Outcomes of Spinal Manipulation and Neurological Rehabilitation for a Patient With Chronic Tension-Type Headaches and a Prior History of Head Trauma

Chronic tension-type headaches (TTH) can be a debilitating condition that may include peripheral vestibular system involvement. This case report describes the response to spinal manipulation (SM) and neurologic rehabilitation for a 44-year-old male with TTH complicated by a history of concussion. The patient presented to a chiropractic teaching clinic with over 15 years of daily headaches, lasting about seven hours, and rated 5/10 on a visual analog scale. The patient recalled no single causal event. Several years prior to headache onset, the patient had multiple concussions from football and military/police force occupation. Baseline findings included nystagmus, unsteady gaze holding, and latency and fatigue with saccades in all directions. Over the course of seven months, the patient received 24 visits of SM and 17 treatments of trans-auricular vagus nerve stimulation, repetitive peripheral somatosensory stimulation, photobiomodulation, and gaze stabilization exercises. The patient reported 50% headache improvement after seven weeks and 90% improvement at 20 weeks, at which point headache frequency was once a week for one hour or less. No nystagmus was observed in the 27-week exam. Chronic TTH improved with SM and neurologic rehabilitation. While past clinical trials document similar TTH improvement with SM, little is known about neurological rehabilitation treatments for TTH. This case study suggests that research in this area may be warranted.