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Benefits include a reduction of headache days and improvement in several quality of life assessments.
Some evidence for the effectiveness of spinal manipulation towards a reduction of headache episodes has also been presented for TTH [13].
Additionally, we recorded a trend towards a reduction of headache duration but the very long lasting diagnostic delay may have compromised the outcome.
It resulted in a reduction of headache days per month, the need for pain medication and the headache impact score compared to a mono-disciplinary approach.
A reduction of headache frequency (days with headache/month) of >50 % was defined as treatment success and served as primary outcome parameter.
As depicted in Fig. 5, we found a negative correlation (r = −0.44, p < 0.05) between betavalues in the hypothalamus and a reduction of headache days.
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Harpole et al. [14], treating chronic headache patients in a multidisciplinary management program, reported a reduction of 14.5 headache days on average within 3 months.
Patients treated with STPP alone had a reduction of -14.6 headache days/month with respect to -10.6 of those treated with STPP plus additional therapy at 6 months.
Patients were considered as responders when a reduction of monthly headache days by at least 50% was achieved, and, among them, as optimal responders if the reduction obtained was over 75%.
There is good clinical evidence that treatment with onabotulinumtoxinA leads to a reduction of monthly headache days and improves quality of life [3], also in this case report in which other treatment were no possible and not efficacy due to ileointestinal bypass, with secondary malabsorption.
We continued OnabotA therapy when a reduction of number of headache days of at least 30% was achieved.
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