Diagnostic Focus and Assessment: Diagnoses considered are: Brain Tumor, Cervical Disc Displacement, and Cervical-cranial     syndrome.  A brain MRI was ordered and produced normal findings.  Diagnostic reasoning included the C5/C6 disc/osteophyte complex and the encroachment into the ventral aspect of the central canal and contact with the cervical spinal cord. (1) Peter J. Tuchin, GradDipChiro, DipOHS, Henry Pollard, GradDipChiro, GradDipAppSc, Rod Bonillo, DC, DO.  Received 29 June 1999.  Another consideration was the treatment schedule because the patient lives 60 miles west of the clinic and 2 treatments was the ordered therapeutic schedule.

Therapeutic Focus and Assessment:  Assessment of the cervical spine MRI both sagittal and axial views of the C5/C6 and C6/C7 segmental levels revealed adequate space between the cervical cord and posterior vertebral elements.  It was determined that conservative management of this patient was appropriate.  Therapeutic focus was reducing the pressure of the C5/C6 disc/osteophyte complex on the ventral cord.  Promoting healing of damaged nerve tissue and restoring more favorable position and motion of vertebral segments C5/C6.  The modalities used to treat this patient were:

1.     Specific Spinal Adjustments: utilizing a Sigma Precision Adjusting Instrument to introduce a percussive force of 20 lbs. with a maximum of impact number of 50.

2.     Spinal Decompression: A Hill Spinal Decompression table was utilized with 8 lbs. of pull maximum and a cycle of 5 minute at maximum and 5 minutes at reduction to 50% over a 25 minutes treatment session.  The patient completed 18 sessions in total.

3.     Low Level Laser Therapy was used to promote healing on a cellular level using a Dynatron Solaris system.  Treatments consisted of 30 seconds of exposure to an 860-nanometer beam at C5/C6 and C6/C7 levels.

Adjustments Follow-Up And Outcomes

The patient’s compliance to the treatment schedule as rated at 9 of 10.  Completion of the recommended 18 treatments required 1 week longer than anticipated.  For personal reasons the patient missed 2 treatment sessions but made them up by adding a week to the estimated completion date. Upon discharge examination the patient reports her neck pain on the Verbal Analog Scale a 2 of 10 with 0 being the complete absence of pain and 10 being the worst pain imaginable. She further reported her headaches as a 1 on the Verbal Analog Scale.  Both symptoms were constant since 10/01/11.  This is duration of 25 months prior to her first visit. Her symptoms of dizziness and visual disturbances have been absent since 12/13/13.

Discussion: Headaches and Migraine Headaches are a big health     problem. It has been estimated that 47% of the adult population have headache at least once within last year in general.  More than 90% of sufferers are unable to work or function normally during their migraine. American employers lose more than $13 billion each year as a result of 113 million lost workdays due to migraine. (2) Schwartz BS1, Stewart WF, Lipton RB. J Occup Environ Med. 1997 Apr; 39(4): 320-7.

This case report is very limited because it represents the experience and clinical findings for just 1 patient. However a study of the references included with this report as well as reports by care providers as well as testimonials from patients indicates that more study should be invested in the relationship of the cervical spine, its structures and biomechanics during the diagnostic workup on headache and migraine patients.

Informed Consent: The patient provided a signed informed consent.

Competing Interests: There are no competing interests writing of this case report.

De-Identification: All the patient’s related data has been removed from this case report.

The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 . 

References:

1. Schwartz BS1, Stewart WF, Lipton RB.

J Occup Environ Med. 1997 Apr; 39(4): 320-7.

Lost workdays and decreased work effectiveness associated with headache in the workplace.

Wikipedia, The Free Encyclopedia. (2010, July). Human musculoskeletal system. Retrieved from en.wikipedia.org/wiki/Musculoskeletal

2. Vernon, H., Humphreys, K., & Hagino, C. (2007). Chronic mechanical neck pain in adults treated by manual therapy: A systematic review of change scores in randomized clinical trials, Journal of Manipulative and Physiological Therapeutics, 30(3), 215-227.

3. Peter J. Tuchin, GradDipChiro, DipOHS, Henry Pollard, GradDipChiro, GradDipAppSc, Rod Bonillo, DC, DO.  Received 29 June 1999

A randomized controlled trial of chiropractic spinal manipulative therapy for migraine?

4.Mark Studin DC, FASBE (C), DAAPM, DAAMLP, William J. Owens DC, DAAMLP Chronic Neck Pain and Chiropractic. A Comparative Study with Massage Therapy.

5. D’Antoni AV, Croft AC. Prevalence of Herniated Intervertebral Discs of the Cervical Spine in Asymptomatic Subjects Using MRI Scans: A Qualitative Systemic Review. Journal of Whiplash & Related Disorders 2006; 5(1):5-13.

6.  Murphy, D. R., Hurwitz, E. L., & McGovern, E. E. (2009). A nonsurgical approach to the management of patients with lumbar radiculopathy secondary to herniated disc: A prospective observational cohort study with follow-up. Journal of Manipulative and Physiological Therapeutics, 32(9), 723-733.

Additional Topics: Chiropractic Helps Patients Avoid Back Surgery

Back pain is a common symptom which affects or will affect a majority of the population at least once throughout their lifetime. While most back pain cases may resolve on their own, some instances of the pain and discomfort can be attributed to more serious spinal conditions. Fortunately, a variety of treatment options are available for patients before considering spinal surgical interventions. Chiropractic care is a safe and effective, alternative treatment option which helps carefully restore the original health of the spine, reducing or eliminating spinal misalignment which may be causing back pain.