Stiff neck with ear pain: Ear Ache, Pain Or Discomfort And Stiff Neck

27.08.202327.06.2023 by alexxlab

Sternocleidomastoid pain: Diagnosis, causes, and treatment

Pain behind the ear and down the neck and shoulder may result from tension or injury in the sternocleidomastoid muscle. Other possible symptoms include headaches, dizziness, and tingling.

The sternocleidomastoid is a large muscle near the front of the neck. It extends from just under the ear and jaw down to the collarbone.

A person with sternocleidomastoid pain might notice trigger points along the side or front of the neck. Frequently, however, pain from this muscle radiates elsewhere, causing ear, eye, or sinus pain.

Keep reading to learn more about the causes, diagnosis, and treatment of sternocleidomastoid pain.

Share on PinterestPoor posture is a possible cause of sternocleidomastoid pain.

The sternocleidomastoid is a superficial muscle, which means that it is just under the skin, not deep in the neck. It attaches to the mastoid process, which is a portion of the bone just behind the jaw and under the ear. The muscle extends down the length of the neck and ends where the collarbone and breastbone connect.

The sternocleidomastoid helps with the movement and balance of the head. The muscle is visible when a person moves their head from side to side. It also plays a role in the rotation, inclination, and extension of the head and neck.

Due to its important role in supporting the head, any issues that affect posture and head position can irritate this muscle. Sudden head movements, blows to the head, and other types of trauma can also cause pain and injuries.

Most people with sternocleidomastoid pain develop the pain slowly due to a combination of lifestyle issues. When this muscle has to hold the head in an awkward position, it can gradually become irritated and sore.

Some causes of sternocleidomastoid pain include:

carrying a heavy object, such as a child or backpack, in an awkward position
poor posture, for example, when a person spends long days hunched over a computer or straining their neck to reach things in the garden
an awkward work station layout that makes a person hold their neck in an uncomfortable position
tension or injury in other muscles of the shoulders, neck, or back
holding a phone between the ear and shoulder
sleeping in an awkward position or on an uncomfortable pillow

Less frequently, some other factors may cause sternocleidomastoid pain. They include:

Trauma: A fall, blow to the side of the neck, or car accident may injure the neck muscles, causing strains, sprains, and other injuries. A person does not have to fall or experience a serious injury to sustain damage to this part of the body, however. A 2014 case report details a ruptured sternocleidomastoid following an epileptic seizure.
Arthritis: Arthritis in the spine can cause referred pain in the sternocleidomastoid. It may also cause a person to change their posture or move their head in a way that increases the risk of injury.
Myofascial pain syndrome: Myofascial pain syndrome is a type of muscle pain that causes trigger points in a muscle. A person may feel pain radiating to other areas when they press on these trigger points. Most people with myofascial pain experience symptoms following an injury or due to chronic lifestyle issues, such as bad posture.

Generally, people with an injured sternocleidomastoid do not feel pain at the site of the injury. Instead, the pain tends to radiate to other areas of the body. The most common symptoms include:

unexplained ear pain, which may present as soreness, aching, or a sense of fullness in the ear
pain in the face or the front of the head
pain in or above the eyes
dizziness
nausea
throat pain when swallowing
headaches, including migraine-like headaches
pain in the sinuses or nose
neck stiffness, including difficulty rotating the head from side to side
tingling in the face, head, or neck

A doctor will begin the diagnosis of a sternocleidomastoid injury by asking the person about their symptoms and their recent medical history and activities. It is important to tell the doctor about all symptoms, even if they seem unrelated, as injuries to this muscle can cause a wide variety of seemingly unrelated symptoms.

The doctor will then carry out a physical examination, asking the individual to perform voluntary movements. These may reveal tenderness or stiffness in the muscle due to bad posture, chronic muscle weakness, or lifting heavy objects.

Imaging scans may be necessary for the doctor to get a detailed view of the muscles and surrounding structures. An ultrasound can help them diagnose trauma to the sternocleidomastoid, while an X-ray can rule out broken bones.

A person might not notice a sternocleidomastoid injury because the symptoms typically spread to the head and face.

In many cases, they might think that they have an ear infection, migraine episode, eye health issue, or another unrelated issue. It is, therefore, important to see a doctor for any unexplained health symptoms.

