An unusual postural headache: a case report
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(2020) 28:56
CASE REPORT
Open Access
An unusual postural headache: a case report Henry Pollard1*
and Rachel Pollard2
Abstract: Background: This paper presents a case of an evolving unusual thunderclap headache that presented to a chiropractor. Case presentation: The intense “migraine-like” headache was aggravated by standing up and relieved substantially when lying down. This low pressure, orthostatic headache was diagnosed as a spontaneous intracranial hypotension (SIH) secondary to a spontaneous tear of the dura. It was referred to the local hospital for management with autogolous blood injection to form an epidural blood patch of the defect. It resolved substantially within 3 days. Conclusions: The significance of key features in the history and examination and how if not recognised and subsequently treated with manual therapy, the dural tear could be attributed to the treatment of the chiropractor, a treatment that would typically involve cervical manipulation. Discussion is provided of the implications of a missed diagnosis and possible subsequent chiropractic management with the evolving SIH being attributed to the chiropractic intervention rather than its true “spontaneous” nature. Keywords: Spontaneous intracranial hypotension (SIH), Chiropractic, Postural headache, Telemedicine, Diagnosis, Adverse event
Background Intense headaches are relatively uncommon and potentially dangerous diagnostic challenges. Whilst there are commonly occurring intense headaches such as migraine, it is the unusual intense headache that presents the diagnostic challenge. It is taught that the practitioner should consider the patient who describes their headache as being “the worst headache that I have ever had” as a cause for concern [1]. Another equally important patient observation is the regular headache sufferer who presents with a “new” headache unlike any before it, especially if that headache is intense or the worse suffered [2]. Determining the nature of the headache is important [3]. Consideration of the location (unilateral, bilateral, focal) the time to onset, the associated symptoms, the * Correspondence: [email protected] 1 School of Medical and Applied Sciences, CQUniversity Sydney, Level 11, 400 Kent St, Sydney, NSW 2000, Australia Full list of author information is available at the end of the article
association with neck and body (cevicogenic, meningitis, encephalitis) and precipitating red flag conditions are all important. Red flags in the headache history are of concern and should be screened. Red flags include: (1) systemic symptoms including fever; (2) neoplasm history; (3) neurologic deficit (including decreased consciousness); (4) sudden or abrupt onset; (5) older age (onset after 65 years); (6) pattern change or recent onset of new headache; (7) positional headache; (8) precipitated by sneezing, coughing, or exercise; (9) papilledema; (10) progressive headache and atypical presentations; (11) pregnancy or puerperium; (12) painful eye with autonomic features; (13) posttraumatic onset of head
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