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Osteopathic Manipulative Treatment of headache in a polytrauma patient: case report

International Congress of Osteopathy - Milan

Vito Adragna

on 31 October 2015

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Transcript of Osteopathic Manipulative Treatment of headache in a polytrauma patient: case report

Osteopathic Manipulative Treatment of headache in a polytrauma patient:
case report

S. Piazzolla, V. Adragna, G. Lo Voi
Somatic Disfunction
Hit - 6
Perspective of the patient
secondary outcome
primary outcome
International headache Society (IHS) Classification 2013
A headache that occurs for the first time in close temporal relation to a trauma, it is coded as a secondary headache trauma-related. This also applies if the headache has the characteristics of the primary forms, namely form migraine, tension-type headache or cluster headache. The International Headache Society classification through the ICHD-II ranks among the secondary headaches those arising as a result of a head injury and/or neck. Regarding headaches attributed to head trauma, until sufficient time has elapsed for the recovery and remission of symptoms (3 months according to IHS) is considered the diagnosis of acute post-traumatic headache. The post-traumatic headache often persists beyond three months, when it happens, for example, after a head injury, there will be a diagnosis of chronic post-traumatic headache. The same classification is used for whiplash.
International Headache Society 2013
Case report
1994: car accident with the mild head trauma (GlasgowComaScale=13), signs and symptoms of concessive syndrome; distraction of the cervical spine; fractures of acetabulum, pelvis, femural neck, knee, ulna and radius; dislocated shoulder was hospitalized for surgery. During hospitalization, after about one week of injury, began to suffer from headaches. Performed neurological examination, neuro radiological investigations, EEG, evoked potentials, vestibular examination and neuropsychological testing without relief of abnormality, she was then diagnosed with post-traumatic headache (ICHD-II: 5 - ICD-10: G44.88).
From 1995 to 2005: surgeries for prosthetic hips and removal of fixation with rehabilitation. In this period permanent recurrent headache: two/three attacks per month for a period of two/three days, not always tolerable and placated with taking ibuprofen.

2012: tamponade, after which, the frequency, duration and intensity of headache increased enough to affect the quality of his life. Underwent new neurological examinations, orthopedic, x-rays and MRIs cervical spine and skull, from which only a verticalization of the cervical spine. She was prescribed collar Shanz, drug therapy and physiotherapy. Despite therapy, continued to have about three episodes of headache per month. He made a further neurological control and then showing no abnormalities, she was advised to run an osteopathic control.
Primary Outcome
Measure the impact headaches have on patient ability to function on the job, at school, at home and in social situations
Secondary Outcome
quantitative evaluation of pain
Primary Outcome
HIT-6 questionnaire
Secondary Outcome
NRS - (Numerical Rating Scale)
Detection time of outcome
HIT-6 questionnaire
baseline before treatment
after last treatment
one month after the last treatment
one year after the last treatment
For each treatment
omt 1 - 2 - 3 - 4 - 5

A great comfort comes to us from the patient which reports that from the first session began to feel the first benefits, sense of relaxation and well-being, the tension in the area of the head and neck disappeared as if you were freed from a compressive weight, the headache is almost gone and has improved the quality of his life, sleep better and feel more rested and serene.
This case allows us to state that the OMT can be a valuable and effective tool for the treatment of post-traumatic headache in the chronic form in order to improve the quality of life of patients.
Describe an osteopathic manipulative treatment (OMT) approach for patients with chronic post-traumatic headache (IHS 5.2.2)
Yeah !
thanks to osteopaths
1. Adragna V, Camerani BM, Desideri R, Abbura F, Simonetto E; Osteopathic manipulative treatment and chronic tension-type headache: outcome research; J Headache Pain (2012), 13 (Suppl):S51-52
2. Anderson RE, Seniscal C; A comparison of selected osteopathic treatment and relaxation for tension-type headache; Headache. 2006 Sep;46(8):1273-80.
3. Branca B, Giordani B, Lutz T, Saper JR; Self-report of cognition and objective test performance in posttraumatic headache; Headache 1996;36:300-6.
4. Duckro PN, Chibnall JT, Tomazic TJ; Anger, depression, and disability: a path analysis of relationships in a sample of chronic posttraumatic headache patients; Headache 1995;35:7-9.
5. Fernández-de-las-Peñas C, Cuadrado ML; Therapeutic options for cervicogenic headache; Expert Rev Neurother. 2014 Jan;14(1):39-49. doi: 10.1586/14737175.2014.863710. Epub 2013 Dec 2. Review.
6. Haas DC; Chronic postraumatic headaches classified and compared with natural headaches; Cephalalgia 1996; 16: 486-493.
7. Hachinski VV; Posttraumatic headache; Arch Neurol 2000;57:1780.
8. Martelli MF, Grayson RL, Zasler ND; Posttraumatic headache: neuropsychological and psychological effects and treatment implications; J Head Trauma Rehabil 1999;14:49-69.
9. Smitherman TA, Nicholson RA, Penzien DB; Osteopathic treatment versus relaxation for tension-type headache; Headache. 2007 Mar;47(3):450-1; editor reply 451-2.
10. Watanabe TK, Bell KR, Walker WC, Schomer K; Systematic review of interventions for post traumatic headache; PM R. 2012 Feb;4(2):129-40. doi: 10.1016/j.pmrj.2011.06.003. Review.

ski M, et al; Qual Life Res. 2003 Dec; 12(8):9
OMT: from March 19 to June 6, 2013
50-year-old woman
OMT + follow up: to June 2014
One year after the last treatment, the patient says he has only had two episodes of headache but mild, lasting only one day and no longer needed to take medication.
Osteopathic Manipulative Treatment
- visceral tecnique
- cranio-sacral tecnique
- miofascial release
Individual treatment
Times of OMT
4 OMT in 8 weeks
code 93.6
impaired or altered function of related components of the somatic (body framework) system: skeletal, arthroidal, and myofascial structures, and related vascular, lymphatic, and neural elements.
code 739
R. Ward, 2003; Fondamenti di Medicina Osteopatica; 1° ed. Milano: Ambrosiana Zanichelli
Somatic dysfunction
- Visceral Tecnique
- Myofascial realease
- Cranio-sacral tecnique
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