J Manipulative Physiol Ther 2004 (Mar); 27 (3): 217 ~ FULL TEXT
Erin L. Elster, D.C.
OBJECTIVE: To discuss the use of an upper cervical technique in the case of a 23–year-old male patient with rapid-cycling bipolar disorder, sleep disorder, seizure disorder, neck and back pain, and migraine headaches.
CLINICAL FEATURES: The patient participated in a high school track meet at age 17, landing on his head from a height of 10 ft while attempting a pole vault. Prior to the accident, no health problems were reported. Following the accident, the patient developed numerous neurological disorders. Symptoms persisted over the next 6 years, during which time the patient sought treatment from many physicians and other health care practitioners.
INTERVENTION AND OUTCOME: At initial examination, evidence of a subluxation stemming from the upper cervical spine was found through thermography and radiography. Chiropractic care using an upper cervical technique was administered to correct and stabilize the patient's upper neck injury. Assessments at baseline, 2 months, and 4 months were conducted by the patient's neurologist. After 1 month of care, the patient reported an absence of seizures and manic episodes and improved sleep patterns. After 4 months of care, seizures and manic episodes remained absent and migraine headaches were reduced from 3 per week to 2 per month. After 7 months of care, the patient reported the complete absence of symptoms. Eighteen months later, the patient remains asymptomatic.
CONCLUSION: The onset of the symptoms following the patient's accident, the immediate reduction in symptoms correlating with the initiation of care, and the complete absence of all symptoms within 7 months of care suggest a link between the patient's headfirst fall, the upper cervical subluxation, and his neurological conditions. Further investigation into upper cervical trauma as a contributing factor to bipolar disorder, sleep disorder, seizure disorder, and migraine headaches should be pursued.
From the FULL TEXT Article
This article discusses a patient with seemingly unrelated conditions, raising questions as to how chiropractic care, or any single treatment for that matter, could have produced a favorable result. The very idea that such a relatively “simple” solution could provide the answer to a myriad of complex health problems invokes skepticism. It would be natural, therefore, to dismiss the results as an anomaly.
However, over the course of the past century, discoveries in the fields of medicine and science have repeatedly demonstrated similar phenomena throughout the natural world. For example, entire species, such as human beings and chimpanzees, are differentiated through slight variations in genetic sequencing.  Tissues and organs are developed based on the genetic code read through the elegantly simple double helix of the DNA molecule. In fact, everything we know today about both the human body and the natural world lends support to the notion that the myriad of perplexing and seemingly distinct neurological diseases and disorders could, in fact, share a common neurological explanation and resolution.
Consider the case chronology. A healthy 17–year-old landed on his head from a height of approximately 10 ft while attempting a pole-vault at his high school track meet. Immediately thereafter, numerous neurological and pain conditions began. Advice and treatment were sought from many different health care practitioners, but the conditions persisted for 6 years. During a chiropractic evaluation utilizing an upper cervical technique, an upper cervical subluxation was found. After the initial adjustment to the patient's upper neck was administered, the patient's symptoms began to subside and continued to improve until absent during the care period.
As the patient was healthy prior to his headfirst fall and developed symptoms immediately following the accident, it follows that the impact had a causal effect on the patient's various health problems. Hundreds of medical references substantiate this deduction by naming head and neck trauma as a cause of all of the conditions. [20–27] Furthermore, because the patient did not respond to other forms of treatment but showed dramatic improvement following the intervention of chiropractic care utilizing an upper cervical technique, it appears that the upper cervical subluxation contributed to the patient's conditions.
