Migraine is a common disorder affecting up to 10% of children which can interfere with school attendance, academic and sport performances.1,2 The proposed pathophysiology has evolved from one purely vascular in origin to perhaps a neuro-inflammatory etiology.3,4 Clinical evaluation is the mainstay of diagnosis and should include family history, sleep habits and environmental triggers.5,6,7 Spinal manipulation of the cervical spine in adults and teenagers has shown similar effectiveness as prophylactic medications.8,9 A Canada-wide survey revealed that 7% of chiropractic pediatric patients presented for headaches.10 Unfortunately, there is no substantial data at this point to support the benefit of spinal manipulation in the pediatric sufferers of migraine.11,12,13 Recent research found a link between sleep parasomnia (bruxism), colic and migraine sufferers.7,14,15,16 To achieve a precise diagnosis, clinicians must refer to the latest diagnostic criteria to differentiate true migraines from tension headaches, sinus headaches or other organic causes.17 This case report discusses the chiropractic treatment outcome of a 6-year-old female patient suffering from migraine without aura, sleep bruxism and chronic sinus congestion. The patient was treated with mechanical assisted and manual manipulation techniques, massage and sinus lymphatic drainage. After 4 visits migraine intensity reduced from a 5/10 to a 2/10 and the frequency of headaches were reduced from 3 times per week to once a week without the use of medication. After 6 weeks of care, patient symptoms were significantly reduced but the treatment plan was not completed because the family relocated and continued travel to the office was prohibitive. After 17 weeks, the patient relapsed and 3 weeks later, they resumed care with progressive improvement of the child’s well-being once we eliminated migraine triggers such as sun exposure, incorporation of resting periods with naps in the afternoon and cardiac coherence training exercises before bedtime.1,5,7,18,19 This case report highlights the need for high quality research on the effect of spinal manipulation in the treatment of pediatric migraine to provide a potential alternative option to the traditional medical treatment of migraine. This case also opens the discussion on the benefits cervical manipulations and cranial work may potentially have on sinus drainage and immune system response in autonomic conditions like sinus congestion.
Author keywords: Migraine, children, spinal manipulation, bruxism, sinusitis
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