Sample Case 2: Headaches

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A 38 year-old female presents to an outpatient clinic with a one-year history of intermittent headaches and parasthesias in her right hand. She recalls initially having a spasm in her neck from sleeping on an airplane. The spasm resolved, however since then she has always had tension on the right side of her neck and shoulder. Occasionally, the area becomes achy and causes a headache over the right occipital area. She has also felt like her hand "falls asleep" and she needs to shake it to restore sensation. She denies any radiating pain or weakness in her arm or hand. On exam she is tender with palpation over the right suboccipital space. Muscle tension is noted in the right upper trapezius which when squeezed causes radiating pain to her right temporal area.

This patient has first rib and occipital somatic dysfunction causing thoracic outlet symptoms and tension in her upper trapezius. She will benefit from manipulation of her thoracic and cervical spine, occiput, and upper ribs. Because of the length of her symptoms, the number of treatments required to relieve her symptoms will vary.