TwentyThree Year Old Male with Headache, Medicine, College Term Papers.com


		Data Bases
		• Custom Term Papers • Free Term Papers • Free Research Papers • Free Essays • Free Book Reports • Plagiarism?

		Links
		• Top 100 Term Paper Sites • Top 25 Essay Sites • Top 50 Essay Sites • Search 97,000 Papers @ DirectEssays.com • Search 101,000 Papers @ ExampleEssays.com • Search 90,000 Papers @ MegaEssays.com

		Free Essays
		• Term Paper Sites • Chuck III's Free Essays • Free College Essays • TermPaperSites.com • My Term Papers • Get Free Essays • Essay World • Planet Papers

Search Lots of Essays

Back to Subjects - Medicine

TwentyThree Year Old Male with Headache

TwentyThree Year Old Male with Headache Twenty-Three Year Old Male with Headache Treated with Upper Thoracic Adjustment Headaches are a symptom experienced by an estimated 45 million Americans and lead to more than 18 million office visits a year in the United States.1,2 Headaches are also the number one cause for Americans to take over-the-counter analgesic medications.2 Headaches can be classified as 1) Migraine Without Aura (Common Migraine), 2) Migraine With Aura (Classic Migraine), 3) Tension Type Headaches (Musculoskelatal), 4) Tension-Migraine (Mixed Headache Disorder), 5) Recurring Headaches of a Nonmusculoskeletal nature and 6) Headaches as a Symptom of Ominous Disease.1 The cause and successful treatment vary greatly for migraine headaches and such headaches are often referred to and treated by a physician.1 When the patient chooses treatment outside of the medical model it is most often a chiropractor who is chosen as the care provider.2 The true nature of headaches and the proper treatment for them has been reported on so widely that a number of treatment techniques have emerged. Nonthrust manipulation is done by Physical Therapists in musculoskelatal type headaches with reported improvement.1 Spinal manipulation under anesthesia is reported as being used as early as the 1930's and 1940's. This was performed and documented mostly by medical and osteopathic physicians and was used with the idea that fibrous adhesions had formed within joint capsule. While the medical and osteopathic professions have abandoned this in favor of pharmacology and surgery, chiropractors have continued the research and continue to find success.3 Other professionals have found psychological treatment to have a positive effect on chronic headaches, in particular by reducing the frequency of the pain.5 The Chiropractic upper cervical adjustments have also proven to relieve cervicogenic and musculoskelatal headaches by removing interference so close to the brain.2 Some patients, as this case will illustrate, have found relief from upper thoracic adjustments after receiving no relief from cervical adjustments. In the following case, a headache of mechanical origin was unsuccessfully treated with upper cervical adjustments to the Occiput/C1 and the C1/C2 joint couples, but successfully treated with a short-lever, high-amplitude, low-force chiropractic adjustment to the upper thoracic spine, specifically the first thoracic. The patient was a 23-year-old Caucasian male who was a student at Palmer College of Chiropractic. He had been a student between four and six months when he experienced his first headache. It occurred after a week of exams, which he reported studying for an average 4 hours per night for five consecutive nights. The patient presented three days after the symptoms began and no relief had been experienced. He complained of constant suboccipital pain that worsened with flexion or extension of the cervical spine. His symptoms were better in the morning, but worsened as the day progressed and lessened only with rest. Pain was rated at a 6 on a scale of 0-10. The patient was not taking any analgesics due to his health philosophy. The patient recalled no traumatic event that brought on the headache, but acknowledged studying with his head in a flexed position the previous week. Objective findings revealed the patient had decreased right rotation of cervical spine as well as decreased right lateral flexion. A dual probe, a thermal instrument that measures temperature difference across a vertebral segment, revealed a break at Occiput/ Atlas. Increased muscle tension was noted at the left suboccipital region as well as bilateral spasm of the levator scapulae. Vertebral artery integrity tests were unremarkable. X-Rays revealed slight hypolordosis of the cervical spine with no other remarkable findings. Segmental motion tests in the cervical spine revealed decreased P to A occipital glide on the right as well as decreased motion with right lateral bending and right rotation between Occiput and Atlas. Decreased left lateral bending was noted at Atlas/Axis with decreased P to A motion at Axis. Right lateral bending was restricted throughout remainder of cervical spine with tenderness with palpation noted at right lamina of C3-C6. Thoracic motion was notably decreased P to A at T1 and T6 with a decrease in right rotation noted at same levels. Motion was within normal limits through remainder of thoracic and lumbar spine. Pelvic motion was fluid bilaterally and within normal limits. The patient was treated with soft tissue massage on his levator scapulae and suboccipital muscles bilaterally prior to adjustment of Atlas. The Atlas adjustment was performed with the patient supine using a short lever right transverse contact. A low force, high amplitude thrust was applied with the lateral side of the right