instruction: hello doctor I have severe pain in the neck and shoulders often accompanied by numbness and tingling I also have frequent migraines and some times dizziness as well with occasional fainting which is exacerbated by loud sounds and harsh lighting I used to be a professional bass player 20 years but no longer performing live for the past two years due to worsening conditions I am currently taking ot painkillers and homeopathy medicine for migraines
output: hello it would have been better if you had included the mri and ray films or at least the report as I believe it is your cervical spondylosis that may be the cause of your current symptoms I will recommend you to do neck strengthening exercises shoulder elevation exercise and take pregabalin tablets for nerve pain along with duloxetine and take antiinflammatory tablets for a couple of weeks to see the response as your are getting twitching and this may be viral in nature or may be myoclonus I will not to ignore that and perhaps see a neurologist at the next opportunity