Headache 1; Cervicogenic

Presenting symptoms

A 19 year-old female presented with three years of constant, right-sided head pain (cervicogenic headache diagnosis) and associated chronic fatigue.  Pain began after a fall and that included concussion. She had difficulty sleeping and concentrating, and she was non-responsive to migraine medications. All major pathologies were ruled out by extensive imaging testing. She was referred to Myopain Solutions by her physical therapist for soft-tissue treatment to assist her rehabilitation program.

Evaluation, clinical reasoning & treatment strategizing

This patient had already seen seventeen other health care providers before coming to Myopain Solutions (including a pain management specialist, sports concussion specialist, TMJ specialist, chiropractor, neurologists, an endocrinologist, a Lyme disease specialist, and an acupuncturist). She described her head pain as an ‘arc-shaped pain like that of a ram’s horn.’ This description is similar to the trigger point referral patterns of upper trapezius and sternocleidomastoid. When we tried to treat these muscles, however, she could barely tolerate light pressure (allodynia). Every non-compressive acute pain relief technique was tried including sensory distraction, myofascial release, jostling, ice/heat, etc. Nothing changed her pain or ability to tolerate treatment pressure. Due to widespread sensitization she was referred to a Physiatrist for myofascial pain evaluation. Physiatry management included topical compound creams and oral medication. She was next referred to a pain psychologist. Manual therapy was to continue once her pain pressure threshold increased.

Treatment

This patient returned to the Myopain Solutions clinic ten months later for manual treatment. We implemented a new strategy to help quiet her nervous system using a combination of breath-work and gentle myofascial release. This opened a doorway into her nervous system so she could tolerate more treatment pressure. Therapeutic massage was also applied with some gentle trigger point therapy. She began to notice positive changes in her daily pain level.

Outcomes
and follow-up

Due to the enigmatic nature of this case, it is ongoing. Myopain Solutions assisted the patient to help her manage pain symptoms and stay positive. In prolonged pain cases, any alternative sensation or stimulation (vs. the usual pain) can help the nervous system perceive less threat. Changes in perceived threat/stress can lead to cumulative neuromuscular re-education and reduction in symptoms.