This study reports a new case of acanthocephalan (thorny-headed worm) eggs in a coprolite from Bonneville Estates Rockshelter in eastern Nevada and uses archaeological and ethnographic data to better understand long-term relationships between people and acanthocephalans. Acanthocephalans are parasitic worms that use arthropods as intermediate hosts in their multi-host life cycles. Though acanthocephaliasis is rare among humans today, cases have increased in the last decade, and the discovery of acanthocephalan eggs in coprolites from archaeological sites in the Great Basin suggests a deep, shared history. At Bonneville Estates Rockshelter, 9 acanthocephalan eggs were recovered using a modified rehydration-homogenization-micro-sieving protocol on a coprolite that was radiocarbon dated to 6,040 ± 60 14C BP (7,160–6,730 cal BP), pushing back the oldest evidence of human acanthocephalan infection by 3 millennia. Researchers have proposed that the paleoepidemiology of acanthocephalans may relate to subsistence practices due to overlap in locations of infection and areas where insects are part of traditional foodways. This paper considers the paleoepidemiology of acanthocephalan infection through the first combined review of paleoparasitological, ethnographic, and archaeological records in western North America. Ethnographic and archaeological records support the hypothesis that archaeological cases of human acanthocephaliasis may be linked to entomophagy. Additional parasitological analyses are advised to determine whether this distribution is the result of dietary practices, host ecology, taphonomic issues, sampling biases, or a combination of factors.