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.

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.