Application of biomechanical principles to upper cervical spine anatomy to alleviate symptoms of intermittent cranial nerve IX irritation. Directions for successful self-management of headache post-concussion? A case series

ABSTRACT

Background

The neck has been implicated as a potential generator of symptoms such as dizziness and headache in individuals with persistent symptoms post concussion. Anatomically, the neck could also be a potential trigger for autonomic or cranial nerve symptoms. The glossopharyngeal nerve which innervates the upper pharynx is one possible autonomic trigger that might be affected by the upper cervical spine.

Case Description

This is a case series of three individuals with persistent post-traumatic headache (PPTH) and symptoms of autonomic dysregulation who also had signs of intermittent glossopharyngeal nerve irritation associated with certain neck positions or movements. Biomechanical principles were applied to anatomical research on the path of the glossopharyngeal nerve, in relation to the upper cervical spine and the dura mater, to alleviate these intermittent symptoms. The patients were provided techniques to be used as tools to immediately alleviate the intermittent dysphagia, which also alleviated the constant headache at the same time. As part of the overall long-term management program, patients were also taught daily exercises to improve upper cervical and dural stability and mobility.

Outcome

The result was a decrease in intermittent dysphagia, headache, and autonomic symptoms in the long term in persons with PPTH following concussion.

Discussion

Autonomic and dysphagia symptoms may provide clues as to the origin of symptoms in a subgroup of individuals with PPTH.

KEYWORDS:

• Persistent post-traumatic headache treatment
• dysphagia headache
• myodural bridge
• concussion
• autonomic
• sustained neck rotation
• glossopharyngeal
• cranial nerve impingement

Acknowledgements

We would like to acknowledge the illustrative contributions of William “Cody” Vance, GS-11, who was the medical illustrator for the figure contributions to this work.

Disclosure statement

There are no financial disclosures or conflicts of interest to declare. All patients gave consent for inclusion in this case series.

Disclaimer

The views expressed herein are those of the authors and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, The Department of the Air Force, or the Department of Defense of the U.S. Government.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10669817.2023.2233723

Additional information

Funding

The authors received no direct funding for this research.

Notes on contributors

Matt H Hammerle

Matt Hammerle, DPT has treated over 3,000 patients with post-concussive symptoms at Brooke Army Medical Center'’s Brain Injury Rehabilitation Service. In 2011 he contacted Dr. Treleaven after reading one of her articles and suggested that concussion symptoms were very similar to whiplash symptoms. She then joined forces with him and guided him in proper research techniques as they began a decade plus long investigation into the neck's role in concussion. In 2014 Dr. Hammerle won the U.S. Army Medical Command Civilian of the year for 2014 for improved outcomes in the treatment of dizziness post-concussion.

Julia M. Treleaven

Julia Treleaven, PhD is a physiotherapist and Senior Lecturer at the University of Queensland who has been researching whiplash and neck pain since 2000. In 2011 she began guiding Dr. Hammerle in the investigation of the necks role in post-concussive symptoms. She has written over 140 peer reviewed publications, a book and several book chapters related to the management of neck disorders.