Effectiveness of endonasal cranial balloon release technique in relieving symptoms of migraine and improving the quality of work in a sedentary worker -A single case study

Abstract

Migraine is a neurological condition affecting women more than man is often a cause to decrease the quality of work and productivity in workers. This study introduces a novel technique Endonasal Cranial balloon release, which has potential benefits in the treatment of migraine and its symptoms. This is a single case report of 37-year-old female who presented with a 2-year history of migraine with no other comorbidities and having difficulty in participating actively in the workplace. After explaining the entire procedure and written consent, the patient was treated with Endonasal Cranial balloon release for four sessions, each session a day continuously. The pain was assessed by the Visual Analog Scale (VAS). The impact of migraine was assessed by Headache Impact Test (HIT). The impact of migraine on work productivity was assessed by the Work Productivity and Activity Impairment (WPAI) questionnaire. All the outcome measures were measured pre-treatment, Post-treatment after completion of all four sessions, and after one-month follow-up. The patient pain has reduced tremendously, with improved work productivity and participation. This study concludes that the Endonasal Cranial Balloon Release technique would reduce the pain and discomfort due to migraines without remissions. It rehabilitates the worker with improved productivity. We also suggest several randomized clinical trials should be conducted to identify the potential benefits of this therapy.

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DOI: 10.55522/jmpas.V11I2.2224 ISSN NO. 2320–7418
Journal of medical pharmaceutical and allied sciences, Volume 11 – Issue 2, 2224, March – April 2022, Page – 4539 - 4541 4539
Research article
Effectiveness of endonasal cranial balloon release technique in relieving symptoms of migraine and
improving the quality of work in a sedentary worker - A single case study
Anjali Agarwal1, Suraj Kumar2, Gowrishankar Potturi2*
1Era University, Lucknow, Uttar Pradesh, India
2 Department of Physiotherapy, Faculty of Paramedical Sciences, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
ABSTRACT
Migraine is a neurological condition affecting women more than man is often a cause to decrease the quality of work and productivity in
workers. This study introduces a novel technique Endonasal Cranial balloon release, which has potential benefits in the treatment of migraine and its
symptoms. This is a single case report of 37-year-old female who presented with a 2-year history of migraine with no other comorbidities and having
difficulty in participating actively in the work-place. After explaining the entire procedure and written consent, the patient was treated with
Endonasal Cranial balloon release for four sessions, each session a day continuously. The pain was assessed by the Visual Analog Scale (VAS). The
impact of migraine was assessed by Headache Impact Test (HIT). The impact of migraine on work productivity was assessed by the Work
Productivity and Activity Impairment (WPAI) questionnaire. All the outcome measures were measured pre-treatment, Post-treatment after
completion of all four sessions, and after one-month follow-up. The patient pain has reduced tremendously, with improved work productivity and
participation. This study concludes that the Endonasal Cranial Balloon Release technique would reduce the pain and discomfort due to migraines
without remissions. It rehabilitates the worker with improved productivity. We also suggest several randomized clinical trials should be conducted to
identify the potential benefits of this therapy.
Keywords: Migraine, Endonasal Cranial Balloon Release, Headache.
Received - 13-10-2021, Accepted- 14-02-2022
Correspondence: Gowrishankar Potturi*  potturigowrishankar@gmail.com
Department of Physiotherapy, Faculty of Paramedical Sciences, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, UP, India
INTRODUCTION
Migraine is a neurological condition that can cause multiple
symptoms. Migraine affects over 20% of people at some time in their
life (1). Various studies suggest that approximately 1% of the world’s
population may have chronic migraines. (2). It is observed that women
are more affected than men (3). The International Classification of
Headache Disorders (ICHD) uses the term chronic migraine to
describe patients with frequent headaches, believed to be biologically
migrainous (4). The term ‘migraine’ originally comes from the Greek
word Hemicrania, which means ‘half of the head’, representing one
of the most striking features of the condition as in many cases pain
only affects one-half of the head. Equally commonly, pain may also
be felt bilaterally, at the front or back of the head, more rarely in the
face, and rarer still in the body (migraniouscorpalgia). The pain is
generally throbbing in nature. Migraine pain is typically accompanied
by other features such as nausea, dizziness, extreme sensitivity to
lights, noises, and smells, lack of appetite, disturbances of bowel
function and so on. Some persons have a warning symptom known as
an aura that occurs before or with the headache. An aura can include
visual disturbances (flashes of light or blind spots), or other
disturbances, such as tingling on one side of the face or in an arm or
leg and difficulty in speaking. Many studies confirmed that migraine
harms work and productivity (5). The results from previous studies
reveal that the headache, severity and frequency can impact the
quality of life. Mostly, the migraine headaches are treated with drugs
which have adverse effects on long-term use. It is also evident that
there are remissions once the drug is stopped. This study thus
highlights the evidence based novel approach in treating migraine.
This is a single case report to analyze the effectiveness of Endonasal
cranial balloon release in relieving symptoms of migraine and
improving the quality of work in a sedentary woman.
DESCRIPTION OF THE CASE
Patient history
A 37-year-old female ‘X’ who is in teaching profession,
reported to physiotherapy department of the University in Saifai,
Uttar Pradesh, India with severe headache at frontal and temporal
area, occasionally with a sense of foul smell since 2 years (Figure 1).
Often the pain radiated to neck. The patient had no past history of

