Many times pain in side of the neck and head is due to injured joints in the upper neck known as facets. However, sometimes it can also be due to a little known neck nerve that supplies these areas. Given that the nerve goes to some very specific places, if your distribution of pain looks like where the nerve goes, your problems may be due to a problem with this nerve.
The superficial cervical plexus originates from the upper neck spinal nerves. Perhaps most interesting thing to know for patients with pain in side of the neck and head is that the nerve exits the body behind the sternocleidomastoid muscle (SCM). This is the strap muscle on each side of the neck that can become very tight after neck injury. Increased tension in that muscle can therefore irritate these nerves. So let’s look at where the nerves go:
- Back of the head-the plexus gives rise to the lesser occipital nerve
- Side of the neck-the transverse cervical nerve also comes from this spot
- Near the collar bone-the supraclavicular nerves also come from here
- Ear/front of ear near the back of the temple
When this nerve plexus is irritated, you would then have pain in the back of the head on that side, pain in the side to front of the neck, and pain that feels like it’s in the collar bone area. If you have pain in these areas, how would you know whether this nerve is causing the problem? A precise injection of a small amount of numbing medicine (nerve block) at the back part of the SCM muscle under ultrasound guidance can help make the diagnosis by knocking out the pain in these areas for a few hours.
If you have this kind of nerve irritation, what can be done about it? First, since the nerve plexus gets irritated by an SCM muscle that’s way too tight, finding ways to get rid of that tension is critical. The SCM can get this way when the small stabilizing msucles in the neck go off line, when there’s an injury to the C1-C2 facet joint, or just due to injury to the nerves that supply the muscle. Some patients will also need to get scar tissue around the nerve plexus treated with what we call hydrodissection. This is when the growth factors isolated from your blood platelets are carefully injected under precise ultrasound guidance to break up the scarring as well as supply the nerve with healing factors.
The upshot? This nerve issue is often overlooked by even experienced pain management physicians and neurologists, so it’s frankly usually diagnosed by patients who do their homework on the Internet. If you think you have this problem, get seen by a doctor who can perform a precise guided ultrasound nerve block to confirm the diagnosis!