Breakthrough Approach To Headache and Migraine Pain Management

headacheHeadaches are one of the more common conditions that enter the offices of primary care physicians, including chiropractors. The standard medical treatment revolves around the use of medications and/or injections. The standard chiropractic treatment approach includes manual therapies that may include spinal manipulation or adjustments, manual or mechanical cervical traction, spinal decompression using the axiom worldwide DRX 9000 Cervical unit, mobilization techniques, trigger point therapy, physical agents or modalities such as electrical stimulation, ultrasound, etc., and nutritional counseling. While both approaches have their pros and cons, there are far less side effects associated with the chiropractic treatment option.

Headaches can generally be classified as primary or secondary. Primary Headaches include Migraine, Tension, and Cluster. Secondary headaches occur because another condition or injury is present such as after a car accident or slip and fall injury, due an infection, a sinus, jaw, and/or dental condition, a vascular injury such as stroke, a medication side effect, psychiatric disorder and others (1).

Treatment for patients with headaches is dependant on the cause. Choosing a type of health care service for the treatment of headache can be a difficult choice. When considering the use of complementary and alternative medical approaches available to patients with chronic tension-type headaches, a recent report revealed that 40% of 110 patients surveyed utilized some form of an alternative/complementary medical approach. The most frequently utilized was chiropractic (21.9%), followed by acupuncture (17.8%), and massage therapy (17.8%).

If you find yourself frequently utilizing over-the-counter medications such as an anti-inflammatory drugs (ibuprofen: Advil, Nuprin; Naprosyn such as Aleve) or Tylenol, it is probable that the chiropractic management approach will benefit your headache condition.

Frequently, in patients with headaches, the vertebrae in the upper neck lose their normal range of motion and the muscles in that region that attach to the base of the skull become overly tight and squeeze or compress the nerves that feed into the head. This results in radiating pain over the top or around the head, sometimes into the eyes. Chiropractic care can make it easier for you to move your head and neck forwards, back, rotate or twist, and side bend. This, in turn reduces the muscle tension and nerve pinching, which reduces headache pain.
Migraine Headaches And Chiropractic Care?

Many patients with migraine headaches seek out alternative therapies for their condition if daily medications do not seem to help. Some choose to look East and may consider chiropractic for their care. But what is the evidence for this treatment? Does it work?

Several studies suggest chiropractic care may be an effective treatment for patients with this severe problem.

Although it may seem difficult to understand just how a spinal adjustment might help a patient with migraine, it is what the research does, in fact, show. It is something that doctors of chiropractic and their patients have known anecdotally for decades. Having scientific proof for something can provide to you added confidence in your health care choices.

It could be that sprains of the delicate joints of the neck region interfere with the neural connection to the blood supply of the brain. Or perhaps it is imbalanced neuromuscular reflexes that are the culprit. Ultimately, how something works is less important to a patient than IF something works.

Another factor to consider in a health care decision is the safety profile of chiropractic vs. long-term medication use, as well as potential side effects. The safety of chiropractic care is well proven, with few people experiencing untoward side effects or severe complications.

Chiropractic is a natural, non-drug, and proven alternative and efficacious treatment for migraine.
Headaches and Posture

Have you ever glanced at your reflection in a storefront window or mirror as you walked by and noticed your posture? Scary, isnt it? We all know that we should stand up straight but we soon forget when we get busy and stop thinking about it.

Poor posture is often due to years of standing slouched and this bad habit usually starts at a young age. Just look around when youre in an airport or shopping mall and notice the many people have poor posture. In fact, peoples posture may reflect their attitude if theyre happy, sad or depressed. Poor posture may be related to self-consciousness, especially during adolescence. It is also genetic as we frequently see a trait throughout family members with similar postural tendencies.

The most common postural fault associated with headaches is the forward based head and shoulders. From the side, it appears that the head is significantly forward relative to the shoulders, the upper back is rounded forward and the shoulders are rolled forwards and rotated inward. One exercise that helps reduce this postural bad habit is tucking in the chin and pretending a book is balancing on top of the head. The objective is to not allow the book to slide forward off your head and land on your toes!

It takes approximately 3 months of CONSTANT self-reminding before the new good habit posture becomes automatic, so be patient. Soon youll catch yourself doing it right without thinking about it.

Frequently, posture is faulty lower down the kinetic chain. The first link of the chain is the feet and the last link is the head. Since we stand on two feet, any change in that first link or the feet, can alter the rest of the chain, especially areas furthest away the head, resulting in headaches. For example, if one leg is short, the pelvis drops, the spine shifts (scoliosis), the shoulder drops and the head shifts trying to keep the eyes level. A short leg usually needs to be managed with a heel lift, an arch support or combination of both to properly treat the headache patient.

