Introduction: Chronic migraine (CM) is a common primary headache. There are no gold standard prophylactic treatments for CM. OnabotulinumtoxinA is currently the only FDA approved prophylactic therapy for treatment of CM. Patients are seeking alternative treatments for headaches including spinal manipulative therapy (SMT). SMT has been indicated in two large systematic reviews reporting moderate evidence as a treatment for migraine headaches.
Clinical Features: A 44 year-old Caucasian male reported to the hospital-based chiropractic clinic with frequent debilitating headaches in a unilateral presentation, sensitivity to light and sound, nausea, and occasional emesis.
Interventions and Outcomes: He began quarterly OnabotulinumtoxinA injections. A new primary care provider initiated etodolac and consulted the chiropractic clinic. Following eight weekly chiropractic visits, the headache disability index was re-administered and scored at 32/100, a 20 point reduction from initial.
Conclusion: The use of outcome measures helped to identify effective changes in treatment for a patient undergoing pharmacologic and manual therapy interventions for chronic migraine. Utilization of consistent outcome measures across disciplines may assist providers in quantifying and comparing self-rated disability within and between different treatment modalities.
Author affiliations: NH: Central Iowa VA Healthcare System, Pain Management; Adjunct Faculty, Palmer College of Chiropractic; KP: Palmer College of Chiropractic DoD/VA Clerkship; NJ: Central Iowa VA Healthcare System, Pain Management; LH: Central Iowa VA Healthcare System, Primary Care
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