Mr B is a 55-year-old man who presents with a six month history of episodes of throbbing pain in the left side of his neck and the back of his head. There was no obvious precipitating event before the first episode. He experiences around 10 episodes per day with each episode lasting approximately 15 minutes. They can be precipitated by touching or moving his neck. He feels they are getting more frequent with time.
Paracetamol and NSAIDs have no effect on the pain.
His GP arranged an MRI of his cervical spine which was unremarkable.
He is generally fit and well, other than hypertension for which he takes amlodipine.
He is understandably distressed by the pain which has disrupted the plans he had made for enjoying his retirement.
What further questions would you like to ask?
What investigations would you perform?
What treatments would you offer?
