Multimodal Neurorehabilitation of a Patient with Chronic Headache Syndrome
Background: A 33-year-old male patient presented with a previous diagnosis of chronic headache syndrome. His primary care physician had previously diagnosed the patient and diagnosis was confirmed through his medical neurologist and chiropractor. The patient had a chief complaint of decreased ability to concentrate, memory loss, and brain fog. The patient reported a constant pounding pressure of the left temporal region, which started 3 years prior and has progressively gotten worse. Additionally, the patient reported that he felt a “constant sensation of rotation of his eyes” which kept him awake at night.
Methods: The patient underwent a comprehensive neurologic examination including cognitive testing through the C3 Logix™ program utilizing digital symbol matching and Trails A & B. Examination revealed an anisocoria, a V:A ratio of 3:1 on the left, a leftward drift of the eyes and a left hypertropia. A normal optokinetic response was present with horizontal stimulation bilaterally, however a decreased response was noted in the downward direction. Anti-saccades were successful in six out of ten attempts, although processing speed was delayed. The patient was treated daily, throughout the day, for one week. Treatments included orthodromic somatosensory nerve stimulation without head recording on the ophthalmic branch of the trigeminal nerve bilaterally to maximum tolerance and to the mandibular branch of the trigeminal nerve to the point where fasciculations were generated. Additionally, neuromuscular re-education therapy, vestibular rehabilitation exercises, vision therapy, therapeutic activities, and multi-axis rotational therapy were included as treatments.
Results: Following this treatment protocol, the patient’s V:A ratio was reduced to 1:1 bilaterally. Anti-saccades were successful in all ten out of ten attempts, with increased processing speed. The patient reported that his headaches had decreased and mental clarity had improved, which was evidenced by repeated cognitive testing through the C3 logix™ program. Trails A improved from 40.4 seconds to 19.7 seconds, while Trails B improved from 65.0 seconds to 43.0 seconds.
Conclusion: The improvement of neurological function and subsequent decrease in headache symptoms in this case indicates that brain-based treatment can potentially be effective in the management of chronic headache syndrome. These results promote the need for further research in this area.