Most health care providers EXCEPT Chiropractic Physicians typically ignore these issues. Chiropractic Doctors are specifically trained to analyze posture and correct it. You can depend on our clinic for up-to-date treatment approaches such as these.
The Neck and Headache Connection

Patients with headaches also commonly complain of neck pain. This relationship is the rule, not the exception and therefore, treatment for headaches must include treatment of the neck to achieve optimum results. The term, cervicogenic headaches has been an accepted term because of the intimate connection between the neck and head for many years. There are many anatomical reasons why neck problems result in headaches.Some of these include:

* The first 3 nerves exiting the spine in the upper neck go directly into the head. They penetrate the muscles at the top of the neck near the attachments to the skull and therefore, any excess pressure on these nerves by the muscles or spinal joints will result in irritation and subsequent pain.
* The origin or nucleus of the 5th cranial nerve called the Trigeminal, innervates the sensation to the face and is located in the upper cervical region near the origin of the 2nd cervical spinal nerve, which innervates sensation to the back of the head up to the top. Therefore, problems located in the upper neck will often result in pain radiating up from the base of the skull/upper neck over the top of the skull to the eyes and /or face.
* The 11th cranial nerve that innervates the upper shoulders and muscles in the front of the neck arises from the top 5 to 7 spinal cord levels in the neck. Injury anywhere in the neck can result in spasm and pain in these large muscle groups.
* Other interconnections between the 2nd cervical nerve and trigeminal/5th cranial nerve include communication with the 7th cranial / facial nerve, the 9th cranial / glossopharyngeal nerve, and the 10th cranial / vagus nerve. These connections can affect facial muscle strength/movements, taste, tongue and throat movements, and stomach complaints such as nausea from these three cranial nerve interconnections, respectively.

When patients seek treatment for their headaches, a thorough examination of the neck, upper back, and cranial nerves is routinely performed for the above reasons. It is common to find upper cervical movement and vertebral alignment problems present in patients complaining of headaches. Tender points located between the shoulder blades, along the upper shoulders, on the sides of the neck and particularly, at the base of the skull are commonly found.

Pain often radiates from the tender point over the top of the skull when pressure is applied in the upper neck/base of the skull area. Tenderness on the sides of the head, in the temples, over the eyes, and near the jaw joint are also common. Traction or pulling the head to stretch the neck is often quite pain relieving and this is often performed as part of the chiropractic visit and can also be applied at home with the use of a home cervical traction unit. Chiropractic adjustments applied to the fixated or misaligned vertebra in the upper neck often brings very satisfying relief to the headache sufferer. Exercises that promote movement in the neck, as well as strengthening exercises are also helpful in both reducing headache pain and in preventing occurrences, especially with stress or tension headaches.

Headaches: A Self-Assessment of Function

Headaches are a very common problem seen in chiropractic offices. Most types of headaches are manageable without requiring an extensive workup. Headaches can vary from mild and barely noticeable to extreme, so much so that it results in total disability restricted to bed rest in a dark, quiet room.

The ability to track the treatment or care approach being received is difficult. This is because there are not any good, reliable tests for most types of headaches, especially the most common tension-type of headache. Even vascular headaches such as migraine and cluster varieties are not associated with reliable tests that can track progress or change. One inexpensive, reliable method that is self-administered is called the Headache Disability Index (HDI). This is a 25-question form that the headache sufferer completes and a total score is calculated. In the list of 25 questions, there are three choices for scoring: a YES response = 4 points, a SOMETIMES response = 2 points, and a NO response is not worth any points. The highest possible score = 100 (4 points x 25 questions). Therefore, if the patients headache total score, for example is 38 points, the percentage is 38%. When patients present for chiropractic treatment, this method of assessment is often utilized and can be very helpful to determine the effectiveness of the care being provided, especially because of the lack of special tests that exists for most types of headaches. Here is a list of questions that are included in the HDI:

E01. Because of my headaches I feel handicapped.

F02. Because of my headaches I feel restricted in performing my routine daily activities.

E03. No one understands the effect my headaches have on my life.

F04. I restrict my recreational activities (e.g. sports, hobbies) because of my headaches.

E05. My headaches make me angry.

E06. Sometimes I feel that I am going to lose control because of my headaches.

F07. Because of my headaches I am less likely to socialize.

E08. My spouse (significant other), or family and friends have no idea what I am going through because of my headaches.

E09. My headaches are so bad that I feel I am going to go insane.

E10. My outlook on the world is affected by my headaches.

E11. I am afraid to go outside when I feel that a headache is starting.

E12. I feel desperate because of my headaches.

F13. I am concerned that I am paying penalties at work or at home because of my headaches.

E14. My headaches place stress on my relationships with family or friends.

F15. I avoid being around people when I have a headache.

F16. I believe my headaches are making it difficult for me to achieve my goals in life.

F17. I am unable to think clearly because of my headaches.

F18. I get tense (e.g. muscle tension) because of my headaches.

F19. I do not enjoy social gatherings because of my headaches.

E20. I feel irritable because of my headaches.

F21. I avoid traveling because of my headaches.

E22. My headaches make me feel confused.

E23. My headaches make me feel frustrated.

F24. I find it difficult to read because of my headaches.

F25. I find it difficult to focus my attention away from my headaches and on other things.



2. Rossi, P.; Di Lorenzo, G.; Faroni, J.; Malpezzi, M.G.; Cesarino, F.; Nappi, G. Use of complementary and alternative medicine by patients with chronic tension-type headache: results of a headache clinic survey. HEADACHE 2006; 46:(4); 622-31

3. (Tuchin PJ. A twelve month clinical trial of chiropractic spinal manipulative therapy for migraine. Australas Chiropr Osteopathy 1999;8:61 and Tuchin PJ, et. al. A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. J Manipulative Physiol Ther 2000;23:91 and Nelson CF, et. al. The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. J Manipulative Physiol Ther 1998;21:511.)

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