Case 3. Intense neck pain and migraine headache

Updated: Jul 10




  1. Type of Trauma: Recent trauma; fall on face on the stairs and old trauma; fall from the yacht.

  2. Sign and Symptoms: Lifelong severe chronic migraine headache. Acute onset of severe neck pain. The patient was advised to visit an orthopedic surgeon after the MRI scan.

  3. Imaging findings: MRI and CBCT revealed a hypoplastic occipital condyle, multiple levels of the degenerative disc disease, and CCJ subluxation.

  4. Adjustments: CCJ correction; Atlas

  5. Outcome: Neck pain improved dramatically in a single visit. After a few more visits, the patient regained normal range of motion of the neck and the neck pain and the headache disappeared.


The patient is a mid 50s female who visited me for her intense neck pain. She has a history of migraine headaches with the prodrom on her right calf muscle.

She has had the headache ever since she can remember like when she was very young, ~14 years old.

Also a history of falling from a yacht, quite a height in her 20s and recently she fall on her face onto the stairs (Direct facial contusion).

The chief complaint was her neck pain and the chronic intense headache.


Combination of the headache and the neck pain was debilitating. She was already waiting for her case to be reviewed by an orthopedic surgeon and seeking an alternative options. She was on a migraine medication to control the headache. Certain migraine medication was the only source of the relief.


The CBCT revealed multiple variants in her anatomy and her atlas was misaligned posteriorly to the left, resulting in the right atlas rotated anteriorly and possibly disrupting the flow or size of the vasculature on both sides.


Note the degenerative changes of the disc in the lower cervical spine. There are posteriorly growing osteophyte possibly encroaching to the space of the spinal canal. Also note the odontoid process is migrating superiorly by exceeding the McGregor line.

This type of near straight line was found in my other case and likely suggests the presence of the hypoplastic occipital condyle.

Her Schmit-Fischer angle is exceeding the normal range which is 123~127.


Her upper cervical spine was adjusted and her pain on the neck disappeared in 24 hours. Degenerative spines were mobilized in her follow up visits and the outcome was even greater than the initial.

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