Headaches/Migraines

 

Headaches are among the most common of health problems. Chiropractic and other non-medical practitioners are increasingly sought out by the public. Twenty-seven percent of Americans who visit health care providers outside of the medical field do so for headache relief according to Un-conventional Medicine in the United States, NEJM 28 May 1993. Pp.246-252.

Peer Reviewed Journals:

1) The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for prophylaxis of migraine headache. Nelson CF, Bronfort G, Evans R, et al. Journal of Manipulative and Physiological Therapeutics, October 1998: Vol. 21, No. 8, pp 511-19.

• This study compared the relative effectiveness of treating migraines by with chiropractic care alone, with the antidepressant/antianxiety drug amitriptyline (best known under the brand name Elavil); and with a combination of both the drug therapy and chiropractic care. Patients who received only chiropractic showed significant improvement, on a par with those given the powerful prescription drug (though without the side effects). The headache index, from a diary kept by each patient, showed chiropractic to have reduced the severity and frequency of headaches as well or better than the combined therapy or amitriptyline alone at each stage of the study.

2) Spectrum of pathophysiological disorders in cervicogenic headache and its therapeutic indications. Martelletti P, LaTour D, Giacovazzo M Journal of the Neuromusculoskeletal System 1995; 3:182-7.

• This describes a number of patients who were diagnosed with cervicogenic headache (headache arising from neck structures) and received chiropractic care. The patients reported improvement.

3) Incidence of ponticulus posterior of the atlas in migraine and cervicogenic headache. Wight S, Osborne N, Breen AC. Journal of Manipulative and Physiological Therapeutics, Jan. 1999; vol. 22, no. 1, pp15-20.

• A common structural variation of the atlas vertebra is called ponticulus posticus (also known as foramen arcuale or “Kimmerle’s anomaly”). Investigators studied the relationship between this condition and headache symptoms in 895 first-time chiropractic patients. The patients’ complaints included migraine with aura (classical migraine), migraine without aura (common migraine), cervicogenic headache, neck pain only, and other problems. They were examined for the presence or absence of partial or complete ponticulus posticus. The authors found a significant correlation of ponticulus posticus with migraine without aura. They explain that because the ponticulus posticus is intimately attached to the atlanto-occipital membrane (where the spine and skull meet) and this membrane, in turn, is attached to the dura (the outermost covering of the brain and spinal cord), small tensions exerted on the dura may result in excruciating head pain of a type experienced in migraine. The beneficial results of chiropractic for migraine and cervicogenic headache are possibly related to the nature of the structures connecting the upper spine to the skull.

4) The effect of spinal manipulation in the treatment of cervicogenic headache. Nilsson N, Christensen HW, Hartvigsen J. JMPT 1997; 20:326-330. This is a randomized controlled trial performed at the University of Odense, Denmark by chiropractors and medical doctors.

• From the abstract: Fifty-three [patients] suffering from frequent headaches who fulfilled the International Headache Society criteria for cervicogenic headache…were recruited from 450 headache sufferers from responded to the newspaper advertisements. …28 of the group received high-velocity, low-amplitude cervical manipulation twice a week for three wk. The remaining 25 received low-level laser in the upper cervical region and deep friction massage in the lower cervical/upper thoracic region, also twice a week for three weeks.
• Results: The use of analgesics decreased by 36% in the manipulation group, but was unchanged in the soft-tissue group; this difference was statistically significant. The number of headache hours per day decreased by 69% in the manipulation group compared with 37% in the soft-tissue group; this was significant. Finally, the headache intensity per episode decreased by 36% in the manipulation group, compared with 17% in the soft-tissue group; this was significant. At a four-week follow-up, she remained pain free.

5) Spinal manipulation vs. Amitriptyline for the treatment of chronic tension-type head-aches: a randomized clinical trial. Boline PD, Kasaak K, Bronfort G, Nelson C, Anderson AV, JMPT, 1995; 18: 148-154.

• Six weeks of drug therapy were compared to six weeks of chiropractic adjustments. The drug therapy was considered slightly more effective than chiropractic however 82% of the patients had side effects which included drowsiness, weight gain and dry mouth. Cardiac problems and glaucoma were also associated with amitriptyline use. Chiropractic patients had no side effects (apart from slight neck stiffness in the first two weeks of the study that 5% of the patients reported). After four weeks, chiropractic and drug therapy was halted in both groups. The patients who used drugs began having headaches again while the chiropractic group continued to express headache relief, as well as higher levels of energy and vitality than the drug therapy group.

6) A controlled trial of manipulation for migraine. Aust and New Zealand Journal of Medicine 1978;8:589-593. Parker GB, Tupling H, Pryor D.

• Spinal manipulation administered by chiropractors, spinal manipulation administered by medical practitioners and physical therapists and a mobilization procedure administered by physical therapists was studied. Eighty-five (85) patients received two manipulations per week over a 2-month period. At the end of the study, all three groups showed clinically significant improvement in the frequency, intensity, and duration of migraine headache episodes.

7) The effect of manipulation (toggle recoil technique) for headaches with upper cervical joint dysfunction: a pilot study. