A 16 year-old female with constant, right-sided head pain for three years (cervicogenic headache diagnosis) and associated chronic fatigue. She could not sleep well or concentrate due to pain, and was non-responsive to migraine medications. All major pathologies were ruled out by extensive imaging testing. She was referred to 360 NMT by her physical therapist for soft-tissue treatment to assist his rehabilitation program.
Evaluation, clinical reasoning & treatment strategizing
This patient had already seen seventeen other health care providers before coming to 360 NMT (including a pain management specialist, sports concussion specialist, TMJ specialist, chiropractor, neurologists, an endocrinologist, a Lyme specialist and an acupuncturist). She described her head pain as an “arc-shaped pain like that of a ram’s horn” which immediately brought upper trapezius and SCM trigger point referral patterns to mind. However, she could barely tolerate even the lightest touch on these muscles (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 wide spread sensitization she was referred to a physiatrist for myofascial pain evaluation.
The physiatrist began treatment and management that included further X-rays to rule out gross cervical instability, topical compound creams, oral medication and referral to a pain psychologist. Manual therapy was to continue once her pain pressure threshold increased. This patient returned to the 360 NMT 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. Therapeutic massage was also applied to her whole body along with some gentle trigger point therapy. This opened a doorway into her nervous system. She began to react less severely to treatment and she noticed small changes in her daily pain level.
Outcomes and follow-up
Due to the enigmatic source of her pain, this case is ongoing. While she continues to search for more answers via medical consultations, 360 NMT will assist to help her manage pain symptoms when needed and provide encouragement to stay positive! In these types of complex cases, any alternate sensation we can stimulate (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.