anything I've ever had before in my life," is, "I've got a good chance that this is a VAD going on." What we're looking for here ... Head pain isn't unusual in a chiropractor's office, neck pain isn't unusual, but to join those together with that phrase, "unlike anything I ever had before in my life," when you hear that, stop, just stop. You need to back up and start to question the patient more thoroughly. You need to go into as much detail as necessary to get you to a point of comfort regarding what's going on with that patient. You obviously want to look much more closely at the neurologicals of that point. You want to look at the history issues associated with that patient. Begin to try and pull together the pieces of their experiences in the days, weeks before seeing you that day, that would begin to create the pattern that would indicate to you that something of a VAD nature is underway. According to the literature, for those patients who experienced a VAD, on follow-up 50% had a recent appearance of a new chief complaint of upper quadrant neck pain and/or pain in the hemicranium. The pain was described as throbbing, steady, sharp, or the classic description, the thunderclap headache. The thunderclap headache is as much of a sign of a VAD in progress as you and I are ever going to get in practice. This is the headache that if you've ever been on a country road in Alabama or Georgia, you're in a thunderstorm and you're riding along, and that lightning strikes right on the road next to you or a telephone pole right by your car, you know that that clap of thunder just rattles you to your core or your being. This thunderclap headache is a kind of headache that is just, it stops that person cold. It's this intense, intense resounding headache, it can be very brief but it's extremely sharp. The presence of that headache and when there's no other explanation for it, that should cause you and I, to be concerned about what's going on in that individual. If you notice the slide that's appearing right now, you'll see that there's a specific pain pattern associated with a referral pain coming from injury to the vertebral artery, and there's also a pain pattern associated with a pain coming from an injury to the internal carotid artery. You'll notice that the internal carotid artery pain is more of an anterior facial pain and an anterior neck pain versus the vertebral artery pain, which is more of a posterior neck pain, an occipital pain and higher up in the head and skull than it is with the internal carotid characterization. At this point you want to ask the patient, you want to stop and back up a little bit. Tell me some more about this pain. Were you doing anything before you experienced the pain? Did it come out of the blue? How do you feel otherwise? Are you lightheaded? Are you dizzy? How is your appetite? So on. Stopping cold in your tracks when you hear that phrase, "A pain unlike anything I've ever had before in my life," will cause your circumstances down the road and patient's circumstances down the road in certain cases to be infinitely better than if you don't.
Taking a step back, slowing down, paying close attention to everything about that
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