DOI: 10.55522/jmpas.V11I2.2224 ISSN NO. 2320–7418
Journal of medical pharmaceutical and allied sciences, Volume 11 – Issue 2, 2224, March – April 2022, Page – 4539 - 4541 4540
trauma around head, neck &face. The patient was diagnosed with
Migraine by a neurologist after clinical examination and on medical
management. The patient had no complete relaxation, and had
frequent bouts of migraine attack. The patient reported no other
comorbidity.
Figure 1: site of pain of patient
Clinical Examination
Written consent was taken before examining the patient.
Cervical compression-distraction tests, Upper limb neural tissue
tension test, Vertebrobasilar insufficiency test, and cervical range of
motion were assessed. All the findings were negative ruling out the
possibility of cervical spine involvement.
Investigations
Investigations (MRI, CT Scan of Brain and Spine, Lab
investigations, X-ray Skull, and cervical spine) ruled no underlying
pathology.
Outcome Measures
The pain was assessed by the Visual Analog Scale (VAS). It is a
unidimensional measure of pain related to intensity. It is a patient
self- administered scale having a range from 0 to 10 on a straight
horizontal line with equidistant points. The point’0’ indicates no pain,
‘5’ indicates moderate pain and ‘10’ indicates severe pain. The
impact of migraine was assessed by Headache Impact Test (HIT).
The impact of migraine on work productivity was assessed by the
Work Productivity and Activity Impairment (WPAI) questionnaire.
WPAI-GH is expressed in percentages by multiplying the scores by
100. It has four components.
Percent work time missed due to health = Q2/(Q2 + Q4) for
those who were currently employed.
Percent impairment while working due to health = Q5/10
for those who were currently employed and worked in the past seven
days.
Percent overall work impairment due to health Q2/(Q2 +
Q4) + ((1 - Q2/(Q2 + Q4)) × (Q5/10)).
Percent activity impairment due to health Q6/10.
The overall mean of the four components was also
calculated. All the outcome measures were measured pre-treatment,
Post-treatment after completion of all four sessions, and after one-
month follow-up.
Interventions
Endonasal cranial balloon release technique was given to
the patient. The patient had four continuous sessions. The patient
didn’t take any other forms of therapy nor analgesics during and after
the therapy.
Procedure
Endonasal cranial balloon release: It is a powerful physical
technique that adjusts the bones of the skull and face. After
explaining the entire procedure and assurance, the patient is made to
lie supine on the treatment couch. Nasal Skeletal Release is
performed using a finger cot/balloon attached to a blood pressure
bulb. (Figure 2) The finger cot is lubricated and then placed into each
of the six nasal passages one by one. Once the balloon is positioned
properly, the balloon is then quickly inflated which mobilizes the
bones of the face and cranium. It is a very quick procedure and feels
similar to the sensation of water shooting up in the nose. The opposite
nostril is lightly compressed to prevent air from escaping. The patient
takes a deep breath through the mouth and holds it then the finger cot
is gently inflated making its way into the nasopharynx, causing it to
widen. The finger cot is inserted into the inferior turbinate of the nose
on both sides on the first day, then into the middle turbinate on the
second day, then into the upper turbinate on the third day, and then
into all three nasal passages of both sides on the fourth day. The
patient was given four treatment sessions on continuous days.
Figure 2: endonasal balloon release instrument
RESULTS
The outcome measures are measured pre-intervention, post-
intervention, and after one-month follow-up. The patient had a
reduction in pain, improved work productivity, and decreased
migraine-related symptoms. The summary of the scores is tabulated
in table 1.
Table 1: Outcome Measures pre-intervention, post-intervention and after one month
follow up

