Eric Chun Pu Chu Valerie Kok Yan Chu Alan Te-Chang Chen Benjamin Kah Chun Cheong



 Objective: To describe the case of a 21-year-old male with a 10-year history of neurofibromatosis type 1 (NF1) who complained of nuchal pain (2 on a 0-10 point numeric pain rating scale, NRS) and right frontal headache (8 on NRS) for six months.

 Clinical features: The painful symptoms were associated with a great impact on the sleep and routine tasks during the month preceding the first presentation to the practitioner. The patient scored an 84% on the Neck Disability Index (NDI). Spinal palpation revealed restricted range of motion at C2/3, C4/5, C5/6, T1/2, T3/4 and T7/8 vertebral segments. Radiographic evaluation of the cervical spine revealed reduced cervical lordosis with Cobb angle 3°.

Intervention and outcomes: Chiropractic treatment aimed to reduce pain, muscle hypertonicity and restore spinal mobility. Treatment consisted of thermal ultrasound therapy, cervical manipulation with a high-velocity, low-amplitude force, and skin to skin contact manual adjustment. As the result of 12-month treatment, the patient experienced a resolution of neck pain and headache. He reported a reduced headache score from 8 to 0 on a scale of 10. His NDI reduced from 84 % to 8%, and cervical lordosis was restored from 3° to 20° as measured by the Cobb angle between the inferior endplate of C2 to the inferior endplate of C7.

Conclusion: This case report details the long-term recovery of a patient with NF1 from severe headaches and neck pain following chiropractic treatment. It provides evidence and highlights the value of chiropractic intervention in improving neuromuscular functions and resolving cervicogenic headache in a patient with NF1, especially when the problems cannot be effectively solved by pharmacological or other conservative means. Chiropractic manipulative therapy may be a viable option as conservative management of musculoskeletal dysfunction resulting from NF1.