Physical Therapy Diagnosis and Management of a Patient with Chronic Daily Headache: A Case Report

Wed, 15 Sep 2010

Tamer S. Issa, PT, BSc, DPT
Peter A. Huijbregts, PT, DPT, OCS, FAAOMPT, FCAMT

Abstract: Chronic headaches are a significant health problem for patients and often a
clinical enigma for the medical professionals who treat such patients. The purpose of this
case report is to describe the physical therapy diagnosis and management of a patient with
chronic daily headache. The patient was a 48-year-old woman with a medical diagnosis of
combined common migraine headache and chronic tension-type headache. An exacerbation
of these long-standing headache complaints had resulted in a chronic daily headache for the
preceding eight months. Symptoms included bilateral headache, neck pain, left facial pain,
and tinnitus. Outcome measures used included the Henry Ford Hospital Headache Disability
Inventory (HDI) and the Neck Disability Index (NDI). Examination revealed myofascial,
articular, postural, and neuromuscular impairments of the head and neck region. Treatment
incorporated myofascial trigger point dry needling, orthopaedic manual physical therapy,
exercise therapy, and patient education. On the final visit, the patient reported no headaches
during the preceding month. There was a 31% improvement in the HDI emotional score,
a 42% improvement in the functional score, and a 36% improvement in the total score
for the HDI, the latter exceeding the minimal detectable change for the total score on this
measure. The NDI at discharge showed an 18% improvement with a maximal improvement
during the course of treatment of 26%. Both improvements exceeded the minimal clinically
important difference for the NDI. This case report indicates that physical therapy diagnosis
and management as described may be indicated for the conservative care of patients with
chronic headaches.

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