Ask a doctor on the topic of Neurology

Headache, muscle stiffness at the back of the head, elevated CK value.

March 26, 2013 | 20,00 EUR | answered by Christian Welsch

To my story:

In June/July of last year, I had to take time off work due to exhaustion (burnout syndrome). During this time, I underwent medical examinations (stomach + colonoscopy, abdominal CT, thyroid nuclear scan + endocrinological examination) as somatic symptoms also appeared. To relax, I engaged in sports and also received various Thai massages at the end of August.

Shortly thereafter, starting in September, I began to experience slowly developing headaches (initially fatigue-like headaches). These headaches have been located on the side of the back of my head, mostly on the right side - but mostly dull, occasionally sharp. These pains radiate from the back of the head to the temples and up to the eyebrows, occasionally even to the half of the face with eye pressure. In the face, it's not really a pain, but more of a tingling sensation. (Numbness) When lying down, the pain or tingling completely shifts to the temples. It feels like there's a fly on the head the whole time...

Additionally, muscle twitches started all over my body. Certain muscle groups on the right and left side of the back of my head also began to harden. These hard muscle areas (when they are really hard, sharp pains occur) behind the ears are palpable. (I have amateurishly read something about musculus semispinalis capitis and occipitalis major) During sleep at night, everything relaxes again and only intensifies again with the day...

I was subsequently examined multiple times (2x head CT, 3x head MRI, angiography, duplex sonography, EEG) - all without findings. After that, I underwent an atlas treatment, hoping it would help. However, there was no improvement. It was only in January that a clue was discovered. Based on a blood test (CK in January at 700, February = 650, in March at 352; CK MB between 23 and 29; CK MB percentage of CK = 7.7%; CK breakdown = 95% CM -MM; 5% CM-MB, LDH value = 246), it was discovered that there could be a muscular problem. An EMG was performed by a neurologist - without findings. I received a referral to a physiotherapist there. The physiotherapist suggested that the musculus + Nervus occipitalis major could be related. And the musculus occipitalis major seems to be the muscle that is always hardened. Three weeks ago, I underwent physiotherapeutic treatment. Massages and various manual therapies (osteopathy, trigger point therapy, electrical stimulation, and heat therapies) were performed as my body, especially shoulders, neck, and head overall, seemed very tense. After the sessions, I felt somewhat better but there was no significant improvement.

Last week, I visited an orthopedist due to

Christian Welsch

Dear inquirer,

Most likely, your complaints of tension headaches and the described CK increases are a result of the massages and intense exercise. I consider rhabdomyolysis and a relevant muscular dystrophy disease to be unlikely, as in those cases the CK levels would not decrease and would be elevated. There are some rare genetic diseases such as malignant hyperthermia, which are associated with elevated CK levels without causing any impairments in normal life. Here, a genetic predisposition can also cause elevated CK levels.

Other possibilities could be medications (especially lipid-lowering drugs) or endocrine disorders, especially hypothyroidism. If only burnout was considered after these things, in my opinion it would be sensible to re-measure these laboratory values.

If tension headaches are identified, relaxation techniques are the most effective (autogenic training, progressive muscle relaxation, etc.). Experience shows that there are clear symptoms and one may wish for immediate improvement with a realignment, but only a longer-term therapy concept is truly helpful. Tension headaches have a high psychosomatic component and often occur in situations of overload.

I hope I could reassure you that a serious illness was not overlooked. You should have the diagnostic tests done to rule out some rare diseases.

Do you have any questions? Wishing you a speedy recovery,

C. Welsch