Multimodal Musculoskeletal Treatment in Refractory Chronic Headache: A Case Report

Patients with chronic headaches frequently experience disabling symptoms that heavily impact their quality of life and ability to perform activities of daily living.Current standard treatment focuses on pharmacologic interventions and includes abortive therapies such as analgesics and migraine-targeting therapies.We report a case of a 66-year-old female with a 12-month history of a persistent, refractory secondary headache characterized by cervicogenic and occipital neuralgia features, unresponsive to multiple pharmacologic and non-pharmacologic interventions.After little progress was made with her previous treatment plan of analgesics, Rimegepant (Nurtec), physical therapy and dry needling, the patient was offered a multimodal musculoskeletal approach, including acupuncture, osteopathic manual therapy (OMT) and home exercise recommendations by a single physician provider.These therapies have been shown to provide relief in patients suffering from chronic pain.Following this multimodal approach, the patient reported significant symptom relief in their headache frequency and intensity, allowing her to have less reliance on medication, while also significantly improving her sleep quality.This case demonstrates a potential avenue for further research to hopefully develop new minimally invasive treatments of chronic headaches that can improve a patient's quality of life.