ACUTE MIGRAINE – MEDICAL MASSAGE vs. TRADITIONAL MEDICAL MODEL

NEWS FROM THE CLINIC

We have concluded posting our five-part article about Medical Massage therapy for headaches. Here is a case from the clinic in Daytona Beach, Florida, associated with SOMI.

Dr. Jeff Cullers, who practices Medical Massage there, illustrates here the practical application of the information from the article. It gives therapists a first-hand professional experience of how MEDICAL MASSAGE PROTOCOL for Headache was successfully applied in a clinical setting.

Dr. Ross Turchaninov

ACUTE MIGRAINE – MEDICAL MASSAGE vs. TRADITIONAL MEDICAL MODEL

By Dr. Jeff Cullers, DC, CMMP

Recently, a 35-year-old female came to my office suffering from a debilitating Headache. She was crying, extremely distraught and could barely maintain a conversation without effort and pain. The situation was even more complicated, since she was supposed to leave on a long-anticipated vacation with her family.

Her main complaint was that she had been suffering from Headache/Migraine-type pain for the previous 2 weeks. Due to the severity of symptoms, she had gone to the emergency room twice, had been evaluated by a neurologist and had had a CT scan and an MRI of her head and neck. The diagnosis she was given at the ER was acute Headache/Migraine. She was prescribed medications, which she took, but she stated that the medications were only temporarily relieving the intensity of the symptoms. She was otherwise healthy and stated she had no previous trauma or external stressors.

She told me that recently she’d been seen by a chiropractor, but after having a cervical manipulation, her Headache had persistently worsened. She had been using ice on her neck. She rated her head pain at a 9/10 on the Mankoski Pain Scale. She described her pain as constant, right-sided, sharp, radiating and shooting into the right side of her temporal and frontal head as well as the right eye. She also said that the pain worsened when she looked up into neck extension. I suspected that her Migraine was triggered by compression of the Greater or Lesser Occipital Nerves.

EVALUATION

Observation

Bilateral restriction of cervical ROM in all planes accompanied by moderate pain. The intensity of pain increases when the patient moves the head from cervical flexion into extension.

Palpatory Evaluation

1. Vertical Cervical Compression Test – Negative for Cervical Disc Pathology
2. Connective Tissue Zones – Positive for CTZs in Zone 1 of the 1st and 2nd levels of the Upper Thoracic and Cervical areas, as well as CTZs in Zone 4 of the 1st and 2nd levels of the Lumbar areas.
3. Trigger Point Test is positive bilaterally for the Upper Trapezius, Semispinalis Capitis and Oblique Capitis Inferior Muscles. On the right side, it is positive for the Oblique Capitis Superior Muscle, with pain radiating behind the right eye.
4. Grinstein’s Points – Negative
5. Sensory Test – Hypoesthesia (decrease of sensation with skin stimulation) on the right supraorbital area
6. Eyeball Palpation Test – Upon visual assessment, the right eye protruded from the orbit. The application of mild pressure on the right eyeball triggered pain behind the eye.

Based on her symptoms and evaluation, I considered my initial assessment to be correct. The patient suffered from Migraine developed secondarily as the result of compression of the greater occipital nerve by the posterior cervical and suboccipital muscles. A Cluster Headache on the right became the consequence.

TREATMENT STRATEGY

The treatment included the MEDICAL MASSAGE PROTOCOL for Migraine/GONN as it is presented in Medical Massage Volume I and the Video Library of MEDICAL MASSAGE PROTOCOLS on the Science of Massage Institute website (Medical Massage Courses & Certification). I also added MPS Therapy using the Dolphin Neurostim.

1st Session

I started with MPS Therapy to the Parasympathetic and Migraine Acupressure points for 15 minutes, followed by the MEDICAL MASSAGE PROTOCOL for Migraine/GONN for 30 minutes. Based on the evaluation, I included in the basic protocol work on the CTZs using mobile cupping with silicone jars and Trigger Point Therapy after detecting the entrance to each TP. At the end of the session, the PIR protocol for each cervical muscle was performed separately to ensure stability of clinical results.

2nd Session

The 2nd visit consisted of the same treatment protocol. There was an initial flare-up of symptoms on the day after the first session and a very mild improvement by our second meeting. The patient said that her neurologist had recommended an injection around the greater occipital nerve, and she was considering doing it during her next visit to her neurologist.

3rd Session

Before the beginning of the session, the patient excitedly informed me that she felt much better, with only a mild Headache present. She looked optimistic with a smile on her face, and palpatory evaluation revealed a significant decrease of hypertonicity of the posterior cervical and suboccipital muscles. The right eyeball didn’t protrude from the orbit.

4th Session

According to the patient, Headache symptoms had decreased by 95%, and her Cervical ROM was completely pain-free. The same treatment protocol was performed.

The patient was able to go on the Disney Cruise with her family. She contacted me after she returned and stated that she and her family had a fantastic vacation and that she was completely symptom-free. I recommended that she schedule one visit per month for a session of Medical Massage as a supportive measure to prevent accumulation of tension in the posterior neck.

LESSONS

• Evaluation which is provided by SOMI is a must component of the therapy, since it allows the development of a correct treatment strategy.
• Therapists must formulate therapy using MEDICAL MASSAGE PROTOCOLS as a foundation, but be creative in using steps which match the patient’s symptoms.
• Removing tension in the soft tissues on a layer-by-layer basis allowed us to completely eliminate an acute Migraine Headache in only 4 visits!

ABOUT THE AUTHOR

Category: Blog

Tags: JMS 2016 Issue #2