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Case Reports
. 2023 Oct 31;17(1):478.
doi: 10.1186/s13256-023-04092-9.

Multimodal treatment, including extracorporeal shock wave therapy, for refractory chronic tension-type headache: a case report

Toru Takekawa  1 , Toshifumi Chino  2 , Naoki Yamada  2 , Shu Watanabe  2 , Masahiro Abo  2 , Renpei Sengoku  3
Affiliations
Case Reports

Multimodal treatment, including extracorporeal shock wave therapy, for refractory chronic tension-type headache: a case report

Toru Takekawa et al. J Med Case Rep. .

Abstract

Background: Few reports have described multidisciplinary treatment, including extracorporeal shock wave therapy, for patients with refractory chronic tension-type headache. In this study, we conducted multidisciplinary treatment for a patient with chronic tension-type headache who suffered from chronic headache refractory to treatment.

Case presentation: The patient was a 45-year-old Japanese male suffering from 20 years of headache. As his headache had worsened recently, he visited a local clinic. With the diagnosis of suspected tension-type headache, its treatment was unsuccessful and he was referred to our hospital. The neurology department confirmed the tension-type headache and prescribed another medication, but he showed no improvement. Then, the patient was referred to the rehabilitation medicine department for consultation. At the initial visit, we identified multiple myofascial trigger points in his bilateral posterior neck and upper back regions. At the initial visit, he was prescribed 10 mL of 1% lidocaine injected into the muscles in these areas. In addition, he received 2000 extracorporeal shock wave therapy into bilateral trapezius muscles, and was instructed to take oral Kakkonto extract granules, benfotiamine, pyridoxine hydrochloride, and cyanocobalamin. Cervical muscle and shoulder girdle stretches and exercises were also recommended. At follow-up treatment visits, we used extracorporeal shock wave therapy to bilateral trapezius muscles, which led to immediate pain relief. After 11 weeks, he was not taking any medication and his headache was subjectively improved and his medical treatment ended.

Conclusion: A patient with chronic tension-type headache refractory to regular treatment was successfully treated with a multimodal approach including extracorporeal shock wave therapy in addition to standard treatment. For patients with tension-type headache accompanied by myofascial trigger points, it may be recommended to promptly consider aggressive multimodal treatment that includes extracorporeal shock wave therapy.

Keywords: Case reports; Extracorporeal shock wave therapy; Intractable; Kampo; Medicine; Pain; Trigger points.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The extracorporeal shock wave therapy (ESWT) device we used on him and an image of the treatment. This instrument can emit radial pressure wave. This photograph is an image of ESWT; the man is not the patient in this case report
Fig. 2
Fig. 2
(From Ref [4], partially modified). Changes in the patient’s headache symptoms
Fig. 3
Fig. 3
Vicious cycle of pain in tension-type headache (TTH). TrP trigger point
Fig. 4
Fig. 4
Myofascial trigger point (TrP) and tension-type headache (TTH). ESWT extracorporeal shock wave therapy. Illustration drawn by Mr. T. Yano of the Information Processing Office, Narita Hospital
See this image and copyright information in PMC

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