Chronic Neck Pain with Occiptal Headache and Post COVID-19 Vaccine Sequelae - A Case Report
Abstract
A 58 year-old female who receives weekly acupuncture presents with chronic pain in her neck with radiation to the occipital region of the head. Along with the upper extremities of the head and neck, the patient has a presentation of hemorrhoids with varied degrees of aggravation. The treatment principles included needles with respect to both ashi and distal treatment and moxa where indicated. This documentation includes three treatments to which the patient responded to a moderate degree of balance within her constitutional presentation.
Introduction
Headaches are a common presentation at the clinic, and distinctly during the pandemic of 2021. The occurrences of headaches have increased due to the overuse of technology that strains the neck and head, and many patients have reported overall body pain due to sitting so much to attend class or meetings to establish normalcy in as unprecedented time; however, the most frequent presentation is tension and pain in and surrounding head and neck region.1 The normal stress the overuse of technology places upon the body is now met with a new factor: the amount of time spent sitting with head an neck strain in relationship to movement and circulation of normal physiological relationships. Sitting for several hours can cause significant postural strain in the neck, back, and shoulders. Within the framework of the assessment of neck pain and the strain that is the causative factor, we need to look at the body as a whole and the connective tissue and planes of fascia that create the network of whole ness in the body. As areas of the neck and head begin to experience soreness, the muscles around your spine and shoulder girdle become tense or guarded. As you continue to work in the same position, these muscles fatigue and become more painful. The surrounding muscles start to contract to help compensate for the fatigue in the primary stabilizing muscles. As a result, you may experience significant pain and muscle guarding throughout the neck, head and upper back region.2 The patient is very specific about the kind of pain that she experiences and the quality and affected areas, but during this time the pain has shifted in intensity and frequency due to the new external factors that contribute to the internal systemic imbalance: The post-COVID-19 vaccine symptoms. In contrast to the upper head and neck pain, the patient experiences frequent hemorrhoids that cause her aggravation,
Case Description
Case History
A 58 year-old female who receives weekly acupuncture presents with chronic pain in her neck with radiation to the occipital region of the head and jaw. Along with the upper extremities of the head and neck, the patient has a presentation of hemorrhoids with varied degrees of aggravation. The patient has presented with these symptoms for a number of months with some degree of fluctuation in both the level of pain and the relief of pain. The first observation of the patient came after a break in treatment due to school closures and pandemic safety precautions. This first visit the chief complaint is an Occipital headache that radiates to the jaw, which is present upon waking. As she moves through her day she notices it is most pronounced in the morning and is activated by being in the car. The quality of radiation is pain experienced in the jaw with an increase in clenching the jaw. The patient presents with slight dizziness, frontal eye pain, and musculoskeletal pain in the knees and low back. There is a chilly sensation that she experiences throughout the day. Urination is normal with waking to urinate once at night. Appetite is low accompanied by nausea and pain that feels better after she eats, but cramping and bloating are present after she eats. There is constipation with dry and hard stools. The patient reports that the hemorrhoids have improved with treatment, but over the past week have gotten a little worse. No bleeding is reported, but they are made worse by the dry and hard stools during elimination. Patient reports that her energy levels are ok and her sleep pattern has been good for the past two nights.
The patient’s pulse on the right was wiry in the cun position, slippery in the guan position and weak in the chi position. The left pulse reading was wiry in all positions. There was no tongue diagnosis due to mask wearing for COVID-19 precautions.
Diagnostic Assessment
Bian Bing: Headache, Neck Pain, Hemorroids
Bian Zheng: Shaoyang Pattern. Spleen and Kidney Yang Deficiency
The treatment principles for this patient were to Harmonize the Shaoyang and Tonify the Spleen and Kidney. The point selection for the this treatment:
1st Fifteen Minutes: LI4, SJ5, GB20, Ren6, ST25, Erbai.
2nd Fifteen Minutes: ST36, SP9, KD7, LV3
The 8 Principle Theory for this Treatment: Internal, Excess, Cold, Mixed.
Therapeutic Intervention
The needles used 34 Gauge Seirin Pyonex, x 1.5 mm length, and 32 Gauge Seirin Pyonex 1.0 mm length. There were three treatment sessions where the needling was done over a 40-minute sessions. Needle retention varied according to the stage of the treatment.
Points and Techniques | Rationale
TREATMENT 1
1st Fifteen Minutes: LI4, SJ5, GB20, Ren6, ST25, Erbai.
2nd Fifteen Minutes: ST36, SP9, KD7, LV3
Treats prolapse of the rectum and hemorrhoids,
Expel wind and release the exterior
Resolves dampness and damp-heat
Regulates qi and blood and removes stagnation
Tonify Kidney and Spleen. Fortify the Yang
In the first treatment the treatment was guided by the patients constitutional deficiency and the chronic complaints of hemorrhoids and persistent neck pain with radiation throughout the head and neck.
Pulse indication and objective assessment: Pulse: R: Cun- wiry, Guan- slippery, Chi- weak, and a Wiry overall.
The 8 Principle Theory for this treatment: Internal, Excess, Cold, Mixed.
