Transcript An Osteopathic Module for the Pediatric Migraine Patient

American College of
Osteopathic Pediatricians

AT Still, DO was known to cure a migraine with a
swing. Migraines are common in the pediatric
population. Migraines affect 4% of children in the US.
50% of children that present to their primary doctor
with the complaint of headache are diagnosed with
migraine. The male to female ratio in children is 1:1.
Migraines are characterized by throbbing pain,
nausea, vomiting, photophobia, phonophobia,
irritability, paresthesias, and tightness of neck and
scalp muscles. Migraine attacks can last as long as 13 days and can be quite disabling. Migraines in
children are often of shorter duration than adults and
can be characterized by less pronounced symptoms
such as cyclic vomiting, abdominal pain and vertigo.

Migraines are caused by disordered neurogenic
control of the craniocervical circulation
especially the trigeminal vascular system. The
cerebral blood vessels are affected by
trigeminal, vagal and upper cervical neurons
that converge in the trigeminal nucleus in the
brainstem. The current theory is that some
trigger (different in each patient) causes
enhanced neuronal firing that sends a wave of
depolarization to these pain sensitive blood
vessels resulting in an inflammatory reaction
causing vasodilatation and irritation to
surrounding nerves. This results in pain.

During the acute phase of migraine, active OMT techniques
can increase blood flow to the head resulting in an
exacerbation of symptoms. Therefore, at that time gentle
techniques such as cervical/thoracic myofascial release and
sub occipital release should be performed. 75% of patients
with migraine complain of back or neck pain during, or
immediately before a migraine. In these patients, special
attention should be given to the muscles of the neck, scalp
and upper thoracics. Children with migraines have been
found to have paraspinal muscle spasm at the level of T4,
along with neck muscle spasms. In the times that a patient is
not having a migraine, more direct techniques can be used
such as cervical HVLA which can prevent further migraines
from occurring. For some patients, one of the triggers of
migraine is musculoskeletal pain and by eliminating this
trigger, these migraines can be avoided.
 1)Patient
is supine.
 2)Physician stands at head of patient on
opposite side to be treated
 3)Place one hand on the patient’s
forehead.
 4) With the other hand grasp the
posterior cervical muscles and stretch.
 1)Patient
is supine with physician at head
of bed.
 2)Place index and middle fingers in the
occipital sulcus on both sides.
 3)Apply linear traction until a release is
felt, about 1 minute are as long as
needed to feel the release.
 1)
Patient is supine with physician sitting
at the head of patient.
 2)Place 2nd metacarpophalangeal joint
along the posteriorly rotated articular
pillar.
 3)Side bend away and rotate towards the
point of somatic dysfunction.
 4)Apply rapid rotary thrust and then
recheck to see if dysfunction is improved.
Organ/System
EENT
Parasympathetic
Sympathetic
Ant.
Chapman's
Post.
Chapman's
T1-T4
T1-4, 2nd ICS
Suboccipital
Heart
Cr Nerves (III, VII, IX,
X)
Vagus (CN X)
T1-T4
T3 sp process
Respiratory
Vagus (CN X)
T2-T7
T1-4 on L,
T2-3
3rd & 4th ICS
Esophagus
Vagus (CN X)
T2-T8
---
T3-5 sp
process
---
Foregut
Vagus (CN X)
T5-T9 (Greater Splanchnic)
---
---
Stomach
Vagus (CN X)
T5-T9 (Greater Splanchnic)
Liver
Vagus (CN X)
Gallbladder
T6-7 on L
T5-T9 (Greater Splanchnic)
5th-6th ICS on
L
Rib 5 on R
Vagus (CN X)
T5-T9 (Greater Splanchnic)
Rib 6 on R
T6
Spleen
Vagus (CN X)
T5-T9 (Greater Splanchnic)
Rib 7 on L
T7
Pancreas
Vagus (CN X)
Rib 7 on R
T7
Midgut
Vagus (CN X)
T5-T9 (Greater Splanchnic), T9T12 (Lesser Splanchnic)
Thoracic Splanchnics (Lesser)
Small Intestine
Vagus (CN X)
T9-T11 (Lesser Splanchnic)
Ribs 9-11
T8-10
Tip of 12th Rib
T11-12 on R
Appendix
Hindgut
Ascending Colon
Transverse Colon
T12
Pelvic Splanchnics (S24)
Vagus (CN X)
Vagus (CN X)
Lumbar (Least) Splanchnics
T9-T11 (Lesser Splanchnic)
T5-6
---
---
---
--T10-11
T9-T11 (Lesser Splanchnic)
R Femur @
hip
Near Knees
L Femur @ hip
T12-L2
Descending Colon
Pelvic Splanchnic (S2-4)
Least Splanchnic
Colon & Rectum
Pelvic Splanchnics (S24)
T8-L2
---
---
---
 Question1: A, B, C, D, E.
 Question2: A, B, C, D, E.
 Question3: A, B, C, D, E.
A
12 year old presents with headaches
that have been defined as migraines. You
may perform the following OMT.
• a. Galbreath maneuvre
• b. Occipital release
• c. Sinus efflurage
• d. Triple release
• e. Temporal release
 Dr
Still once used this to treat his own
migraine:
• a. a pulley system
• b. a mule
• c. a swing
• d. a tractor
• e. a tree limb
 Migraines
are typically caused by
problems with which nerve:
• a. vagus nerve
• b. trigeminal nerve
• c. occipital nerve
• d. phrenic nerve
• e. accessory nerve
 I, _________________________,
successfully completed the Pediatric
OMT Module on __ __ 20__
Signatures:
 Pediatric Resident ____________________
 Pediatric Residency
Director____________
(
Please print and give to program
director.)