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 ).