With this in mind, we began to treat the exterior symptoms by releasing the exterior, clearing some of the deficiency heat and moving the qi stagnation consistent in a Shaoyang stage with an underlying KD and SP Yang deficiency. The points chosen were: LI4, SJ5, GB20, Ren6, ST25, Erbai, ST36, SP9, KD7, LV3
TREATMENT 2
1st Fifteen Minutes: LI4, TB5, TB16, PC6, GB41, Ki7
2nd Fifteen Minutes: ST36, SP9, KD7, LV3
Benefits the head and sense organs, Regulates and descends the qi
Unbinds the chest and regulates qi
Regulates the Heart and calms the spirit
Fortifies the Spleen and resolves dampness
Raises the Yang and foster the original qi
The second treatment took a new trajectory due to the patient receiving the first dose of the Pfizer COVID-19 vaccine. Forma diagnostic viewpoint, this is an unprecedented pathogen being both exterior and lodging directly at the Shaoyang level. Although the patient continued to experience head and neck pain previous to the vaccine, the condition went deeper into the body affecting the upper jiao in the Heart and the Lungs. The patient became short of breath walking up the stairs today, has tightness and discomfort in the chest and Heart palpitations that have been more significant qualified by using a 24 hour heart monitor. Acupuncture and moxa eased the chest discomfort (left side) for 1 day. The chest discomfort has been present daily, worse with eating big meals In addition she experiences light headedness, PVC, and fatigue daily which has increased in frequency post vaccination. Considering the symptoms as a cold pathogen invading, the treatment strategy changed. The objective findings presented with a pulse diagnosis of L - slightly wiry and R – slighty wiry, guan is slippery. The 8 Principle diagnosis is: Exterior, Cold, Deficiency, Yin. Her previous 8 principle was Internal, Excess, Cold , Mixed evidencing that the cold pathogen is invading the body and producing deficiency at the yin level which is already weak due to the underlying Kidney and Spleen Yang Deficiency. Given that there is already a damp presentation in her constitution, the vaccine created a situation where the cold damp weakened her defensive qi and became a Shaoyang Presentation. The treatment Plan for this weak was assessed to Harmonize the Shaoyang, Transform Damp and Rectify the Zheng Qi. Points were selected to vent the pathogen and foster the original Qi. The points chosen were: LI4, TB5, TB16, PC6, GB41, Ki7, ST36, SP9, KD7, LV3.
TREATMENT 3
1st Fifteen Minutes: SJ5, GB41, GB20, REN17, DY 20
2nd Fifteen Minutes: ST36, REN6, ER Bai, ST25, SP6
Treats prolapse of the rectum and hemorrhoids,
Expel wind and release the exterior
Resolves dampness and damp-heat
Regulates qi and blood and removes stagnation
Tonify Kidney and Spleen; fortify the Yang
The previous treatment was effective in clearing some of the post-vaccination sequelae, but the patient still has intermittent chest pain and has returned with a chief complaint of and Occipital Headache that is accompanied by fatigue, and the previous neck pain that is flaring on both sides. Both of these presentations are mad better by both rest and moderate movement. The shortness of breath and Heart palpitation and chest tightness are better and her energy levels have slowly come back to what she considers as normal. She also reports an asymptomatic UTI that was confirmed by a lab urinalysis test. She reports the hemorrhoid is coming out more and experiences some vaginal dryness that may be associated with the UTI. Overall she feels cold. The objective findings were: Pulse and rate: R: Slightly wiry, overall weak; L: slightly wiry, overall weak. 8 Principle: Cold, Yin, Deficiency, Internal/External. With the consideration that there is still some integration of the treatment to treat the external vaccination invasion, the assessment and plan was treat the Shaoyang level pattern and Tonify Spleen Qi. The points chosen were SJ5, GB41, GB20, REN17, DY 20 and secondly ST36, REN6, ER Bai, ST25, SP6.
Discussion
This case represents some of the most common presentation we see in the clinic. Patients are struggling with constitutional deficiency and are met with the terrain of lifestyle and external influences. In this particular case, the pandemic, and more specifically, the COVID-19 vaccine is not something that we have treated. Patients have had different viewpoints on the vaccine, its efficacy and its risk factors in relevance to present underlying conditions. In this patients experience, the vaccine had adverse effects that she did not have in her typical constitutional presentation and exacerbated the current patterns for which she is being treated. We must always look at the constitution and the terrain that a patient undergoes when treating both external and internal conditions. The was good resolution in treated her particular symptoms using the diagnosis as a Shaoyang pattern, as they did not go to a deep level where the organs or the blood were damaged, however; the qi was effected in her normal ability to adapt to a new terrain within her constitutional pattern.
Conclusion
This case reflects how the treatment of acupuncture can reduce and re-regulate the conditions of both underlying health conditions and the worsening of symptoms when the body does not have the defensive qi to meet the terrain to which it is forced to engage. This patient recovered well from the vaccination sequelae and was able to maintain stability with the conditions for which she chooses acupuncture as her treatment modality.
PARQ
Patient gave informed consent for all treatments performed.