Presentation on theme: "American College of Osteopathic Pediatricians"— Presentation transcript:
1American College of Osteopathic Pediatricians An Osteopathic Module for the Pediatric Migraine Patient Rachael Zanotti-Morocco, DOAmerican College of Osteopathic Pediatricians
2BackgroundAT Still, DO was known to cure a migraine with a swing. Migraines are common in the pediatric population. Migraines affect 4% of children in the US. 50% of children that present to their primary doctor with the complaint of headache are diagnosed with migraine. The male to female ratio in children is 1:1. Migraines are characterized by throbbing pain, nausea, vomiting, photophobia, phonophobia, irritability, paresthesias, and tightness of neck and scalp muscles. Migraine attacks can last as long as 1-3 days and can be quite disabling. Migraines in children are often of shorter duration than adults and can be characterized by less pronounced symptoms such as cyclic vomiting, abdominal pain and vertigo.
3BackgroundMigraines are caused by disordered neurogenic control of the craniocervical circulation especially the trigeminal vascular system. The cerebral blood vessels are affected by trigeminal, vagal and upper cervical neurons that converge in the trigeminal nucleus in the brainstem. The current theory is that some trigger (different in each patient) causes enhanced neuronal firing that sends a wave of depolarization to these pain sensitive blood vessels resulting in an inflammatory reaction causing vasodilatation and irritation to surrounding nerves. This results in pain.
4BackgroundDuring the acute phase of migraine, active OMT techniques can increase blood flow to the head resulting in an exacerbation of symptoms. Therefore, at that time gentle techniques such as cervical/thoracic myofascial release and sub occipital release should be performed. 75% of patients with migraine complain of back or neck pain during, or immediately before a migraine. In these patients, special attention should be given to the muscles of the neck, scalp and upper thoracics. Children with migraines have been found to have paraspinal muscle spasm at the level of T4, along with neck muscle spasms. In the times that a patient is not having a migraine, more direct techniques can be used such as cervical HVLA which can prevent further migraines from occurring. For some patients, one of the triggers of migraine is musculoskeletal pain and by eliminating this trigger, these migraines can be avoided.
6How It Is Done: 1)Patient is supine. 2)Physician stands at head of patient on opposite side to be treated3)Place one hand on the patient’s forehead.4) With the other hand grasp the posterior cervical muscles and stretch.
7Demonstrate the procedure on patient in front of director
9How It Is Done: 1)Patient is supine with physician at head of bed. 2)Place index and middle fingers in the occipital sulcus on both sides.3)Apply linear traction until a release is felt, about 1 minute are as long as needed to feel the release.
10Demonstrate the procedure on patient in front of director
12How It Is Done:1) Patient is supine with physician sitting at the head of patient.2)Place 2nd metacarpophalangeal joint along the posteriorly rotated articular pillar.3)Side bend away and rotate towards the point of somatic dysfunction.4)Apply rapid rotary thrust and then recheck to see if dysfunction is improved.
13Demonstrate the procedure on patient in front of director
14Innervation Table Organ/System Parasympathetic Sympathetic Ant. Chapman'sPost. Chapman'sEENTCr Nerves (III, VII, IX, X)T1-T4T1-4, 2nd ICSSuboccipitalHeartVagus (CN X)T1-4 on L, T2-3T3 sp processRespiratoryT2-T73rd & 4th ICST3-5 sp processEsophagusT2-T8---ForegutT5-T9 (Greater Splanchnic)Stomach5th-6th ICS on LT6-7 on LLiverRib 5 on RT5-6GallbladderRib 6 on RT6SpleenRib 7 on LT7PancreasT5-T9 (Greater Splanchnic), T9-T12 (Lesser Splanchnic)Rib 7 on RMidgutThoracic Splanchnics (Lesser)Small IntestineT9-T11 (Lesser Splanchnic)Ribs 9-11T8-10Appendix T12Tip of 12th RibT11-12 on RHindgutPelvic Splanchnics (S2-4)Lumbar (Least) SplanchnicsAscending Colon Vagus (CN X)T9-T11 (Lesser Splanchnic)R hipT10-11Transverse ColonNear KneesDescending ColonPelvic Splanchnic (S2-4)Least SplanchnicL hipT12-L2Colon & RectumPelvic Splanchnics (S2-4)T8-L2
15Print out the answer sheet to use with the following questions.
16Circle the correct answer and review with director: Question1: A, B, C, D, E.Question2: A, B, C, D, E.Question3: A, B, C, D, E.
17Question 1A 12 year old presents with headaches that have been defined as migraines. You may perform the following OMT.a. Galbreath maneuvreb. Occipital releasec. Sinus effluraged. Triple releasee. Temporal release
18Question 2 Dr Still once used this to treat his own migraine: a. a pulley systemb. a mulec. a swingd. a tractore. a tree limb
19Question 3Migraines are typically caused by problems with which nerve:a. vagus nerveb. trigeminal nervec. occipital nerved. phrenic nervee. accessory nerve
20Certificate of Completion I, _________________________, successfully completed the Pediatric OMT Module on __ __ 20__Signatures:Pediatric Resident ____________________Pediatric Residency Director____________( Please print and give to program director.)