Upper cervical chiropractic management of a patient with headaches, neck pain and a history of traumatic internal carotid artery compromise: a case report

OBJECTIVE: This case describes the upper cervical chiropractic management of a patient with neck pain and headaches with a history of cervical artery compromise following a motor vehicle accident. BACKGROUND: A 54-year-old male with neck pain and headaches was seen in a chiropractic office. Eight months prior to his initial visit, the patient was involved in a motor vehicle accident (MVA) which resulted in partial dissection of his left internal carotid artery. The patient reported severe cervicalgia, headaches and painful restricted cervical motion. Physical exam and cervical imaging assessed acceptable risk for treatment and indicated altered axis of motion in the first cervical vertebrae (C1) relative to the occiput (Co). OUTCOMES: The patient was examined over a 6 month period and received a total of 5 Blair upper cervical chiropractic adjustments. Physical exam findings, the Numerical Rating Scale (NRS), the Neck Pain Disability Index (NDI) and the RAND-36 outcomes were used to track progress. The NRS, NDI and RAND-36 demonstrated positive changes in presenting symptoms. CONCLUSION: More investigation is needed to understand the relationship between a history of traumatic cervical artery compromise and the effectiveness and safety of upper cervical chiropractic care utilizing Blair protocol to manage latent symptoms.