With appropriate treatment, sternocleidomastoid pain usually goes away.

Sternocleidomastoid pain: Diagnosis, causes, and treatment

Pain behind the ear and down the neck and shoulder may result from tension or injury in the sternocleidomastoid muscle. Other possible symptoms include headaches, dizziness, and tingling.

The sternocleidomastoid is a large muscle near the front of the neck. It extends from just under the ear and jaw down to the collarbone.

A person with sternocleidomastoid pain might notice trigger points along the side or front of the neck. Frequently, however, pain from this muscle radiates elsewhere, causing ear, eye, or sinus pain.

Keep reading to learn more about the causes, diagnosis, and treatment of sternocleidomastoid pain.

Share on PinterestPoor posture is a possible cause of sternocleidomastoid pain.

Some causes of sternocleidomastoid pain include:

carrying a heavy object, such as a child or backpack, in an awkward position
poor posture, for example, when a person spends long days hunched over a computer or straining their neck to reach things in the garden
an awkward work station layout that makes a person hold their neck in an uncomfortable position
tension or injury in other muscles of the shoulders, neck, or back
holding a phone between the ear and shoulder
sleeping in an awkward position or on an uncomfortable pillow

Less frequently, some other factors may cause sternocleidomastoid pain. They include:

Trauma: A fall, blow to the side of the neck, or car accident may injure the neck muscles, causing strains, sprains, and other injuries. A person does not have to fall or experience a serious injury to sustain damage to this part of the body, however. A 2014 case report details a ruptured sternocleidomastoid following an epileptic seizure.
Arthritis: Arthritis in the spine can cause referred pain in the sternocleidomastoid. It may also cause a person to change their posture or move their head in a way that increases the risk of injury.
Myofascial pain syndrome: Myofascial pain syndrome is a type of muscle pain that causes trigger points in a muscle. A person may feel pain radiating to other areas when they press on these trigger points. Most people with myofascial pain experience symptoms following an injury or due to chronic lifestyle issues, such as bad posture.

Generally, people with an injured sternocleidomastoid do not feel pain at the site of the injury. Instead, the pain tends to radiate to other areas of the body. The most common symptoms include:

unexplained ear pain, which may present as soreness, aching, or a sense of fullness in the ear
pain in the face or the front of the head
pain in or above the eyes
dizziness
nausea
throat pain when swallowing
headaches, including migraine-like headaches
pain in the sinuses or nose
neck stiffness, including difficulty rotating the head from side to side
tingling in the face, head, or neck

A person might not notice a sternocleidomastoid injury because the symptoms typically spread to the head and face.

With appropriate treatment, sternocleidomastoid pain usually goes away.

Hemorrhagic stroke

Hemorrhagic stroke (cerebral hemorrhage) – can occur when a vessel ruptures in people suffering from hypertension and atherosclerosis, hemorrhagic diathesis, single and multiple aneurysms of the cerebral vessels due to congenital inferiority of the arteries, head injuries, coarctation of the aorta (pronounced sclerotic changes in the vascular walls with subsequent formation of aneurysms), septic endocarditis (specific arteritis leads to mycotic aneurysms with their subsequent rupture).
In 80-85% of observations, aneurysms are localized in the system of internal carotid and 15% – in the system of vertebral and basilar arteries, also in hemorrhagic diathesis.

