An interesting thought occurred to me the other day as I was finishing up a particular headache surgical procedure. Something that has come up over the years is that patients tell me that their headaches are worse when they are sick with the cold, flu or some other such issue. I have been pondering why this symptom change might be taking place for a long time. As with many of my blog posts, there are several possible causes for this phenomenon in my opinion and so I have decided to delineate these possibilities below.
One reason is that people who are sick are often more stressed either because of or as a cause of their illness. It is considered reasonable that stress, of whatever type, can weaken the immune system and thus mitigate the body’s ability to fight various pathogens. These pathogens can cause all manner of irritation and inflammation in various tissues such as muscles hence the muscle discomfort with the flu, for example. If one type of tissue is irritated, the surrounding tissues might suffer the same fate. In addition, when we are stressed, our blood pressure often rises. Since many of the nerves which we address during our operations are compressed by surrounding blood vessels, it follows that when these vessels beat harder (i.e. during a period of relative hypertension) the nerves which are already irritated may become even more so. But another, third thing happens during an infectious scenario, one to which most people can also relate. Have you ever felt your neck when you feel you have a sore throat or the sniffles? If so, you have probably noticed that the lymph nodes in the area are swollen and often tender. That is because these lymph nodes are the factories for pathogen-fighting cells and they ramp up production (hence swell) when you are sick. As I was dissecting this person’s greater occipital and lesser occipital nerves, I noticed several enlarged lymph nodes located within the already crowded spaces through which these nerves passed. Bear in mind that we don’t operate on people who are sick so these nodes were particularly enlarged given that fact alone. The nodes were further compressing these poor nerves which were already pressured by the surrounding blood vessels and scarred connective tissue. I could only imagine what occurs to these nerves if that person were to contract the flu. Those nodes would surely swell, sometimes quite dramatically and place even further pressure in the area causing even further pain. With pain comes higher blood pressure, hence more compression and so begins the upward spiral. One recurring question from patients is, “What is compressing my nerves?” The answer used to be possibly spastic muscle, tight/scarred connective tissue, enlarged or aberrant blood vessels. It now also includes abnormally large and/or poorly localized lymph nodes. Happily these nodes can be removed carefully and selectively to further relieve pressure during a decompression procedure and many of the patients in whom this lymph node removal was necessary have gone on to do quite well. Finally, none of the nodes which I have biopsied to date have revealed any evidence for malignancy or other pathology, further happily capping a saga that has resulted in many positive outcomes.