DOI: 10.55522/jmpas.V11I2.2224 ISSN NO. 2320–7418
Journal of medical pharmaceutical and allied sciences, Volume 11 – Issue 2, 2224, March – April 2022, Page – 4539 - 4541 4541
Outcome measure
Pre-
intervention
Post-
intervention
After one-month
follow-up
P<0.05
Pain vas*
9
1
1
Hit
78%
46%
42%
Wpai
-gh
Percent work time
missed due to
health
15.68%
2.27%
2.27%
Percent
impairment while
working due to
health
90%
10%
10%
Percent overall
work impairment
due to health
91.56%
11.8%
11.8%
Percent activity
impairment due to
health
80%
10%
10%
*Measured out of a total score of 10.
DISCUSSION
After four continuous sessions of Endonasal Cranial
balloon release, the patient had relief from pain and migraine-related
symptoms. The Pain VAS score reduced from 8 to 0 and the, HIT
score reduced from 78% to 46%. Endonasal Cranial balloon release
also known as Cranial Facial Release (CFR) technique was derived
from the Richard Stober technique. The mechanism of action behind
the Endonasal cranial balloon release technique is to induce mobility
in the cranial system –especially sphenoid bone which facilitates the
normal cranial respiratory function (6). After the manipulation, there
will be an unrestricted and smooth flow of CSF (7). The Endonasal
Cranial Ballon release will align the bones of the skull for optimal
blood flow to the brain and spinal. The neurotransmitter activity is
also optimized.
Manipulative therapy is regarded as the best treatment
option in relieving headaches due to migraine in a study by Nelson
CF et.al (1998), have reported that cervical spine manipulations can
result in a decrease in headaches. Manipulative therapy had been
suggested as a treatment option in many studies. In the case of
craniofacial bones, the high-velocity low amplitude thrusts are not
possible as the range of motions in the craniofacial bones is very
minimal. The Endonasal Cranial balloon release technique is the
optimal option for mobilizing these bones.
Spenomandibularis muscle is often associated with retro-
orbital and temporal headaches. The Endonasal cranial balloon
release technique can release the spasm of the muscle resulting in the
relaxation and relief of pain.
Migraine is a major concern among the workers and their
productivity. Several studies across multiple countries reported that
migraine causes loss of productivity and monetary loss among the
workers (8). In this present study, our client is an Assistant professor,
who involved herself in teaching and other academic activities. The
migraine headaches prevented her from participating actively in
academic activities. After the treatment session, she started her
academic activities and had no complaints about productivity.
CONCLUSIONS
This study concludes that the Endonasal Cranial Balloon
Release technique would reduce the pain and discomfort due to
migraines without remissions. It rehabilitates the worker with
improved productivity. We also suggest several randomized clinical
trials should be conducted to identify the potential benefits of this
therapy.
ACKNOWLEDGMENT
The authors acknowledge Vice Chancellor of Uttar Pradesh
University of Medical Sciences to conduct the research for the
betterment of the patients. The authors wish to acknowledge patient
for his supportive nature and cooperation.
Competing interests Nil
Funding Nil
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How to cite this article
Anjali Agarwal, Suraj Kumar, Gowrishankar Potturi, 2022.
Effectiveness of endonasal cranial balloon release technique in
relieving symptoms of migraine and improving the quality of
work in a sedentary worker-a single case study
. J. Med.
P’ceutical Allied Sci. V 11 - I 2, Pages - 4539 - 4541 doi:
10.55522/jmpas.V11I2.2224.