Last year, my wife and I put our 1-year-old daughter into daycare for the first time. She developed an upper respiratory infection and passed it along to me. Despite Tessalon Perles, albuterol, and a variety of over-the-counter remedies, I had a hacking, bronchospasm-type cough for a few days. At one point, I was at home watching a sitcom and started laughing and coughing at the same time, which resulted in a twinge in the left side of my neck. I didn’t have any pain but noticed that I would reflexively hold my neck whenever I coughed.
Explore This IssueACEP Now: Vol 36 – No 02 – February 2017
Early the next week, I was in a meeting and developed a left occipital headache. Nothing major but enough to make me take some Tylenol when I got home. The next morning, the headache was back and now was associated with a sunburn-like sensation to my left frontal and parietal scalp. I would also develop a headache in that region whenever I pushed on my neck at the base of my scalp. The pain would go away when I stopped. That night at dinner, I noticed that the sniffing position was now quite uncomfortable for me. Tylenol, Motrin, and Robaxin didn’t help, but lying on my side (either side) and either ice or heat did help. I had an early shift the next morning, so figuring I pulled something while coughing, I slapped on some ice and went to bed.
The next day at work, the symptoms persisted. I spoke to one of my colleagues, who commented that his brother had something very similar and it turned out to be shingles. That sounded reasonable, so I started Valtrex and prednisone and went about my business. We were leaving for Hawaii the next morning for a friend’s wedding, so I popped over to the barber after work. The pain from the comb through my hair was quite impressive as was the pain from wearing a baseball cap.
Over night, the headache worsened and settled into a persistent pre-orbital pain along with my neck pain. It was still better when I was on my side. The shingles rash that I was expecting had yet to materialize. I was having no other symptoms. By the afternoon, I was becoming a bit more concerned and called my emergency department and spoke with a doctor. If I came in, based on what I’m saying, would she do any imaging? She didn’t think so, and in her shoes, I wouldn’t either. I still figured I pulled something while coughing, though I couldn’t really link that to the neuralgia symptoms. That evening, I was texting with another emergency physician, and she matter-of-factly diagnosed me with a vertebral artery dissection (VAD). Thanks, I said, but I’ll stick with rash-less shingles and muscle strain with secondary neuralgia.