Clinical picture of hemorrhagic stroke
Hemorrhagic stroke in 60-75% of cases leads to the death of patients. It is characterized by a lightning-fast development of the disease with loss of consciousness and a rapid transition to a coma. The patient’s breathing becomes hoarse, vomiting appears. The skin of the face is purple-bluish in color, the body temperature rises. The pupil on the side of the hemispheric hemorrhage expands significantly, the reaction to light disappears, “floating” or pendulum movements of the eyeballs appear, as well as abduction of the eyes and turn of the head towards the focus. On the side opposite to the hemorrhage, hemiplegia is found with an increase (or decrease) in tendon and periosteal reflexes in the first hours of the disease. There is urinary and fecal incontinence. Focal symptoms depend on the extent and location of the hematoma, especially since as the brain stem is compressed, nystagmus, a disorder of cardiovascular activity and respiration appear. A severe complication of hemorrhagic stroke is a breakthrough of blood into the ventricles of the brain, which is accompanied by the appearance of tonic convulsions, mainly in the flexors of the upper limbs and extensors of the lower limbs (hormetonia, decerebrate rigidity), arising spontaneously or under the influence of strong external stimuli (pain pricks of the skin, bright light, strong sound).
Hemorrhage in the cerebellum is manifested by dizziness, a sharp pain syndrome in the neck and muscles of the shoulder girdle, nausea, vomiting, hypotension and impaired coordination. As the condition worsens, a different position of the eyeballs in the vertical plane (Hertwig-Magendie symptom), meningeal symptoms, nystagmus, respiratory failure and cardiac activity are noted.
Subarachnoid hemorrhage often occurs as a result of rupture of aneurysms localized in the arterial circle of the large brain (circle of Willis), especially in young people. After short precursors in the form of a headache, tinnitus, a sharp headache appears, often with psychomotor agitation, vomiting, sometimes damage to the cranial nerves, neck stiffness, bilateral Kernig’s symptom, photophobia, and sometimes epileptiform syndrome.

Diagnostics
Computed or magnetic resonance imaging helps to determine the nature of the stroke (ischemic or hemorrhagic), to determine the topical lesion, which is important in the surgical treatment of hemorrhages.

Rice. Computed tomography of the brain.

Hypertensive subcortical hematoma in the right frontal lobe.

The main and decisive moment in the confirmation of subarachnoid hemorrhage in the absence of computed or magnetic resonance imaging data is the presence of blood (or discoloration if the patient presents late) in the cerebrospinal fluid, which flows out under high pressure. It should be released in drops under the control of the mandrin.
Contraindications to puncture are the agonal state, the increase in cardiovascular insufficiency with arterial hypotension.

Treatment of hemorrhagic stroke
Includes hospitalization and monitoring of the state of vital functions. Symptomatic agents are prescribed (the fight against cerebral edema and a decrease in blood pressure). Drugs to stop bleeding are usually ineffective, except in cases of hemorrhagic diathesis.
To reduce the irritating effect of the blood-containing cerebrospinal fluid during subarachnoid hemorrhage on the vessels of the brain, as well as to relieve intracranial pressure, a lumbar puncture should be repeated after 2-3 days, while removing at least 5-8 ml of fluid.
Surgical treatment of hemorrhages in the brain are primarily patients with lateral hematoma, as well as with hemorrhage in the cerebellum, the lethality in which, if only conservative treatment is used, reaches 90-97%. The operation should be performed on the 1-3rd day of the stroke or after 1. 5-2 weeks. Contraindications for surgical treatment, as well as angiographic studies are severe somatic diseases (cardiovascular insufficiency III degree, malignant neoplasms, liver or kidney disease in the decompensated stage).

Stroke: types, signs, first aid and rehabilitation

Stroke kills 6 million people worldwide every year. Most people are disabled after that. The prognosis directly depends on the speed of medical care. Therefore, it is so important to know how the disease manifests itself and how to behave in the current situation.

What is a stroke, its types

Stroke is a violation of cerebral circulation, leading to brain damage.

The pathology is widespread. Only in the Russian Federation there are 3 cases of stroke per 1000 inhabitants. In the post-mortem statement, it is listed as the cause of death in 23.5% of people.

Even if patients do not die after suffering a vascular accident, more than 80% of them remain disabled. Often neurological disorders are so severe that the patient is not able to take care of himself. Stroke is the third leading cause of death.

There are 2 types of stroke: ischemic and hemorrhagic. The mechanism of their development and treatment features have nothing to do with each other. There is also a special kind of hemorrhagic vascular disease – this is a subarachnoid hemorrhage.

Ischemic

Ischemic stroke is a violation of the blood circulation of the brain, accompanied by an acute onset. Pathology develops due to a violation or complete cessation of blood supply to the brain. This leads to softening of its tissues and infarction of the affected area. It is cerebral ischemia that is one of the main causes of death in people around the world. Such a stroke occurs 6 times more often than a hemorrhagic lesion.

It can be 2 types :

Thrombotic . It develops due to blockage of blood vessels in the brain by a thrombus.
Embolic . Occurs when blood vessels located away from the brain overlap. The most common source of embolism is the heart muscle (cardioembolic stroke).

