Improvements in Cognition, Chronic Migraine Headaches with Aura and Benign Paroxysmal Positional Vertigo (BPPV) in a 35-year-old Female Patient Following Neurological and Vestibular Rehabilitation.

Abstract

Event Abstract Back to Event Improvements in Cognition, Chronic Migraine Headaches with Aura and Benign Paroxysmal Positional Vertigo (BPPV) in a 35-year-old Female Patient Following Neurological and Vestibular Rehabilitation. Trevor D. Eason1* 1 Carrick Institute, United States Presentation: A 35-year-old female patient presented with cognitive decline, persistent episodes of benign paroxysmal positional vertigo, and chronic, persistent migraine headaches. The history included episodes of chronic migrainous headaches originating when she was 12-years-old. The migraine headaches are normally preceded by scintillations. The patient stated that she had never been able to ride in the back of a car, participate at amusement parks and has frequent dizziness and described oscillopsia. The origination of the episodes of benign paroxysmal positional vertigo occurred 2 years ago spontaneously upon arising one morning. The patient stated that medication she has been prescribed does not have the same effect as it once did concerning her migraine episodes. Findings: During neurocognitive testing on the C3 Logix program, upon intake, Trails A time was measured at 40.8 seconds while Trails B time was measured at 45.2 seconds. Her simple reaction time was 383 milliseconds and her choice reaction time was 411 milliseconds. Her initial symptom severity score was 86% based on the associated subjective questionnaire where 0% is no symptoms. A Comprehensive Assessment of Postural Systems (CAPS®) (Pagnacco 2014) was performed assessing the patient's balance and stability, on both a solid and foamed surface, with his eyes opened, eyes closed, and with multiple head positions. Her average balance and stability score on intake was calculated as 27.12%. Videonystagography (VNG®) demonstrated mixed torsional, geotropic, upbeat nystagmus when placed in a Dix-Halpike maneuver for the right posterior canal. A 2-3 Hz. left beat nystagmus was also observed with gaze fixation eliminated in primary position. Methods: A 12-day multi-modal neurological rehabilitation program was administered in 12 one-hour treatment sessions (Carrick, 2017). Initial treatment consisted of an Epley maneuver to alleviate the right posterior canal debris. Each session after consisted of neurological and vestibular rehabilitation exercises directed towards the right vestibular apparatus and cerebellum integration, somatosensory evoked potentials, cognitive exercises, orthoptic training, and off-vertical axis rotation (Gdowski 1999) using a multi-axis rotational chair. Initially, she was placed on a paleo diet and a supplement protocol. Based on clinical symptoms indicating alterations in energy production, she was placed on multiple nutrient formulas containing Vitamin E (11 mg), docosahexaenoic acid (1200 mg), Phosphatidylcholine (60 mg) 1 x daily. CoQ10 (200 mg) and Pyrroloquinoline quinone disodium salt (PQQ) (5 mg) were also administered in a 5 ml. dose 1 x daily. She was advised to reduce smoking and enroll in smoking cessation counseling. Outcomes: Upon discharge, Trails A time decreased to 23.5 seconds (-42.4%), and Trails B time decreased to 32.7 seconds (-27.7%). Simple reaction time decreased to 277 seconds (-27.7%), and choice reaction time decreased to 312 seconds(-24.1%). Symptom severity score decreased to 7 (-91.9%) where 0 is no symptoms. The average balance and stability score improved resulting in a score of 85.37% (+214.9%). Upon Videonystagography (VNG®), no mixed torsional, geotropic, upbeat nystagmus was observed when placed in a Dix-Halpike maneuver for the right posterior canal. No nystagmus was observed with gaze fixation eliminated in a neutral gaze or primary ocular position. Concurrently, full resolution of her migraine headaches occurred after the BPPV was eliminated. Conclusions: The author suggests further investigation into the use of multi-modal neurological, vestibular rehabilitation strategies and supplemental clinical nutrition strategies for the treatment of BPPV, and migraine headaches with aura. The author also suggests further investigation into multi-modal, intensive approaches to improve stability scores, simple and choice reaction times, symptom severity scores and stability of eye movements associated with proper neurological and vestibular function. Acknowledgements The author would like to thank and acknowledge Professor Frederick Carrick and his pioneering work in the field of clinical neuroscience. The author would also like to thank the Carrick Institute for providing the education utilized to create the multi-modal treatments implemented in this case study.