Chiropractic management of cluster-tic syndrome : A case report

To report a case of cluster-tic syndrome (CTS), a rare chronic head pain syndrome recognised by the International Headache Society (IHS). This report describes utilisation of chiropractic in a multi-modal management plan for CTS. The case illustrates a cervical association with head pain, a feature that has not previously been reported. The confluence of nociceptive afferents through the trigenminocervical nucleus and trigeminovascular system has been hypothesised to be responsible for the change. Clinical Features: This case involves a 61-year-old Caucasian male who has suffered typical cluster headaches for more than 30 years. He recently developed a tic-like pain that overlapped his typical cluster headaches. Cervical spine flexion relieved the headaches and the tic-like pains. Intervention and Outcome: The condition was managed with a multi-modal approach that integrated a traditional pharmacological approach and chiropractic, which included cervical and thoracic spinal manipulation therapy (SMT). This approach provided great relief when the pharmacological approach alone did not. Conclusions: This paper describes a new form of management for alleviation of cluster-tic syndrome. Further case studies are required to outline the utility of this approach. Future research should investigate the role of the cervical spine in head pain syndromes. Use of allied health professions may provide new opportunities in the management of chronic pain syndromes.