In 80% of cases, the pathological focus is localized in the middle cerebral artery. Other vessels account for the remaining 20%.

Causes that can provoke ischemic damage to cerebral arteries and veins :

Myocardial infarction.
High or low blood pressure.
Atrial fibrillation.
Diabetes mellitus.
Lipid metabolism disorders.

Risk factors include: old age, hereditary predisposition to vascular accidents, as well as lifestyle habits.

Symptoms of ischemic stroke do not develop as quickly as symptoms of hemorrhagic brain damage.

Its manifestations :

Drowsiness, stupor.
Brief syncope.
Headache, dizziness.
Nausea and vomiting.
Pain in the eyes, which is aggravated by movement.
Convulsions.
Sweating, hot flashes, dry mouth.

Neurological manifestations of ischemia differ depending on which part of the brain is affected. To a greater or lesser extent, the lower and upper limbs suffer, paresis of the tongue and face is observed, visual and / or auditory function worsens.

Hemorrhagic

Hemorrhagic stroke is a hemorrhage in the cranial cavity. The most common cause of a ruptured vessel is high blood pressure.

Other provoking factors include :

Aneurysm.
Malformation of cerebral vessels.
Vasculitis.
Systemic connective tissue diseases.
Taking certain medications.
Amyloid angiopathy.

The onset of the pathology is acute, most often the manifestation occurs against the background of high blood pressure. A person has severe headaches, dizziness, accompanied by vomiting or nausea. This state is quickly replaced by stupor, loss of consciousness, up to the development of coma. Seizures are possible.

Neurological symptoms are manifested in the form of memory loss, deterioration of sensitivity and speech function. One side of the body, which is on the opposite side of the lesion, loses the ability to function normally. This applies not only to the muscles of the body, but also to the face.

A stroke with a breakthrough of blood into the ventricles of the brain is difficult to tolerate. The victim develops symptoms of meningitis, convulsions occur. He quickly loses consciousness.

The next 3 weeks after a stroke are considered the most difficult. At this time, cerebral edema progresses. It is he who is the main cause of death of patients. Starting from the fourth week, in survivors, the symptoms of the lesion become reversed. From this time on, the severity of brain damage can be assessed. They determine what degree of disability to assign to the victim.

Subarachnoid hemorrhage

Subarachnoid hemorrhage is understood as a condition that develops as a result of a rupture of vessels into the subarachnoid space of the brain. This pathology is a type of hemorrhagic stroke.

The subarachnoid space contains cerebrospinal fluid, the volume of which increases due to blood flow. The patient has increased intracranial pressure, aseptic meningitis develops. The situation is aggravated by the reaction of the vessels of the brain. They spasm, which leads to ischemia of the affected areas. The patient develops an ischemic stroke or transient ischemic attacks.

The following causes lead to hemorrhage in the subarachnoid space :

Traumatic brain injury with damage to the integrity of blood vessels.
Aneurysm rupture.
Dissection of the carotid or vertebral artery.
Myxoma of the heart.
Brain tumor.
Amyloidosis.
Diseases associated with impaired blood clotting.
Uncontrolled intake of anticoagulants.

The pathology is manifested by a severe headache. Possible loss of consciousness. In parallel, symptoms of meningitis develop, with neck stiffness, vomiting, and photophobia. The hallmark is an increase in body temperature. In severe cases, there is a disorder of respiratory function and cardiac activity. With prolonged fainting and coma, one can suspect that blood has entered the ventricles of the brain. This occurs during its massive outpouring and threatens with serious consequences.

Signs and symptoms of a stroke

Stroke manifests unexpectedly for a person, although sometimes it is preceded by certain symptoms. If you interpret them correctly, you can avoid a formidable vascular catastrophe.

Harbingers of impending stroke include :

Prolonged headaches. They do not have a clear localization. It is not possible to cope with them with the help of analgesics.
Dizziness. It occurs at rest and can intensify when performing any action.
Buzzing in the ears.
Sudden attack of atrial fibrillation.
Difficulty swallowing food.
Memory deterioration.
Numbness of hands and feet.
Loss of coordination.
Insomnia.
Increased fatigue.
Decreased overall performance.
Rapid heartbeat and constant thirst.

The listed symptoms may have different intensity. They should not be ignored, you need to contact the doctor.

