Chief Complaint: Shooting pains in (L) occipital and parietal regions of the head, radiates to top of the head.
Western Diagnosis: Occipital neuralgia
Medical History: 73 yr old status post surgery for throat cancer. Developed tingling and pressure sensation in occipital region which developed into severe shooting pains over a period of about 8 months. Shooting pains are rated at 9/10 level and occur 3-4 times/day. Patient has had 7 nerve blocks and surgery none of which helped to reduce symptoms.
Pertinent Medical History: Throat cancer 1997 treated with chemo therapy and radiation for 13 weeks. Developed inability to swallow due to scarring from radiation which required placement of gastric tube for feeding. Surgery to reduce scarring in the throat was unsuccessful.
Other surgeries: Hysterectomy
Hypertension
Meds: Neurontin, Darvocet, prilosec, Tylenol ES, Paxil, Catapress patch
Family History: Father died of cancer.
Patient does not exercise and has liquid diet for tube feeding.
Questioning exam: Appetite: Poor Complains of frequent bloating.
Thirst: Always thirsty with dry mouth and throat. Sips water but is not allowed to drink thin liquids.
Energy level: Poor. Worn out from the pain.
Sleep: Takes sleeping pills, otherwise wakes constantly with pain
Eyes: frequent tearing
Always feels cold, palms of hands are red and feel hot at times.
Sweat: no
Urination: Frequent
BM: usually daily, tendency towards loose bowels.
Chest: Cough with dry yellow phlegm.
Dry skin
Bruise easily
Mental / emotional: worries a lot + easily angered or irritated
Pulse exam: Pulse: Thready, Slow
Very tender on palpation along spleen, liver, and gallbladder meridians.
Reduced range of motion in cervical spine with severe scarring in (L)occipital and parietal region. Very tight upper traps and SCM muscle.
Tongue exam: Tongue: Red, yin deficiency cracks, ulceration and dark red areas in the center and on the sides.
OM Diagnosis: Liver yang rising with underlying yin deficiency. Qi / blood stagnation in GB / UB channels.
The tongue, pulse, and symptoms such as; thirst, dry throat, shooting pain in UB/GB area radiating to vertex, teary eyes, irritability, HTN, all point towards yin deficiency with yang rising. The tingling sensation and shooting / stabbing pains point towards qi and blood stagnation.
Treatment Principle: Move qi and blood in the channels. Subdue liver yang.
Point Prescription: (L) HT4, 7, GB41
® KD3, SP6
This treatment initially gave great relief with less frequent attacks + reduced pain intensity. Patient was able to reduce pain medication. However when patient got angry or went through periods of stress the pain would come back. I tried some electrical stimulation and needled ashi points in the scalp which gave further relief.
Patient claimed 70% relief of symptoms.
Herbal Formula: Herbal Formula:
Bai shao 9
ge gen 9
yan hu suo 6
qiang huo 6
wei ling xian 6
tian ma 9
gou teng 9
long dan cao 6
mai men dong 9
shi hu 9
huang lian 6
wu zhu yu 2
hai piao xiao 9
mu li 9
chen pi6
fu ling 9
bai zhu 9
gan cao 6
After about one month of just acupuncture I added the above herbal formula to open the channels, subdue LV yang, and assist the digestive system.
The herbal formula did not give much relief and in the end we just continued with acupuncture treatments.
Lifestyle Prescription: Tuina: Passive stretches neck / shoulder muscles. Loosen up scar tissue in occipital region. Traction. Taught patient to use acupressure points to control symptoms if experiencing a flare- up.
Results: Patients quality of life had much improved but she continued to have little flare-ups here and there at which time she would come back for more therapy. About 5 months after the initial start of treatment the patient had an MRI which showed a popcorn like bony tumor at the base of her skull partly in the UB channel distribution.
I started adding UB60 to her acupuncture prescription which made a big difference and she was able to go without treatment for about 5 months.
Synopsis: Recently the patient had some other medical problems after which the head pains started flaring up again.
I now use intradermals at UB60 and occasionally GB41 both on the left side. Whenever the patient has an episode she presses those points and her pain subsides within 1-2 minutes. Once every few weeks the patient comes back for an acupuncture treatment and this way she has been able to sustain a good treatment effect.
I believe the reason why this patient was unable to make full recovery is because of the tumor that is still there pressing on the occipital nerve.
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