• Neff SM
• Garcia BC

• Adult
• Affiliation / Martinsburg Veterans Affairs Medical Center
• Affiliation / Palmer College of Chiropractic
• Affiliation(G) / United States / Iowa / Davenport
• Affiliation(G) / United States / West Virginia / Martinsburg
• Male
• Migraine Disorders / diagnosis
• Open Access Document
• Stroke / diagnosis
• Vertebral Artery Dissection / diagnosis

Introduction: The purpose of this case report is to describe the management of a patient with an atypical migraine at an integrated veterans’ hospital setting. Patients often utilize chiropractic for the treatment of headaches disorders. While headaches most commonly are benign, in some cases a headache may indicate a much more serious pathology.

Clinical Features: A 41-year-old male sought care for a severe episode of acute neck pain and neck stiffness, which was accompanied by abnormalities upon neurological examination. The patient exhibited nystagmus and complained of diplopia when cardinal planes of gaze were evaluated. The patient was unable to perform heel to shin,tandem gait, finger-nose, and finger-nose-finger tests. Initially, a vertebral artery dissection was suspected, based upon the patients age, and presentation. With concerns that this patient was suffering from a stroke, he was immediately transported to the emergency department (ED) on site where further examination was performed.

Intervention and Outcome: The arteries within the cervical spine and head were evaluated via vascular ultrasound and magnetic resonance angiography (MRA) to rule out cerebrovascular accident.

Advanced imaging determined that this patient was not experiencing a vertebral artery dissection or stroke, and the patient was diagnosed with an atypical migraine.  The patient’s migraine was treated in the ED with Dilaudid 1mg, Reglan IV and Compazine.  He was discharged and directed to return to the chiropractic clinic the next morning.  He returned to the chiropractic clinic the following morning, and he was treated utilizing diversified high-velocity, low-amplitude (HVLA) manipulationto the cervical spine.  He reported relief following treatment.

Conclusion: This case report demonstrates the need for thorough history and neurological exam when a patient presents with a migraine in the chiropractic office and serves as a reminder that life-threatening conditions should be ruled out before proceeding with chiropractic care.

Author affiliations: SMN: Staff Chiropractor, Martinsburg Veterans Affairs Medical Center, Martinsburg, WV; Adjunct Faculty, Palmer College of Chiropractic; BCG: Student, Palmer College of Chiropractic

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