Dr. Keith Roach: Time can heal many wounds, but not this pain in the neck

January 23, 2019

DEAR DR. ROACH: I am a 77-year-old man in reasonably good health. I am physically active and at normal weight. About a month and a half ago, I suddenly experienced very sharp neck pain upon waking, a severe pain that prevented me from turning my neck. Some days later, my doctor indicated that time will heal it. Blood tests were normal.

This neck pain still bothers me, although the severity has appreciably declined. A chiropractor did not help. Is this something I just should live with and assume that it will eventually go away, or could there be a more insidious cause for it? — L.H.

ANSWER: Although there are many causes for sudden onset of neck pain, the description you give is most consistent with torticollis, also called “wryneck” or just “twisted neck,” which is what “torticollis” means in Latin.

Most cases of torticollis in adults are spontaneous, often relating to minor trauma, and your description of it coming on upon or immediately after waking is common. It is often due to damage to the muscle, which can spasm, causing the head to be turned to one side and sometimes downward. Torticollis may resolve in a few days, but several weeks is not uncommon.

However, six weeks is getting on to being a long time to continue to have symptoms. Blood testing is not commonly used to make a diagnosis, as most of the concerning possibilities are seen primarily by imaging studies, whether plane (i.e., taken in a single plane) X-rays or a CT or MRI scan. The list of more serious conditions that can present themselves with neck pain is long, but especially includes a herniated disc and osteoarthritis. At age 77, a more thorough evaluation is appropriate after six weeks.

I would say it’s time for a re-evaluation. If your doctor needs help, a neurologist is likely to have a lot of expertise with this condition.

DEAR DR. ROACH: I noticed the sudden onset of rainbow halo around bright lights in both eyes. I have normal vision and no redness or pain in the eyes. I checked my blood pressure at home and it was 145/95, which is very high for me. — N.R.

ANSWER: The rainbow halo effect is an uncommon symptom of glaucoma, especially acute angle-closure glaucoma.

Glaucoma is a disease of the retina. The major risk factor is elevated pressure inside the eye. Pressures inside the eye are not measured by a blood pressure. They need to be measured by an eye professional, an optometrist or ophthalmologist. (People with glaucoma are more likely to have high blood pressure, though). It is possible to get glaucoma with normal eye pressures, however, which is why a retinal exam also is necessary.

Fluid produced in the aqueous humor (eyeball) needs to drain, and it normally does so through the trabecular meshwork at the edge of the eye. However, some people are born with a narrow angle. This narrow angle is predisposed to being blocked, which prevents the fluid from escaping and causes the pressure in the eye to raise. The pressure is transmitted to the retina, causing visual changes, such as decreased vision and the halo effect you noticed. With very high pressure, there can be severe eye pain and even nausea and vomiting.

If you do have acute angle-closure glaucoma, the eye can be treated medically or with a laser operation to create a new hole for the fluid in the eye to drain through. Open angle glaucoma is usually treated with eyedrops.

There are other causes for halos, such as migraine aura, but I think your symptoms deserve an urgent evaluation by an eye care specialist.

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