care--- being such a struggle. I'd recently read an article about a guy w/chronic head pain from brain injury in Iraq. Even after the issue about the poor care at Walter Reed hit the media, this guy got lost in the system and one day they found him dead from overdose on similar treatment I'm getting. Recently I felt "lost" while being treated and can see how this could easily occur. This guy had not shown up for a regular check in and the military was very casual about it. He was very vulnerable as he'd just been placed on the meds and was supposed to be increasing his dosage in stages. When he didn't show up they should have been alarmed and gone to his housing. His wife had called the base when he didn't check in with her and they still were not alarmed or compelled to check on him. In the article it sounded like he could have been resusitated if he'd been found earlier. He was finally found at his computer so its likely an accident on his part. I too have this sense of getting lost and dismissed sometimes. This feeling has improved since I've found my current PCP however. It didn't help that my neurosurgeon became disabled as soon as I visited him however!     

[bridgie]

Staypoz, what was the name of the work shop or CD?