Outcomes
Immediately following DN treatment, the patient reported decreased neck stiffness and a pain intensity reduction (NPRS, 0-10) to 3/10 (from 6/10) for headache pain. At the third appointment, near complete relief of work-related headaches (1/10 on the NPRS) was described with onset occurring only during prolonged periods of work without attention to ergonomics.
Eight weeks from the initial evaluation, a complete cessation of work-related headaches with a significant reduction in muscle stiffness was reported. In addition, the patient demonstrated increased active range of motion in cervical rotation, side bend, flexion and extension, along with increased strength of middle trapezius, rhomboids, and shoulder external rotators. Emphasis was placed on a modified at-home workspace to optimize computer ergonomics and progressive strength training focusing on retraction-based exercises.
The patient was seen for a total of 5 visits over the course of two months. Timeline of interventions can be found in Figure 2 . At discharge (8 weeks after initial evaluation) and at 6-month follow-up, the patient reported no headaches during the workday, no disability (i.e., a 0/50 score on the NDI), and no pain (i.e., 0/10 score on the NPRS). (Table 1 ).