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Case Reports
. 2023 Dec;31(6):457-465.
doi: 10.1080/10669817.2023.2233723. Epub 2023 Jul 10.

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

Matt H Hammerle  1 , Julia M Treleaven  2
Affiliations
Case Reports

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

Matt H Hammerle et al. J Man Manip Ther. 2023 Dec.

Abstract

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.

Keywords: Persistent post-traumatic headache treatment; autonomic; concussion; cranial nerve impingement; dysphagia headache; glossopharyngeal; myodural bridge; sustained neck rotation.

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Conflict of interest statement

There are no financial disclosures or conflicts of interest to declare. All patients gave consent for inclusion in this case series.

Figures

Figure 1.
Figure 1.
Relationship of the myodural bridges and the suboccipitals to the dura mater and the glossopharyngeal nerve with it'’s respective branches to the upper cervical spine.
Figure 2.
Figure 2.
Inferior view of the branches of the glossopharyngeal nerve and their relationship to the upper cervical spine. Note the dural septa that separates the glossopharyngeal nerve from the vagus and spinal accessory nerves. In some indiviiduals this can be a boney canal.
See this image and copyright information in PMC

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