When examining the neuropathology involved in the patient's various conditions, several similarities exist. In the cases of bipolar and sleep disorders, symptoms are thought to be caused by alterations in neurochemistry, specifically serotonin, a neurotransmitter that originates in the raphe nuclei in the pons of the brainstem. [28–29] Seizures have been linked to widespread activation and/or hypersensitivity of the brainstem.  Migraine headaches have been attributed to malfunctions of the brainstem trigeminal nucleus and brainstem serotonergic pathways that affect nerves and blood vessels in the head. [31–32] Postural abnormalities and paraspinal imbalances can occur due to improper innervation of antigravity muscles, influenced by serotonergic pathways within the brainstem and several brainstem nuclei, including the vestibular nucleus. [33–34] Thus, all of the patient's conditions could arise from malfunctions within the brainstem and most could be attributed to a single neurotransmitter, serotonin.
The relationship between upper cervical subluxation and brainstem function is an area requiring further research. Since chiropractic care appeared to stimulate the patient's symptomatic improvements, then it follows that the care may have generated improvement in his brainstem chemistry and circuitry. Two theories, discussed below, are proposed to explain the relationship between upper cervical subluxation and neurological dysfunction.
The first mechanism, central nervous system facilitation, can occur from an increase in afferent signals to the brainstem coming from articular mechanoreceptors after a spinal injury. [35–38] The upper cervical spine is uniquely at risk for this problem because it possesses inherently poor biomechanical stability (lacks intervertebral disks and vertical zygapophyseal joints), along with the greatest concentration of spinal mechanoreceptors.
Hyperafferent activation (through central nervous system facilitation) of the sympathetic vasomotor center in the brainstem may lead to the second mechanism, cerebral penumbra, or brain hibernation. [39–42] According to this theory, a neuron can exist in a state of hibernation when a certain threshold of ischemia is reached. This ischemia level (not severe enough to cause cell death) allows the cell to remain alive, but the cell ceases to perform its designated purpose. The brain cell may remain in a hibernation state indefinitely, with the potential to resume function if normal blood flow is restored. If the degree of ischemia increases, the number of functioning brain cells decreases and the disability worsens.
The question remains as to why this upper cervical chiropractic procedure produced results when other techniques (chiropractic, rolfing, massage, etc.) performed on the patient's neck were unable to do so. The answer likely rests in the utilization of advanced diagnostic technology (paraspinal digital infrared imaging and the laser-aligned upper cervical radiographs) and the specific upper cervical adjusting procedure. The combination of the diagnostics and the adjustment allowed for precise diagnosis, correction, and stabilization of this patient's upper cervical subluxation.
It is therefore possible to theorize the following: the patient's headfirst impact sprained spinal ligaments in his upper neck, allowing for an upper cervical subluxation. Due to the upper cervical subluxation, a variety of complex, detrimental neurological changes developed (probably originating in the brainstem), which ultimately allowed for the manifestation of the patient's conditions. Despite a variety of treatments administered, the patient's symptoms remained until the upper cervical subluxation was discovered and reduced. Once the patient's upper cervical alignment was corrected and stabilized, irritation to the central nervous system was eliminated and the patient's normal neurophysiology was restored.
This case could be considered unique because it is the first to document favorable results utilizing chiropractic care with bipolar, sleep, and seizure disorders and migraine headaches in combination. However, as mentioned previously, the link between head trauma, upper cervical subluxation, and neurological disease already has been established. [3–4] Therefore, further research focusing on trauma-induced upper cervical injuries and their neurophysiological manifestations is recommended.
This case report details the history of a 23–year-old man suffering from bipolar disorder, sleep disorder, seizures, migraine headaches, and neck and back pain following a headfirst fall; the 18–month intervention of chiropractic care utilizing an upper cervical technique; and the patient's response. Evidence of an upper cervical subluxation was found using paraspinal digital infrared imaging and upper cervical radiographs. It was corrected by performing a specific adjustment to the first cervical vertebra according to radiographic findings. The upper neck subluxation could have been caused by an accident in which the patient fell headfirst into the ground while pole vaulting. All of the patient's conditions were absent by the seventh month of care and remained absent at the conclusion of care. Further investigation into upper cervical injury and resulting neuropathophysiology as a possible etiology or contributing factor to bipolar disorder, sleep disorder, seizures, and headaches should be pursued.