17 y.o Female with Chronic daily Headaches and Migraines

• ¹ Chiropractic neurology, United States

This is a case report of a 17-year-old female who has chronic migraines and chronic headaches. She states that she almost always has a headache. Sometimes it just feels like pressure, but other times it feels like stabbing. Sometimes they are debilitating, sometimes not. She has had these headaches on and off for 2 years currently but has had a prior episode in 2011 that was helped and aided by glasses. Her condition is aggravated by flashing lights, loud noises, stress and lots of people. The only way she can get relief is laying down in a dark quiet room or getting massages. Her pain can be anywhere from a 7 to a 10. She states she has symptoms 98 percent of the time. She has been diagnosed with chronic migraines. She is currently being treated with Quartette, gabapentin and zonisamide. METHODS: She was examined using a Functional Neurology Examination. She was found to have a pathological OTR with the right side lower. She has a right yaw, a decreased VOR, with low gain bilaterally. She has light sensitivity, more on the right eye than left. She has gaze instability both in left and right gaze at 20 degrees. She has square-wave jerks to the right noted on neutral gaze. She has a left corectasia. She has a ptosis. She has convergence insufficiency with accommodative convergence. CAPS testing shows 74.1 right anterior in the neutral position, 72.4 left anterior with head left and with head right 76.1 right anterior. VNG testing shows more of a right corectasia, gaze instability both to the left and to the right, hypermetric pursuits with overshooting to the right on a consistent basis, hypermetric pursuits to the right that improve at faster speeds. Optokinetics are low gain with an exaggerated pursuit component. INTERVENTIONS: This patient was treated with a functional neurology approach. She was given gaze stability exercises, first using gaze holding and moving into yes-yes/no-no exercises once her gaze became stable. She was given exercises using a Brock String to work on convergence and divergence exercises. We are doing non-linear, non-complex movements to decrease cerebellipetal bombardment to the contralateral nigra to improve collicular activation of omnipause cells to improve gaze stability and to reduce light sensitivity. She was given red lenses to help with her light sensitivity. She was treated with SSEP to V3. We used cold laser on her neck. She was given vertical pursuits. She was treated with suboccipital release and myofascial techniques to the upper cervical area and areas of the trigeminal fasciculus, and greater and lesser occipital nerves. She was manipulated using coupled motion and chiropractic reductions at the occiput and C2 on the right. She was given Halmagyi exercises to improve her vestibuloocular gain. RESULTS: Following 3 treatments, the patient no longer had a consistent headache. The patient's headache was down to being intermittent and was no worse than a 4. She still had complaints of neck pain, and we continue to treat her neck pain, in addition to progressing her neurological therapy. After 15 sessions, she has approximately 3 headaches a week. She tends to find eye activity such as excessive reading, looking at the board and then looking at her books, and excessive neck strain to be contributing factors but overall is having mostly good days in the week, with headaches that are fewer in frequency and less intensity