Symptoms of ischemic stroke develop slowly. With hemorrhagic brain damage, the clinical picture unfolds rapidly.

It is possible to suspect a cerebral catastrophe by the following manifestations :

General cerebral symptoms . The patient has unbearable headaches. Nausea ends with vomiting. Consciousness is disturbed, both stupor and coma may occur.
Focal symptoms . They directly depend on where exactly the lesion is localized. The patient may decrease or completely lose muscle strength on one side of the body. Half of the face is paralyzed, causing it to become distorted. The corner of the mouth is lowered, the nasolabial fold is smoothed out. On the same side, the sensitivity of the hands and feet decreases. The victim’s speech worsens, he hardly orients himself in space.
Epileptiform symptoms . Sometimes a stroke provokes an epileptic seizure. The patient loses consciousness, he has convulsions, foam appears from the mouth. The pupil does not react to the beam of light, it is dilated from the side of the lesion. Eyes move to the right, then to the left.
Other symptoms . The patient’s breathing quickens, the depth of inspiration decreases. Perhaps a significant decrease in blood pressure, increased heart rate. Often a stroke is accompanied by uncontrolled urination and defecation.

When the first signs of a stroke appear, you should not hesitate to call an ambulance.

Diagnostic methods

It is important to quickly distinguish stroke from other diseases that can lead to the development of similar symptoms. It is almost impossible to do this on your own, as well as to determine the type of vascular catastrophe.

The main difference between ischemic stroke is a gradual increase in symptoms that do not lead to loss of consciousness. With hemorrhagic hemorrhage, the patient turns off quickly. However, stroke does not always have a classic course. The disease can begin and proceed atypically.

Diagnosis begins with an examination of the patient. The doctor collects an anamnesis, finds out the presence of chronic diseases. Most often, information can be obtained not from the victim himself, but from his relatives. The doctor performs an ECG, determines the heart rate, takes a blood test, measures blood pressure.

It is possible to make a correct diagnosis and obtain maximum information about the patient’s condition thanks to instrumental diagnostic methods. The best option is to conduct a CT scan of the brain. Performing an MRI is difficult, as the procedure is extended in time. It takes about an hour. It is impossible to spend this amount of time diagnosing an acute stroke.

Computed tomography makes it possible to clarify the type of pathology, its location, to understand how badly the brain was damaged, whether the ventricles are affected, etc. The main problem is that it is not always possible to perform a CT scan as soon as possible. In this case, doctors have to focus on the symptoms of the disease.

Diffusion-weighted tomography (DWT) is used to locate a stroke. Information will be received in a few minutes.

Other examination methods include :

Lumbar puncture.
Cerebral angiography.
Magnetic resonance angiography. It is carried out without the introduction of a contrast agent.
Doppler ultrasound.

After the diagnosis is made, the doctor will immediately begin treatment.

Who is at risk

There are people who need to be especially alert for stroke because they are at risk.

Among them :

Persons with hypertension.
Patients with diabetes mellitus.
Men and women over 65 years of age.
People with abdominal obesity.
Persons with a hereditary predisposition to vascular pathologies.
Patients with previous stroke or heart attack.
Patients with diagnosed atherosclerosis.
Women over the age of 35 taking oral contraceptives.
Smokers.
People suffering from heart rhythm disorders.
People with high cholesterol.

Most often, patients with the listed diagnoses are registered at the dispensary. Separately, it should be noted people living in a state of chronic stress. Emotional overstrain negatively affects all body systems and can cause a stroke.

How to provide first aid for a stroke

There is a clear algorithm for providing first aid to a person who has suffered a stroke a:

Call the medical team . To do this, you need to dial 103 from a landline phone. If a smartphone is at hand, then the call is made to a single number 112. The doctor should immediately be informed that the person is unwell and there is a suspicion of a stroke.
The casualty must be laid down on a flat surface so that his head is higher than his body. They take off his glasses, remove the lenses. If possible, you need to help him get removable dentures.
If consciousness is absent, the patient’s mouth should be slightly opened and the head turned to one side . This is done to prevent aspiration of vomit. Be sure to listen to the patient’s breathing.
For better access to fresh air, it is recommended to open a window or vent .
Documents must be prepared for the arrival of the medical team, if available .

