Chiropractic Treatment of Mild Head Trauma: A Case History

Blum CLProceedings of the 2002 International Conference on Spinal Manipulation, Toronto Ontario, CanadaOct 2002;:136-8

Introduction: Background: A female in her mid 30s has been seen at this office for the past year and a half for a closed head injury she sustained at work on August 7, 2000. She presented with mild head trauma (MHT) secondary to “hitting her head” on a ledge above her desk at work.

Objectives: Evaluating incorporating cranial manipulative therapies and sacro occipital technique into conservative methodologies of treatment for MHT.

Purpose: The purpose of this case study is to illustrate how cranial manipulative therapy (CMT) and sacro occipital technique (SOT) can be used to treat MHT. In the months following the accident, the patient had persistent headaches, myofascial pain in the cervical and upper thoracic regions as well as mood alterations. She was referred to a neurologist for an evaluation and to help monitor her recovery following the initial stage of chiropractic care. The patient was also referred for biofeedback care for head trauma and was recommended to seek a psychiatric evaluation. When she was last seen for a neuropsychiatric evaluation she was recommended to investigate the “Brain Injury Rehabilitation Center” at a Los Angeles based hospital. With regards to head trauma research has shown that “persistent headache is a common symptom following a minor head injury concussion, possibly related to simultaneous injury of structures of the cervical spine.” [1] Chronic, recurrent headache is a common sequelae to head injury. “The evaluation and analysis of post-traumatic headache is very difficult, as is reflected in the extensive literature on this subject. Headache that results from head trauma is often accompanied by other symptoms such as dizziness, difficulty in concentration, nervousness, personality changes, and insomnia. This constellation of symptoms is known as the “post-traumatic syndrome.”[2,3] Problems related to “mild traumatic brain injury (MTBI) include various pain syndromes, cognitive impairments, disorders of affect, cranial nerve dysfunction, and vertigo, arising from injury to the brain, head, or cervical spine. Symptoms are usually transient, although a small percentage of afflicted individuals develop long-lasting problems, often preventing them from leading productive lives.” [4] “Neurologic injuries, such as head trauma often cause changes in mood. Mood alterations, including depression, mania, and compulsive behavior, are difficult to quantify.” [5] It has also been found that, “head trauma may produce alterations of consciousness by direct damage to the brain-stem reticular activating system or by widespread damage to the cerebral hemispheres.” [6] The subject has been a patient at various times over the years at this office. She had never presented with the specific constellation of conditions such as headache, neck and upper thoracic pain, and mood alterations. Since her injury, she consistently indicated her desire to be able to return to full pre-injury activities and exhibited the anticipated frustration when this has not been possible for her. Croft notes that “A significant number of patients with minor brain injuries and cervical spine injuries develop subjective symptoms, such as insomnia, irritability, cognitive deficits, headaches, and visual disturbances, which physicians have historically been unable to account for on an organic basis. Owing to the fact that many such complaints are also seen in a variety of emotional disorders and the fact that many of these individuals are involved in litigation, pejorative terminology such as “litigation neurosis” and “compensation neurosis” has evolved and become firmly entrenched within the medical vernacular. Recent research has provided compelling evidence that such subjective complaints may arise out of organic lesions and, coupled with a review of the literature concerning outcomes… with cases of postconcussion syndrome (PCS) in litigated and nonlitigated cases, suggests that the terms “litigation neurosis” and “compensation neurosis” should be abandoned.” [7]

Methods: The patient sought treatment at this office for the treatment of post traumatic head trauma and my particular expertise in cranial therapeutic care. There have been some studies which have discussed chiropractic’s treatment for care and evaluation of brain trauma, post traumatic headache, or closed head trauma. [8-10] Chiropractors skilled in treatment of the cranium and related meninges can use gentle methods to alleviate stress, tension and disability associated with head injuries. During care, the patient had tried various alternatives to the chiropractic care; however, she apparently had negative side effects to medication prescribed and her MHT symptomatology would be exacerbated. Chiropractic care and manual therapies have been shown to be an effective method of care for head trauma. [11-14] There are some articles published in chiropractic literature regarding treatment of cranial trauma and related conditions. [15-7 ] The patient received chiropractic care in the form of CMT [18-32] and SOT [33-40] for treatment of sequelae secondary to MHT, such as disorientation, dizziness, head and neck pain, depression, and blurred vision. While not conclusive, cranial therapies have shown to be a conservative method of care for closed head trauma and the sequelae associated with traumatic pressures to the brain [15-7, 42-4].

Results: The patient had relatively normal EEG and MRI however was still symptomatic months following MHT. She found that CMT and SOT would control her symptoms of disorientation, dizziness, depression, head and neck pain, and blurred vision for periods of 3-7 days. While various alternatives had been sought for her ongoing discomfort, she found that pharmaceutical medications, which were prescribed, upset her stomach, exacerbated her depression and fatigue.

Discussion: The patient was concerned that after being evaluated and treated by two neurologists and taking medication, her condition had not improved significantly months following trauma. Periods of time were taken where SOT and CMT were not employed to evaluate the necessity or effectiveness of treatment. In each case following increased time away from care her symptoms regressed or worsened. There have been some studies suggesting that CMT can affect EEG and CEEG Studies [17 ] as well as Brain Stem Evoked Response [45], which might help explain the effectiveness of CMT for MHT. Treatment of closed head trauma, mild brain traumatic injury and post concussion syndrome is an inexact science. Usually the goal is to aid the patient in their ability to function and gradually return to pre-injury levels of activity. With different patients and different magnitude or direction of head trauma, predictions of length of care necessary to allow normal functioning is difficult to ascertain.

Conclusion: It is suggested that greater research is needed into the study of chiropractic’s care of MHT and whether CMT and SOT might be an effective conservative mode of treatment for this condition.

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