American College of Osteopathic Pediatricians Slide 2 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 1- 3 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. Slide
3 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. Slide 4 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. Slide 5 Slide 6 1)Patient is supine.
2)Physician stands at head of patient on opposite side to be
treated 3)Place one hand on the patients forehead. 4) With the
other hand grasp the posterior cervical muscles and stretch. Slide
7 Slide 8 Slide 9 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. Slide 10 Slide
11 Slide 12 1) Patient is supine with physician sitting at the head
of patient. 2)Place 2 nd 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. Slide 13
Slide 14 Innervation Table
Organ/SystemParasympatheticSympatheticAnt. Chapman's Post.
Chapman's EENTCr Nerves (III, VII, IX, X) T1-T4T1-4, 2 nd
ICSSuboccipital HeartVagus (CN X)T1-T4T1-4 on L, T2-3 T3 sp process
RespiratoryVagus (CN X)T2-T73 rd & 4 th ICST3-5 sp process
EsophagusVagus (CN X)T2-T8--- ForegutVagus (CN X)T5-T9 (Greater
Splanchnic)--- StomachVagus (CN X)T5-T9 (Greater Splanchnic)5 th -6
th ICS on L T6-7 on L LiverVagus (CN X)T5-T9 (Greater
Splanchnic)Rib 5 on RT5-6 GallbladderVagus (CN X)T5-T9 (Greater
Splanchnic)Rib 6 on RT6 SpleenVagus (CN X)T5-T9 (Greater
Splanchnic)Rib 7 on LT7 PancreasVagus (CN X)T5-T9 (Greater
Splanchnic), T9- T12 (Lesser Splanchnic) Rib 7 on RT7 MidgutVagus
(CN X)Thoracic Splanchnics (Lesser)--- Small IntestineVagus (CN
X)T9-T11 (Lesser Splanchnic)Ribs 9-11T8-10 Appendix T12Tip of 12 th
RibT11-12 on R HindgutPelvic Splanchnics (S2- 4) Lumbar (Least)
Splanchnics--- Ascending Colon Vagus (CN X)T9-T11 (Lesser
Splanchnic)R Femur @ hip T10-11 Transverse Colon Vagus (CN X)T9-T11
(Lesser Splanchnic)Near Knees--- Descending ColonPelvic Splanchnic
(S2-4)Least SplanchnicL Femur @ hipT12-L2 Colon & RectumPelvic
Splanchnics (S2- 4) T8-L2--- Slide 15 Slide 16 Question1: A, B, C,
D, E. Question2: A, B, C, D, E. Question3: A, B, C, D, E. Slide 17
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 Slide 18 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 Slide 19 Migraines are typically caused by problems with
which nerve: a. vagus nerve b. trigeminal nerve c. occipital nerve
d. phrenic nerve e. accessory nerve Slide 20 I,
_________________________, successfully completed the Pediatric OMT
Module on __ __ 20__ Signatures: Pediatric Resident
____________________ Pediatric Residency Director____________ (
Please print and give to program director.) Slide 21
