Conservative management of neck and thoracic pain in an adult with neurofibromatosis-1

ObjectiveTo describe the case of a 21-year-old female with previously diagnosed neurofibromatosis type 1 (NF1) with neck, scapular, lumbar, and temporomandibular discomfort along with headaches.Clinical featuresThe patient had chronic tightness and pain in the cervicothoracic region as well as pain in the lumbar spine at the site of prior neurofibroma removal. Radiographs demonstrated multilevel osseous changes. In addition to NF-1, she was diagnosed with cervical myalgia, tension-type headaches, and chronic temporomandibular joint disorder.Intervention and outcomesTreatment consisted of a course of manual therapy including cervical flexiondistraction, myofascial release, patient education on workplace ergonomics, and an at-home active care plan. The patient experienced a reduction in pain and headache frequency.SummaryManual therapy in the form of cervical flexion-distraction with myofascial release and education on workplace ergonomics were effective in reducing neck and thoracic pain as well as reducing headache frequency in a 21-year-old with NF-1.     

The Prevalence of Neck Pain in Migraine

(Headache 2010;50:1273‐1277) Objective.— To determine the prevalence of neck pain at the time of migraine treatment relative to the prevalence of nausea, a defining associated symptom of migraine. Methods.— This is a prospective, observational cross‐sectional study of 113 migraineurs, ranging in attack frequency from episodic to chronic migraine. Subjects were examined by headache medicine specialists to confirm the diagnosis of migraine and exclude both cervicogenic headache and fibromyalgia. Details of all migraines were recorded over the course of at least 1 month and until 6 qualifying migraines had been treated. For each attack, subjects recorded the presence or absence of nausea as well as the intensity of headache and neck pain (graded as none, mild, moderate, or severe). Results.— Subjects recorded 2411 headache days, 786 of which were migraines. The majority of migraines were treated in the moderate pain stage. Regardless of the intensity of headache pain at time of treatment, neck pain was a more frequent accompaniment of migraine than was nausea (P < .0001). Prevalence of neck pain correlated with chronicity of headache as attacks moved from episodic to chronic daily headache. Conclusions.— In this representative cross‐section of migraineurs, neck pain was more commonly associated with migraine than was nausea, a defining characteristic of the disorder. Awareness of neck pain as a common associated feature of migraine may improve diagnostic accuracy and have a beneficial impact on time to treatment.