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History
Patient is a 39 year-old single female. She is employed
on a fulltime basis in a professional position in an
office setting, with computer work a primary component
of her job.
She presented to our office with complaints of migraine
headaches with neck pain and stiffness. She had been
affected with these headaches for many years (well over
15) and could not pinpoint a specific incident to provoke
the onset of these headaches. At the time she presented
to our office, the patient described headaches 3-4 times
per week and rated them at 7 out of 10 on a pain scale
where 10 is most severe. The headaches were especially
severe during her menstrual periods. They were located
more prominently to the left frontal region of the head
over the left eye with pain and stiffness affecting
the lower portion of her neck and the top of both shoulders.
The patient’s general health history was good despite
the longterm headaches. No other chronic illnesses were
noted. She was not overweight and was a non-smoker.
She exercised regularly including jogging, walking,
and cross-country skiing. She supplemented her diet
with a multi-vitamin, a B-complex vitamin, and vitamin
C. Family history noted that her mother has high cholesterol
and both her mother and sister suffer from headaches.
Her past treatment had been quite extensive. She had
treated with her primary medical physician and had been
prescribed non-steroidal antii n f l a m m a t o r i
e s (NSAIDs), without improvement. ACT scan of her head
was normal. She had tried previous chiropractic care
at another office. Her treatment there consisted of
adjustments with hot packs. This was not effective for
her and she subsequently discontinued care there. She
had tried acupuncture and trigger point injections through
a pain clinic but also did not note improvement with
these therapies. The patient had also attempted Biofeedback
Therapy without effectiveness.
She was subsequently evaluated by a neurologist and
had been prescribed Nortriptyline (50 mg daily), Esgic
Plus (she took this when the stronger headaches occurred-about
two (2) to three (3) times per week), and Imitrex (used
during the most severe headaches). Despite this the
headaches were persisting and the patient had noted
increased neck pain and stiffness over the past few
months. The neurologist then referred the patient to
our office for evaluation and treatment.
Examination & Treatment
The patient was examined noting subluxations in the
upper cervicals (neck) on the left and in the upper
thoracics (between the shoulder blades) with corresponding
range of motion restrictions. Muscular tightness was
noted in the neck with shoulder blade muscles more prominent
on the left side. Vital signs, orthopedic, neurologic,
and vascular tests were normal. X-rays noted a slightly
reversed cervical (neck) curve.
As past singular modes of treatment had been ineffective
for this patient, we felt that a combined treatment
approach would be potentially more beneficial. We initiated
treatment with chiropractic adjustment and acupuncture
two times per week over a 30-day trial period. Within
this time, we also provided exercise instruction, under
the direction of our physical therapists, to assist
in strengthening the neck muscles so the patient would
tolerate her computer duties at work to a greater extent.
After 30 days, approximately 40-50% improvement was
noted. Treatment was reduced to a one (1) time per week
frequency for the next six (6) weeks. Further improvement
was noted and the patient was released to patient returns
as needed care (PRN) status.
Current Status
The patient continues to follow-up in our clinic for
care. She is now able to go approximately three (3)
weeks between treatments. She indicates “this is the
best I have felt in ten (10) years and I rarely need
to take medication when I do get a headache.”
Comments
Long-term recurrent headaches either of a muscle contraction
“tension” or a migraine variety typically respond quite
well to chiropractic and/or acupuncture treatments.
In some cases, a combination of the two therapies may
be necessary. In addition, exercise instruction is also
a vital component when treating these conditions as
the vast majority of these cases have altered spinal
structure with associated muscular weakness. In addressing
this, one can gain greater stability allowing improved
self-management as well.
In dealing with chronic cases such as recurring neck
pain, low back pain, or headaches, it is difficult to
fully resolve these complaints. Therefore, a primary
focus of our care is teaching self-management techniques
and informing patients that occasional follow-up treatments
(tune-ups) are necessary to control these conditions.
In choosing periodic follow-up care over the long run,
we see an overall reduction in the amount of care with
corresponding reduced costs. In addition, the quality
of the patient’s life is improved on a whole providing
increased value.
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Case
Studies
