Multi-Modal Assessment and Treatment of Chronic Headache: The First in a Series of Case Studies

Abstract

The treatment of headache is challenging, and is made more so by the fragmentation of medicine into clinical specialties. Physiologically, migraine headache is a systemic event, affecting multiple neurophysiological systems. Treatment often calls for a multidisciplinary approach. Research supports the efficacy of both general biofeedback and, to a lesser extent, neurofeedback in the treatment of headache, including migraine. Abnormal electrophysiological patterns, detectable with quantitative EEG, are frequently found in patients with migraine, especially after closed head injury. Research has also shown the frequent presence of trigger point activity in several areas of the musculature of the head and neck in headache patients, including those with migraine. Finally, the role of stress has been reported in the onset and exacerbation of headache pain. The authors provide a case study showing the application of quantitative EEG, surface electromyography (SEMG), and psychophysiological stress profiling in the assessment of a 56-year-old female with closed head injury and migraine headache. The treatment included myofascial massage with trigger point release, SEMG training to balance asymmetric muscle tension patterns, and a stress management program, including guided visualization and breath training. This comprehensive intervention produced a significant reduction in headache symptoms and an improvement in work productivity.