index finger of the doctor while patient's head was in slight flexion and left rotation. Bone motion was felt and there was a cavitation. The patient exhibited equal rotation at Occiput/Atlas after the adjustment as well as equal lateral bending. Levator scapulae tone was restored bilaterally and the patient reported feeling "a little better." The remainder of the spine was left alone to be rechecked on the next visit. The patient scheduled an appointment for two days later due to the specific nature of the Atlas adjustment. The following visit the patient reported having no relief from the headache. Upon palpation of the cervical spine segmental motion was within normal limits and the musculature had good tone throughout. There were no breaks with the dual probe in the cervical spine. Motion palpation of the thoracic spine revealed decreased P to A motion at T1 with decreased right rotation. Motion at T6 had improved compared to last visit. The rest of the spine was found to be unremarkable. A short lever adjustment was applied to T1 with the patient prone. Standing on the side of spinous laterality (right), the doctor used his right thumb to contact the spinous while holding the right trapezius with his fingers. The patient turned his head to the left, side opposite spinous laterality, and a low force, high amplitude thrust was applied. There was a cavitation and the patient turned his head back to center. The patient immediately noted a reduction in his pain intensity. The post-check revealed a restoration of motion at T1 in both extension and rotation. The patient reported the pain had reduced to less than a 1 on the 0-10 scale. The pain previously experienced with flexion/extension was gone. The patient was scheduled for the following day to see if the adjustment was holding. When he returned the next day the T1 segment was still moving within normal limits and the headache was still gone. He was then scheduled for the following week and told to come in earlier if the headache came back before the next appointment. The following week the patient presented with no symptoms of the headache and his pain was reported as a 0 on the 0-10 scale. He reported the headache was gone by the time he left the clinic the previous visit and hadn't returned. Upon chiropractic evaluation the patient had good motion at T1 and throughout the entire spine and musculature was tone where it had previously been spastic. The outcome of this case study suggests the relationship between the upper thoracic spine and this type of tension, suboccipital headache and the low force chiropractic adjustment. This improvement may been due to one or any combination of the following theories: 1) Mechanical/Postural: By removing fixation within the motion couples around the first thoracic vertebrae, ROM would be improved in all directions. Forward head posture can be reduced with improved extension in the thoracic spine. Subcranial pressure can be reduced via this method and therefore reduce the patient's symptoms.1 2) Reflexive/Muscular: By adjusting the first thoracic vertebrae the semispinalis capitis and the longissimus capitis are affected because of their insertion to the upper thoracic spine. These muscles also connect to the occiput and the mastoid processes. Golgi tendon organs located within these muscles can, when stretched quickly, cause an inhibitory reflex to the entire muscle, which could allow for a release of tension at the base of the skull.1 3) Reflexive/Sympathetic: Sympathetic innervation to the head and neck originate from the T1-2 spinal levels.4 These spinal levels are believed to correspond to the spinal segmental outflow to the cervical sympathetic trunk and vertebral nerve/plexus.1 Other possible explanations are that, since the time period between the cervical adjustment and the thoracic adjustment was only 48 hours the cervical adjustment may have been in the process of making corrective changes to the body that didn't take effect immediately. The placebo effect was considered and was regarded as a non-factor in the results due to the fact that the expectation of success was present in both cases and success was not achieved until the thoracic adjustment was performed. A cavitation was also heard with both adjustments and motion was restored in each, which also discounts the placebo effect. This case study illustrates a patient with suboccipital headaches that benefited from an upper thoracic chiropractic adjustment. There is little literature in the field that illustrates this relationship and is an area that warrants further investigation. Bibliography: References 1. Viti J, Paris S. The Use of Upper Thoracic Manipulation in a Patient With Headache, The Journal of Manual and Manipulative Therapy. 2000; 8(1):25-28. 2. Alix M, Bates D. A Proposed Etiology of Cervicogenic Headache: The Neurophysiologic Basis and Anatomic Relationship Between the Dura Mater and the Rectus Posterior Capitis Minor Muscle, The Journal of Manipulative and Physiological Therapeutics. Oct. 1999; 22(8):534-539. 3. Herzog J. Use of Cervical Spine Manipulation Under Anesthesia for Management of Cervical Disc Herniation, Cervical Radiculopathy, and Associated Cervicogenic Headache Syndrome. Mar/Apr 1999; 22(3):166-170. 4. Guyton AC. Textbook of Medical Physiology, Philadelphia: W.B. Saunders and Company, 1996; 769-770. 5. Passchier J. Psychological treatment of headache: present and future. Headache Quarterly, Current Treatment & Research. 2001; 12(2):109-12.

Word Count: 1496