Doctors should be told about a person’s illnesses and what medications they are taking. It is forbidden to give the victim any medicines. Medical correction should be carried out by emergency doctors. You should not try to drink or feed a person. This may make the situation worse.

If the patient has fallen and has an epileptic seizure, do not unclench his teeth or try to hold him. The victim must be protected from injury. To do this, put a soft object under his head, for example, a pillow. If a stroke with an epileptic attack happened on the street, then you can use a jacket or other suitable thing. Foam flowing from the mouth is wiped with a cloth. The head should always be on a dais.

Do not try to bring the person to their senses with ammonia. Until the end of the attack, it should not be moved from place to place.

If breathing stops, start resuscitation immediately. To do this, perform a heart massage and do mouth-to-mouth or mouth-to-nose breathing.

Treatment and rehabilitation

The patient receives treatment in a hospital. All patients with suspected stroke are hospitalized on an emergency basis. The optimal time for medical care is the first 3 hours after the brain accident has occurred. A person is placed in the intensive care unit of a neurological hospital. After the acute period is overcome, he is transferred to the early rehabilitation unit.

Until the diagnosis is established, basic therapy is carried out. The patient is corrected for blood pressure, normalizes the heart rhythm, maintains the required level of blood pH. To reduce cerebral edema, diuretics and corticosteroids are prescribed. A trepanation of the skull is possible, which allows to reduce the degree of compression. If necessary, the patient is connected to an artificial respiration apparatus.

Be sure to direct efforts to eliminate the symptoms of a stroke and to alleviate the patient’s condition. He is prescribed drugs to lower body temperature, anticonvulsants, antiemetics. Drugs with a neuroprotective effect are used.

Pathogenetic therapy is based on the type of stroke. With ischemic brain damage, it is necessary to restore the nutrition of the affected area as soon as possible. For this, the patient is prescribed drugs that resolve blood clots. They can be removed mechanically. When thrombolysis fails, the patient is prescribed Acetylsalicylic acid and vasoactive drugs.

In case of stroke, it is extremely important to provide timely treatment of damaged areas of the brain. The course use of the drug accelerates the process of recovery of brain cells after a stroke, even with impaired blood circulation or hypoxia. This allows you to achieve the fastest recovery of memory, thinking, speech, swallowing reflex and the restoration of other functions of daily activities. Gliatilin has a positive effect on the transmission of nerve impulses, protects brain cells from repeated damage, which prevents the risk of a second stroke.

The drug is well tolerated by patients, it is contraindicated in pregnant women, lactating women and people with hypersensitivity to choline alfoscerate.

Courses will need to be taken regularly. Be sure to do physiotherapy exercises, undergo physiotherapy, visit a massage therapist. Many patients after a stroke have to restore motor skills for a long time, learn to serve themselves on their own.

Relatives and friends should support the patient, not leave him alone with the problem. Psychologists are involved in the work. Speech therapy is often required.

Possible consequences, complications

The main risk of stroke is death. If a person survived, then the disease will still make itself felt with certain complications.

Early effects include :

Cerebral edema.
Coma.
Pneumonia.
Paralysis. It can be partial or complete. Most often, one half of the body is affected.
Recurrent stroke.
Pressure sores.
Mental disorders. They can manifest themselves in whims, irritability, aggression, anxiety. Sometimes dementia develops.
Sleep disorders.
Myocardial infarction, gastric ulcer. These disorders develop against the background of increased levels of stress hormones.

After an ischemic stroke, death occurs in 15-25% of cases. Hemorrhagic damage to the cerebral vessels leads to the death of 50-60% of patients. The cause of death is precisely severe complications, such as pneumonia or acute heart failure. The most dangerous are the first 3 months after a stroke.

Hands recover worse than legs in patients. The future health of a person is determined by the severity of brain damage, the speed of medical care, his age and the presence of chronic diseases.

Long-term effects include :

Formation of blood clots in various parts of the body.
Depression.
Problems with speech.
Weakening memory.
Impairment of intellectual abilities.

After a stroke, it takes many months to deal with the consequences. Sometimes a person never fully recovers. In order for the rehabilitation to be as successful as possible, you must strictly follow all the instructions of the doctor.

Stroke is a serious pathology, as it affects the brain. Therefore, even the slightest suspicion of a developing vascular catastrophe is a reason for urgent medical attention.