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Document Typology: Research
Methodology addressed by the publication:International Classification of Functioning, Disability and Health
Title of document: Migraine-Manipulative Therapy
Name of author(s): D.Jatuzis,J.Valaikiene
Name of publisher: Hemodynamics, May 20-23, 2011, Munich, Germany
Language of the publication: English
Language of the review: English
Headache is the common symptom in patients with cervical artery dissection. However, it rarely occurs in isolation, without focal neurological signs, and even more rarely mimics migraine.
We present clinical case of patient with new severe migraine-like hemicrania after cervical manipulative therapy (CMT) in whom contralateral vertebral artery dissection (VAD) was diagnosed after ultrasound and neuroimaging assessment.26 yrs old woman arrived due to severe pulsative unilateral left-side headache, predominantly in temporal region, which started 1 week ago after CMT. Nausea, photophobia, intolerance of physical activity was also present. Patient did not have migraine attacks earlierCervical manipulations were applied for right-side neck pain which alleviated after CMT and resolved 1 week before the onset of hemicrania.
Neurological examination revealed no focal signs.
Reviewer's comments on the document:
Causative relationship between CMT and VAD remains unproven. However, the possibility of VAD should be considered in patients with first attack of migraine-like hemicrania, especially if cervical manipulations or trauma were present recently.
CMT should not be started without ultrasound screening of extracranial arteries in cases of atypical neck pain.n the large number of rheumatic diseases and their often very different types - typical symptomatology is seldom complete - a reliable classification of a particular form of disease is often not easy. The "programmed diagnosis" presented here should be a signpost from the clinical picture, by way of the provisional diagnosis and the necessary diagnostic measures, to the final diagnosis.
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