How Do We Treat Chronic Migraines and Small Fiber Neuropathy?

The case involves a 38-year-old female patient with persistent daily headaches for 1.5 years, along with other symptoms like neck/back pain, tachycardia, anxiety, sleep issues, and exercise/heat intolerance.
Examination revealed sensory changes in her extremities (reduced pinprick/temperature sensation), ocular motor dysfunctions (vergence issues, square wave jerks, convergence spasms), and autonomic dysregulation (delayed blood flow correction, hypoperfusion to the brain upon tilting).
Treatment involved peripheral nerve stimulation, eye exercises, gradual tilt table training, and supine cycling to improve cardiovascular function. After 2 weeks of treatment, objective improvements were seen in sensory function, ocular motor control, and autonomic regulation (maintained cerebral perfusion on tilt table). 3 Months following appointments and daily adherence to a structured at-home plan, the patient reported they no longer had daily symptoms and symptoms had heavily subsided.
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[@lisachristinaconfirmed5067]

Great job on informing dx and treatment plan. More videos like these please.

[@seaweedeater3104]

Thanks for demystifying the process and explaining it so clearly.

[@mountainmolerat]

Terrific explanation. Sounds like an amazing workup and treatment. Wish I could afford it!