By Alexander Germanis
In the 19th century, when the railroads were being laid and telegraph lines were being strung, there were malcontents who sought to do damage to both. For this purpose, men were hired to guard both lines and shoot at any trouble that happened their way. The term “troubleshooting” was later adopted by the repairmen that worked on the faulty telegraph lines, only then it meant to seek out the issue and figure out how to fix it.
Fast forwarding to the 21st century, troubleshooting can now be applied to deducing the source of any problem and subsequently quashing it.
Dr. Ramsin Benyamin, founder of Millennium Pain Center in Bloomington, believes troubleshooting is alive and well in the practice of managing and preventing pain; it falls within the scope of making a proper diagnosis, which we’ve been discussing in our last several articles.
Even something as common as migraine headaches can be troubleshot. “How do we diagnose them? What do we need to do?” Dr. Benyamin asks. “First of all, we listen to the patient.”
The doctor illustrates the plethora of inquiries that contribute to an investigation of the pain. The first question is on the distribution pattern of pain, then comes the question on characteristics of it. Is it a pounding? Is it every day? How many days of the month does it occur? How long does it last? Is there an aura associated with it? Is it only on one side or is it on both? Was there a trauma years ago that initiated it? “History is such an important thing for these headaches,” he stresses.
The examination comes second. Physicians should look for physical triggers — anything that could be acting as the cause. As there are different classifications for headaches — occipital headaches, cervicogenic headaches, migraines, atypical migraines, and cluster — knowing from where the pain originates not only helps to classify the headache but also how to treat it.
Dr. Benyamin cites an example: “A lot of headaches originate from nerves in the neck. So, the first thing you want to identify is whether the source of the pain is in the head or the neck. Next, is there any structural issue? Is there any nerve impingement that can cause a headache? Some people get occipital headaches, which could either be originating from the upper part of the cervical spine or from an occipital nerve being impinged by the muscles around the base of the skull.”
That is why, after the patient history and the initial examination, Dr. Benyamin says the third step is to look at the imaging. “You want to make sure there are, for example, no degenerative changes in the cervical spine — especially in the upper-cervical spine. Such degeneration potentially can contribute to headaches; it can either do it by itself or act like a trigger for migraines.”
Once each of these three steps toward diagnosis are performed comes, what the doctor calls, the interventional diagnostic workup. A perfect example of troubleshooting, the physician will —based on the patient history, examination and imaging — begin to actively seek out the source of the pain, essentially working by process of elimination.
“If you are suspecting a structure — let’s says a little joint in the cervical spine is arthritic — you might think that could be contributing to the headache,” Dr. Benyamin says. “So, we numb that joint temporarily. By using advanced imaging, like live X-ray or CT scan, we can pinpoint it, place a needle, numb it up, and see if the patient gets temporary relief or not.”
As simple as this might sound, a physician also cannot rule out other reasons and causes for a patient’s pain when performing the diagnostic workup. Like with any troubleshooting scenario, there may be more than one culprit causing the problem.
To learn more about the complexities of pinpointing the source of, treating, and preventing migraines, read “Troubleshooting Migraines, Part 2” in next month’s issue of Healthy Cells.
For more information or to schedule an appointment, contact Millennium Pain Center at www.millenniumpaincenter.com or call 309-662-4321. The office is located at 1015 S. Mercer Ave. in Bloomington. The practice provides the most advanced and comprehensive pain management for a wide variety of conditions, including a new treatment for knee osteoarthritis. Drs. Benyamin and Vallejo have been selected among 70 of the Best Pain Physicians in America.