@Rlr286 - first off, any doctor that tells you that you don’t have ES because a certain symptom or symptoms isn’t/aren’t present is WRONG!! Not everyone gets a sore throat, not everyone gets pain that’s “sharp”. Dull, achy pain is vastly more common w/ ES. Good job “sticking to your guns” not treating your migraines w/ beta blockers. It really sounds like they could be related to ES & until your styloids are shortened, they will continue to be a problem. If your PCP really wants to help you, ask for an Rx for Plavix or Brillinta, which are blood thinners. If you have vascular ES, taking a blood thinner should reduce the intensity of your migraines w/in a couple of weeks.
I think the neurologist is wrong to tell you to stop the muscle relaxant. If it’s helping you that much, continue to use it. I think the likelihood of you becoming dependent on it over the short duration you’ll be taking it (most likely months vs years) is low & it’s worth the risk because of the relief it’s currently giving you.
Dr. Hepworth is currently taking new patients so you can call his office & schedule an appt. (probably in April or May at this point) w/o a referral unless your insurance requires a referral. •Dr. Edward Hepworth, IMMUNOe, 3150 E 3rd Ave, Denver, CO 80206 (303) 224-4711 https://www.centura.org/provider-search/edward-hepworth-md
Regarding the scans, a brain MRI w/o contrast isn’t likely to be very helpful, but if your insurance will pay for it, then go ahead & have it done. The CT of your facial bones is also not going to be helpful because your pain is being caused by nerves which are irritated by your styloids (mostly likely trigeminal & facial nerves) & CT scans w/o contrast won’t show soft tissues & even w/ contrast they don’t show nerves. You would do better to get a CT scan of your neck from skull base to hyoid bone w/ the purpose of re-evaluating your styloids since it’s been 3 years since they were noted. There’s a good chance they could have grown more in that time, & they are most likely the key cause of your symptoms.
If you want to check for IJV compression (as a cause of your migraines) then request a dynamic CTA of your neck especially up near the skull base (that’s a CT scan w/ contrast that looks specifically at your veins/arteries). Dynamic means they’ll do the scan w/ your head in various positions since vascular compression doesn’t always show up when the head is in neutral (i.e. looking at the ceiling). I hope your PCP is willing to change the CT order so you can get the CT that will give you the most helpful information. You can also refer your PCP to this site. Though he can’t join the forum, he can read all the posts here. It might be very helpful for him. You can also print off or email the links for these two posts which @Jules wrote & give them to him: