Intense neck pain and Migraine Headache

1. Type of Trauma: Recent trauma; fall on face on the stairs and old trauma; fall from the yacht.

2. Sign and Symptoms: Lifelong severe chronic migraine headache. Acute onset of severe neck pain. The patient was advised to visit an orthopedic surgeon after the MRI scan.

3. Imaging findings: MRI and CBCT revealed a hypoplastic occipital condyle, multiple levels of the degenerative disc disease, and Upper Neck Misalignment.

4. Adjustments: Upper Neck correction; C1 (Atlas)

5. Outcome: Neck pain improved dramatically in a single visit. After a few more visits, the patient regained normal range of motion of the neck and the neck pain and the headache disappeared.

Patient Background:A female in her mid-50s presented with intense chronic neck pain and a long-standing history of migraine headaches. These headaches began in her adolescence (~14 years old) and were often preceded by a prodromal sensation in her right calf muscle.

She has a history of significant trauma, including a fall from a yacht in her 20s and more recently, a facial contusion from falling onto stairs.

Chief Complaint:The combination of chronic neck pain and debilitating migraine headaches significantly impacted her daily life. Despite ongoing treatment with migraine medication, which only provided partial relief, the patient sought alternative options as she awaited review by an orthopedic surgeon.

Initial Assessment:Upon evaluation, the patient reported a long-standing pattern of headache and neck pain that had worsened over time.

Cone Beam CT (CBCT) revealed multiple anatomical variants. Notably, her atlas (C1) was misaligned posteriorly to the left, causing the right atlas to rotate anteriorly. This misalignment likely contributed to potential disruption in the flow or size of the vasculature on both sides, which may have played a role in exacerbating her symptoms.

The CBCT also revealed degenerative changes in the lower cervical spine, with posteriorly growing osteophytes that may be encroaching into the space of the spinal canal. Additionally, the odontoid process was observed to be migrating superiorly, exceeding the McGregor line, which can potentially affect the alignment and stability of the cervical spine.

This type of near straight line, similar to findings in a previous case, likely suggests the presence of a hypoplastic occipital condyle. This anatomical variant can contribute to structural instability in the craniocervical junction, potentially influencing the alignment and function of the cervical spine.

Her Schmit-Fischer angle was found to be outside the normal range, which typically falls between 123–127 degrees.

Following the adjustment to her upper cervical spine, the patient reported that her neck pain had completely disappeared within 24 hours. In subsequent follow-up visits, the degenerative changes in her lower cervical spine were carefully mobilized, leading to an even more significant improvement beyond the initial results.

Disclaimer:

While this case demonstrates a successful outcome, it is important to note that results may vary for different individuals. The effectiveness of the treatment may depend on various factors such as the severity of the condition, the patient's overall health, and the response to treatment. This case should not be interpreted as a guarantee of the same results in all similar cases. Further research and clinical studies are necessary to better understand the relationship between the intervention and its effectiveness in different conditions.