• Cooper SR
• Pfefer MT
• Laurencelle R

• Association of Chiropractic Colleges / congresses

CLINICAL FEATURES: A 32-year-old male musician was diagnosed with whiplash-associated disorder by his general practitioner following an automobile accident. He was prescribed physiotherapy and trigger point injections. After three years of treatment he stopped care due to dissatisfaction. He presented to a chiropractic clinic six months later, with daily headaches that had been increasing in severity and frequency, and sharp posterior neck pain. The headaches, described as "vice-like" started mildly increased in severity throughout the day. He reported using an average of eight extra strength acetaminophen tablets per day to control his headaches. Visual inspection showed a mask-like facies, malformation of both hands and the left foot. The left hand had three partial digits, and the right hand had four partial digits. The left foot was truncated at mid-foot and only vestiges of the metatarsals were present. Vital signs were all within normal limits. Cervical range of motion revealed restricted movement and localized, sharp pain in the mid-cervical spine. Cervical compression reproduced the neck pain. Tenderness was noted during manual palpation of the posterior neck musculature. No motor or sensory disruption was noted. Deep tendon reflexes were intact bilaterally. Respiratory, abdominal, and cardiovascular systems were unrevealing. Cranial nerve exam revealed cranial nerves (CN) I, II, III, IV, VIII-XIII were intact bilaterally. Upon testing the abducens nerve, lateral gaze was completely absent. Jaw jerk reflex was present when testing the trigeminal (CN V) nerve; however, dysesthesia was noted around the mouth. The patient stated that the dysesthesia started following surgery to elongate the mandible 13 years earlier. Testing of the facial nerve revealed only very slight movement of the corners of the mouth and no other facial movements. When asked about this condition, the patient stated he had been previously diagnosed with Mobius syndrome. Mr. P rated his pain intensity as a 6.0/10 on a visual analogue scale (VAS). The initial Neck Disability Index (NDI) score was 28 indicating severe disability. The initial Headache Disability Inventory (HDI) score was 68%.

INTERVENTION AND OUTCOME: A working diagnosis of cervicogenic headache with cervical and thoracic joint dysfunction complicated by Mobius sequence was made. Following informed consent the patient underwent 7 treatments consisting of diversified-type spinal manipulation and stretches for the suboccipetal, trapezius, and levator scapulae muscles. The patient was instructed on self-care and stretching. After the first treatment there was a transient increase in cervical stiffness and discomfort that abated within 24 hours. After the seventh and final treatment, the patient rated his pain 1.8/10 (VAS). The NDI immediately post-treatment was 19 (moderate disability). The HDI was 38. At a four month follow-up the patient rated his pain 3.0/10. The NDI was 21 (moderate disability) and the HDI was 34. At this time the patient was taking 2 acetaminophen tablets per day as needed.

CONCLUSIONS: This case documents the successful resolution of cervicogenic-type headache using primarily spinal manipulative therapy in a patient with Mobius sequence, a rare congenital disorder. This is the first report of any manual treatment in this rare population. Future case studies documenting the treatment of rare populations and future research with regard to these populations is needed.

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