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Management of Chronic Migraine in a 34-year-Old Obese Female

Journal: The AAO Journal Date: 2025/06, 35(2):Pages: 21. doi: Subito , type of study: case report


Keywords:

case report [725]
female [631]
migraine [68]
OMT [3795]
osteopathic manipulative treatment [3816]
women [584]

Abstract:

Introduction: Chronic migraines are a major cause of disability, contributing to frequent emergency department visits and substantial socioeconomic burden. Standard management involves a “migraine cocktail“ comprising intravenous fluids, NSAIDs, triptans, and anti-emetics. This case highlights the potential efficacy of osteopathic manipulative treatment (OMT) as a conservative, adjunctive approach to chronic migraine management, enhancing patient outcomes and quality of life. Case Description: A 34-year-old female presented to urgent care with an acute exacerbation of chronic left-sided migraine with aura, vomiting, and diarrhea, seeking her routine injection-based therapy. Osteopathic evaluation revealed significant cranial and viscerosomatic strain patterns involving the eyes. Results: The patient underwent a brief OMT session, including Osteopathy in the Cranial Field (OCF), ligamentous articular strain (LAS), and balanced membranous and ligamentous tension (BMT/BLT) in a seated position. Her symptoms resolved entirely without pharmacologic intervention. She was referred to an Osteopathic Neuromusculoskeletal Medicine (ONMM) clinic for continued care. Further evaluation identified a history of concussions, motor vehicle collisions, root canals, and a presumed right short leg. Serial OMT sessions achieved increasing migraine-free intervals (3–5 months). Imaging revealed a 15mm left short leg, complicated by compensatory patterns from a prior right proximal lateral tibia fracture. Targeted OMT, scar infiltration, and perineural injections addressed intraosseous and myofascial dysfunctions, resolving a right-sided clinical leg length discrepancy. Two months later, the patient developed a cervicogenic migraine and a left clinical leg length discrepancy. OMT normalized leg lengths, sustaining migraine resolution. Discussion: This case demonstrates OMT’s effectiveness in chronic migraine management, reducing pharmacologic reliance and emergency care. OMT represents a cost-effective, conservative intervention that significantly enhances patient outcomes and quality of life.


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