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Guias e Dicas
Guias e Dicas

Tratamento da cefaléia com maitland, Notas de estudo de Fisioterapia

Australian Journal of Phisiotherapy v4i1

Tipologia: Notas de estudo

2010

Compartilhado em 03/05/2010

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MIGRAINE 23 MIGRAINE G. D. MAIILAND, MAPA. Adelaide Since concentrating on the field of 1, Vasoconstriction, affecting the intra- manipulatior TI have found suficient cranial arteries and causing the cortical evidence to show how and why the chiro- practors and osteopaths can claim to cure such a wide variety of complaints, ranging from angina to acute appendicitis. 1 have also iound that there is no end to the scientific «work which can be done in this fieid as a branch of medical science. One aspect which has been of interest is the treatment of headache by traction and manipulation. In this paper E will discuss only migraine, Relevant published material will be mentioned and the results of manipulative treatment of one patient with migraine discussed, According to Friedman (1955), the clinical pritúre of migraine is headache which is “paroxysmal, periodic, unilateral and throbbing”, occurring against a back- ground of weli-being. Moench (1948) says that at is not a disease entity but is rather a variable symptom complex with a wide variety of manifestations. According to Wolff (1948), its main features appear to be that the pain is periodic and usually unilateral at the onset; later it may become generalized. Tt is usually associated with irritability and nausea, and often associated with photophobia, vomiting, constipation and diarrheea. There may be prodromal symptoms of scotoma, hemianopia, unt- lateral paresthesia and speech disorders. Pain is commonly limited to the head but may include the face and neck. Wolff, Moench and muny other writers describe a feeling of well-being which the patients experience prior to an attack. This is very common and patients are often heard to say “J am dangerously wel] today”. There are all gradations of migraine, from the most severe and disabling illness to trifling symptoms; the duration of an attack may be hours or days. Peters (1953) cutlined three phases through which the patient passes phenomena such as scotoma, hemianopia, diplopra, paralysis, paresthesa and aphasia. This is the short prodromal stage which usually lasts less than thirty minutes. 2. Vasodilatation, causing the gastro- intestinal disturbances and the pounding, throbbing headache, It is in this stage that the patient looks ill. During this stage ergotamine drugs may give complete relief of the headache, although the nausea and vomiting usually continue. 3. CEdema, which is characterized by hard swollen extracranial vessels. In this stage the throbbing pain changes to a constant or sharp pam, with tenderness which lingers on until the attack ends, ustally with exhaustion. As the pain of a migraine attack becomes more severe it spreads, usually from a uni- lateral position to a bilateral position. Marmion (1957) describes an experiment carried out by Knuckle and Armstead which showed that if the middle finger is immersed in ice-cold water and becomes painful, after a time the pain spreads to the adjacent fingers. This spread of pain can ueither he prevented nor relieved by local anasthesia, Although in migraine the immediate cause of the pain is stimulation of the pain- sensitive nerves in and around the difated cranial arteries by the increased amplitude of pulsation, it is cvident that dilatation of blood vessels alone is not sufficient to pro- duce headache. Other dynamic or chemical factors as yet not clearly delineated must contribute (Friedman, 1957). Merritt (1957) says that migraine is a functional disorder but Friedman states that psycho- dynamic factors are important but cannot alone be the cause. He feels that there may be an inherent functional instability of autonomie, endocrine, vascular or enzyme systems, 2 THE ÁUSTRALIAN JOURNAL OF PHYSIOTILERAPY “The only reference to the part played by the cervical spine is that “any pain in the head and neck, shoulder, chest or peri- cardium which is aggravated by coughing, sneezing or straining, is apt to be due to arthritis of the cervical spine” (Moench, 1948). The cure of migraíne appears to be a permanent problem. Peters (1953) states that while one cannot expect to cure migraine. much relief can be afforded if the physician is willing to take the time to talk with the patient. Drug therapy, while heip- ful, is seldom a complete answer. The patient often needs to learn to recognize his prodromal symptoms early, so that appro- priate drugs may be taken promptiy to abort his attacks. This appears to be the main therapeutic approach to migraine. Three relevant articles may be mentioned for their discussion of what may be con- tributory factors. Ryan and Cope (1955) discuss cases of what they term “cervical vertigo”; all these patients had pain in the back of the neck and occipital region. The syndrome could be reproduced by move- ments of the neck. Tissington Tatlow and Bammer (1957) consider that this syn- drome means involvement of the vertebral artery, De Kleyn and Versteegh (1933), from autopsy studies, describe a decrease of vertebral circulation on one side when the head is turned backwards and to the opposite side. Casr Rerorr This patient is described because she had the worst migraine which I have encoun- tered and becanse the result of treatment has been so good. Mrs. H., a woman of 40 years, was referred for treatment. Her doctor stated that she had occipital pain and that there was a disc lesion between the fifth and sixth cervical vertebre: “she also has migraine which T think is a separate entity but no doubt aggravated by the neck lesion”. Her history was one of migraine attacks for twenty-one years, and at the stage of commencement of treatment she was having two attacks every weelz. These attacks would continue unless stopped by treatment with injections, and even with the injections her attacks would last two days. On one or two vecasions they had lasted as long as eight days. The attacks all required complete rest and quiet- ness. She complained of a vicious throb- bing pain in the occipital region which travelled over the top of the head to the frontal region. Usually the right side was more severely affected, but sometimes the pain was greater on the left, especially if there was no break between attacks. There was also a right parietal pain which the patient described as a severe “car pain”. The accompanying symptoms were a lack of concentration, nansea and a blurring or fogginess of vision so that she felt she must close her eyes. The family history was of interest as her mother also suffered from migraine. Ali or nearly alí her attacks were preceded by a marked feeling of well- being. She even used the typical words “dangerously well”. Up to the time of treatment by manipulation she had been treated by dihydroergotamine and “Gyner- gen”, which, in her case, gave relief from the headache but did not prevent the gastro- intestinal and mental disturbances. These were her only means of relief from an attack, She first came for treatment at the end of an attack. She was treated daily for seven days. At the fourth treatment, which was the time for a new attack to begin, she had none of the symptoms of her migraine except head pain. She did not take any drugs but continued with manipulative treatment. At the end of three more days she was free of symptoms and remained so for ten days. This was the longest period of freedom up to that time. The second session of treatment began after the ten asymptomatic days at the onset of an attack which at this stage was two hours old. Painful timitation of head movement was more consistent than previ- ously, as the pain was more localized, less vague and less severe than at the earlier stage of treatment, Extension of the head with rotation to the right was the movement affected and it increased all her symptoms, Treatment continued for ten consecutive days through two mild attacks, the end result again being complete freedom from symptoms. During these two phases the value of traction and the various manipula-