Case report
Combination of acupuncture and spinal manipulative therapy: management of a 32-year-old patient with chronic tension-type headache and migraine

https://doi.org/10.1016/j.jcm.2012.02.003Get rights and content

Abstract

Objective

The purpose of this case study is to describe the treatment using acupuncture and spinal manipulation for a patient with a chronic tension-type headache and episodic migraines.

Clinical Features

A 32-year-old woman presented with headaches of 5 months' duration. She had a history of episodic migraine that began in her teens and had been controlled with medication. She had stopped taking the prescription medications because of gastrointestinal symptoms. A neurologist diagnosed her with mixed headaches, some migrainous and some tension type. Her headaches were chronic, were daily, and fit the International Classification of Headache Disorders criteria of a chronic tension-type headache superimposed with migraine.

Intervention and Outcome

After 5 treatments over a 2-week period (the first using acupuncture only, the next 3 using acupuncture and chiropractic spinal manipulative therapy), her headaches resolved. The patient had no recurrences of headaches in her 1-year follow-up.

Conclusion

The combination of acupuncture with chiropractic spinal manipulative therapy was a reasonable alternative in treating this patient's chronic tension-type headaches superimposed with migraine.

Introduction

Migraines are common primary headaches, affecting 30% of women and 17% of men aged 21 to 34 years.1 These headaches can evolve and become chronic, exacting considerable personal and social economic cost2; they are the most likely headache to lead to analgesic drug overuse.1, 2

Acupuncture has been found to be clinically beneficial for patients with chronic headaches, particularly migraines3, 4, 5, 6 and tension-type headaches (TTHs).7, 8 Acupuncture has also been suggested to be an effective first-line complementary alternative medicine modality to treat migraines.9 Chiropractic care has also demonstrated evidence to manage adults with headaches.10 However, at present, there have been no reported cases of management of migraine headaches with a combination of these 2 management strategies. The purpose of this case report is to describe treatment of chronic TTHs (CTTHs) with superimposed migraine using acupuncture and chiropractic spinal manipulative therapy.

Section snippets

Case report

A 32-year-old woman, 5'4” in height, 63.6 kg, presented in April 2010 with daily headaches that began in 2002. There was no precipitating incident leading up to the headaches other than she stated that she was “stressed” because of working full-time while in graduate school. She saw a neurologist who performed a brain magnetic resonance imaging, the result of which was negative. The patient was diagnosed with mixed headaches. Less than 8 days per month, the headaches were migrainous in nature;

Discussion

This case study supports the literature that recommends acupuncture as first-line therapy for migraines.9 Spinal manipulative therapy has been reported to be an effective prophylactic therapy for migraines14 and treatment of CTTHs.10, 15

Observational and population-based studies describe progressive migraine headaches that become CDHs, a condition that affects 3% to 5% of the population with episodic headaches.16, 17, 18, 19, 20, 21 Chronic daily headaches are defined as primary headaches that

Limitations

As this is a study of one patient, it cannot be certain that the treatment was responsible for the response in the patient, as there are other uncontrolled factors. As well, it is not quantifiable how much of the headache could be attributed to the patient's unusual 5-month diet and how much relief could be attributed to the gradual balancing of the food groups. However, it is suspected that the diet was not a precipitating factor because the onset of migraines started in her teens. It is also

Conclusions

A patient presented with CTTH with superimposed migraine headaches of 5 months' duration. She had not been headache-free without pharmaceutical therapy since she was a teenager. Her headaches resolved after the first 5 sessions, and she reported that she was headache-free 1 year later. The combination of acupuncture with chiropractic spinal manipulative therapy seemed to be a reasonable alternative management strategy in managing this patient's headaches.

Funding sources and potential conflicts of interest

No funding sources or conflicts of interest were reported for this study.

Acknowledgment

The author thanks Yihyun Kwon, DC, MSOM, PhD, faculty advisor, and Jerrilyn Cambron DC, PhD, for their guidance in writing this case report and Robert Hansen, Graphic Designer, for his original illustrations of GB 1, GB 8, and GB 20.

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