title: The Positive Impact of Integrative Medicine in the Treatment of Recalcitrant Chronic daily Headache: A Series of Case Reports.
abstract: People who suffer from recalcitrant chronic daily headache (CDH)-a primary, episodic headache occurring at least 15 days per month, and lasting four or more hours per day for at least three consecutive months(1)-have generally tried many pain relief medications with few positive results. These patients often continue to add more and more medications and travel from clinician to clinician seeking help, without relief. Patients with recalcitrant CDH are often caught in a vicious cycle of increasing pain which results in a substantial impact from their disease on productivity and quality of life. Studies in the United States and Europe indicate that four to five percent of the general population has recalcitrant CDH,(2) which encompasses transformed migraine and chronic tension-type headache.(3) The disability associated with recalcitrant CDH is substantial, as patients have a significantly diminished quality of life and mental health, as well as impaired physical, social, and occupational functioning.(4,5) Research shows that CDH may not be treated effectively with conventional medicine (CM). Integrative medicine (IM) offers a complex, personalized intervention necessary to treat CDH. Many integrative therapies have shown benefit, effectiveness, cost effectiveness and low side effect profile in patients with both chronic headache and chronic pain.(6-17) Yet even within the IM community, clinicians often struggle with the balance between providing evidence-based therapy and patient-centered, complex, personalized integrative approaches, which may use popular but unproven therapies. In this article, we present a series of cases comprising patients with CDH who had previously been recalcitrant to CM approaches. In each case, employing a five-pronged treatment algorithm resulted in the successful IM treatment of CDH. By using this five-pronged approach, clinicians can offer the standardized protocols and scientific rationale they are accustomed to when employing CM options while additionally offering the benefit of IM possibilities.
authors.affiliation: The Alliance Institute for Integrative Medicine, Cincinnati, Ohio, United States.
authors.forename: Steve
authors.initials: S
authors.lastname: Amoils
authors.affiliation: The Alliance Institute for Integrative Medicine, Cincinnati, Ohio, United States.
authors.forename: Sandi
authors.initials: S
authors.lastname: Amoils
authors.affiliation: The Alliance Institute for Integrative Medicine, Cincinnati, Ohio, United States.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Lester
authors.affiliation: The Alliance Institute for Integrative Medicine, Cincinnati, Ohio, United States.
authors.forename: Liz
authors.initials: L
authors.lastname: Woolford
authors.affiliation: The Alliance Institute for Integrative Medicine, Cincinnati, Ohio, United States.
authors.forename: Lisa
authors.initials: L
authors.lastname: Gallagher
keywords: Chronic pain; chronic daily headache; migraine; recalcitrant headache; tension headache
references.citation: Cephalalgia. 2008 Apr;28(4):334-45
references.pmid: 18315686
references.citation: Curr Pain Headache Rep. 2001 Dec;5(6):529-36
references.pmid: 11676887
references.citation: Clin J Pain. 2011 Jun;27(5):448-56
references.pmid: 21317776
references.citation: J Am Osteopath Assoc. 2009 Aug;109(8):403-7
references.pmid: 19706829
references.citation: J Headache Pain. 2012 Mar;13(2):113-20
references.pmid: 21993986
references.citation: Cephalalgia. 2011 May;31(7):837-50
references.pmid: 21464078
references.citation: Arch Intern Med. 2012 Oct 22;172(19):1444-53
references.pmid: 22965186
references.citation: J Am Osteopath Assoc. 2005 Apr;105(4  Suppl 2):23S-29S
references.pmid: 15928350
references.citation: Cephalalgia. 2011 Nov;31(15):1510-21
references.pmid: 22019576
references.citation: J Am Osteopath Assoc. 1979 Jan;78(5):322-5
references.pmid: 581588
references.citation: J Altern Complement Med. 2011 Mar;17(3):225-30
references.pmid: 21385086
references.citation: Headache. 2006 Sep;46(8):1273-80
references.pmid: 16942472
references.citation: BMJ. 2004 Mar 27;328(7442):744
references.pmid: 15023828
references.citation: J Headache Pain. 2007 Oct;8(5):263-72
references.pmid: 17955166
references.citation: BMC Complement Altern Med. 2013 Jun 24;13:146
references.pmid: 23800144