Cluster Headache Case Study
Title[edit | edit source]
Author/s[edit | edit source]
Emily Meyer, Colleen Niehoff, Mary Wray, Alex Norris, Lauren Snider
Abstract[edit | edit source]
100 word limit, non-structured description
Patient Characteristics[edit | edit source]
Tell us about your patient:
- 49 year old male
- Working as a constuction manager for the past 20 years
- Has had intermittent low back pain for as long as he can remember
- Other co-morbiditis include hypertension and diabetes type II, both of which are controlled with medication
- Patient has received previous outpatient care for his low back pain and describes that he had a decrease in pain for a period of time before the pain returned in his low back.
Examination[edit | edit source]
Subjective
The patient is a 40 year old, deconditioned African American male. The patient reports to physical therapy for a work-hardening evaluation that a company has requested in order to clear him for heavy labor. Half way through the lifting evaluation, the patient immediately stops in the middle of the timed trial and sits down against the wall. When the therapist attends to the patient, he reports that he has been experiencing these “headache attacks” for the past month around this time of day. The patient is moved to a private treatment room with the lights off so that he may lie down and rest; however, he instead paces back and forth around the room. Once the patient is stable, the therapist begins to interview the patient on the nature of these headaches. The patient reports that since he started working late night shifts at the construction company one month ago, he was forced to nap throughout the afternoon in order to be safe to work in the early hours of the morning. However, when he would wake up he would experience excruciating, burning pain above and behind his left eye. The pain was so severe that he could “feel something pulsating on the side of my head.” Once the pain subsided 20-30 minutes later, the patient looked in the mirror and saw that his left eyelid was red, swollen, and teary. The patient explains that these headaches have continued, and always seem to start after he wakes up at 5 p.m. (the time of this evaluation), approximately 3-4 times per week. When asked if lying down reduced the symptoms, the patient explained that laying down actually made the pain worse, so he is forced to pace around. In addition, the patient denies an increase in symptoms while staring at lights. The therapist asks if he ever feel nauseous, dizzy or confused. The patient denies any of these symptoms and believes these headaches are just “his body’s way of adjusting to the change in sleep patterns.”
Past Medical History: CAD, DM, HTN
Family History: CAD, DM
Risk Factors: 1 pack/ day smoker, 1-2 Beer/ day
Objective Measurements
Vital Signs:
• Heart Rate: 88
• Blood Pressure: 122/ 80 (Controlled with Lisinopril)
• Respiratory Rate: 16
Pain Scale: During attack 9/10
Sensation: Intact
Reflexes: Intact
AROM:
• Cervical Flexion: WNL
• Cervical Extension: WNL
• Cervical R/ L Rotation: WNL
• Cervical R/ L Sidebend: WNL
• Shoulder Flex/ ABD/ ER/ IR: WNL
MMT:
• Cervical Flexion/ Extension: 5/5
• Cervical ROT: 5/5
• Shoulder Flexion: 5/5
• Shoulder IR/ER: 4+/5
• Shoulder ABD: 4+/5
• Scapular Retractors: 4/5
• Elbow Flexion/ Extension: 5/5
Palpation: No palpable tenderness along suboccipital, upper trapezius, or levator scapulae muscles.
Balance and Vestibular Assessments:
• Single Limb Stance Eyes Open: 36 seconds
• Single Limb Stance Eyes Closed: 20 seconds
• VOR x 1: Negative
• VOR x 2: Negative
• Saccades: Negative
• Smooth Pursuit: Negative
• Nystagmus: Negative.
• Visual Field Cut: Negative
Clinical Hypothesis[edit | edit source]
What was your clinical impression of the patients problem.
Intervention[edit | edit source]
Multidisciplinary approach
- Neurologist
- ENT
- PT: May need to rule out more serious complications before initiating PT
- Y's and T's
- Deep neck flexors
Manual Therapy
- Mobilizations to cervical spine [3]
Other
- General stretching to postural muscles (i.e. Upper Trap) [2]
- Heat [4]
- US [4]
- TENS [4]
- Soft tissue/trigger point massage [1],[4]
- Balance and gait training with use of varying sensory inputs [2]
- Posture education [1],[2]
- Education on ergonomics at home and in the workpalce [1]
Out of our scope
- Relaxation therapy [1],[2],[3]
- Biofeedback [1]
- Cognitive-behavioral therapy (stress-management) [4]
- Acupuncture [4]
- Medications [1],[3]
Outcomes[edit | edit source]
What was the outcome of the intervention.
Discussion[edit | edit source]
This summary statement should include related findings in the literature, potential impact on clinical practices etc.
Related Pages[edit | edit source]
add links to related pages here
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Biondi D. Physical Treatments for Headache: A Structured Review. Headache.2005 Jun;45(6):738-46.
- ↑ 2.0 2.1 2.2 2.3 2.4 Whitney S, Wrisley D, Brown K, Furman J. Physical Therapy for Migraine-Related Vestibulopathy and Vestibular Dysfunction with History of Migraine. Laryngoscope. 2000 Sept; 110(9): 1528-34.
- ↑ 3.0 3.1 3.2 Chaibi A, Tuchin PJ, Russell MB. Manual Therapies for Migraine: A Systematic Review. J Headache Pain. 2011 Apr;12(2):127-33.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Vernon H, McDermaid C S, Hagino C. Systematic review of randomized clinical trials of complementary/alternative therapies in the treatment of tension-type and cervicogenic headache. PubMed [10581824]. 2002 Feb [cited 2015 Mar]. Available from: http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?AccessionNumber=12000003174#.VQyOvEtgNuY.
