Alleviation of Head Pain Associated with Carotid Sinus Hypersensitivity Utilizing Vestibular and Orthoptic Rehabilitation

Background: A 50-year-old, right handed, male businessman, presents for treatment of symptoms associated with Carotid Sinus Hypersensitivity (CSH). Other complaints included head pain and pressure in the front of his head. He rates this pain a 5 out of 6 on a Graded Symptom Checklist (GSC) pain scale. He has difficulty reading for long periods of time. He states that he feels “the walls close in upon him” with any pressure on his neck. Bending forward or placing head in a flexed posture made the symptoms worse. These symptoms have been gradual in onset and had become more frequent. He was given a diagnosis of head pain coexisting with carotid sinus hypersensitivity.

Methodology: On examination the patient was found to have a facial hypomimia. He exhibited a bilateral esophoria and a left hypertropia, using Maddox Rod testing. He had a resting heart rate of 104 bpm. Carotid sinus compression on the right side of the neck produced an absence of heart sounds for approximately to 5 seconds, until the compression was released. A global left-sided extensor weakness (graded at 4/5) was detected upon muscle testing. Gait analysis indicates decreased gait velocity with dual-tasking. Computerized Dynamic Posturography (CDP) revealed overall stability score were 80.64%, with a center of pressure that was anterior 0.5 inches. Saccadometer testing revealed latency and hypermetria bilaterally. Using the rating scales from the Unified Parkinson’s Disease Rating Scale (UPDRS) he had a grade 3 finger tapping bilateral. A treatment program consisting of non-invasive peripheral nerve stimulation, walking near-far exercises with active no-no head movements, vestibular rehabilitation, optokinetic stimulation and visually evoked potentials in the right field of vision was implemented

Results: After 22 treatment sessions over 9 days, the patient reported a significant change in his symptomatology in both headache and head pressure from a constant level of 5to a 1 on a 0 to 6 pain scale. His CDP balance scores improved from 80.64% to 85.295%. Retesting of saccadometer showed improved latency and improved metrics. Despite the improvement in the patient’s symptomatology and vestibular system function, there was not a reduction of carotid irritability.

Conclusion: A condensed schedule of multi-modal therapies may prove to be successful in the alleviation of headache, however may not be effective at alleviating CSH.

Keywords: Headache, Carotid sinus syndrome, Neurorehabilitation, Vestibular Rehabilitation, Orthoptics

Conference: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016.

Presentation Type: Poster Presentation Topic: Abstracts ISCN 2016

Citation: Antonucci MM, Sweeney J and Mullin Elkins L (2016). Alleviation of head pain associated with carotid sinus hypersensitivity utilizing vestibular and orthoptic rehabilitation. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function. doi: 10.3389/conf.fneur.2016.59.00028

Received: 31 Aug 2016; Published Online: 07 Sep 2016.