Hi All,

Have a patient who presented with a 4/52 Hx of R) sided Csp pain + headache, worse @ night. No neuro signs, no limitations to AROM and not reproducing with AROM/quadrant. CT scan degen chances at C6-7. BP higher limit of normal. VBI negative. V. stiff and spasm through Csp - treated with mobs, massage and MFR and US, DFN exs and posture advice throughout day and when sleeping.

Now - no pain/headache through day at all, but still getting pain + headache on R) side after several hours of sleep - bad enough to wake and not be able to return to sleep. Been Rx'd Endep - not helping. Completely resolves once upright again after about 30 minute and then no problem throughout the day until sleeping again.

I'm convinced it must be positional - but what am I missing?

Cheers,
Ray

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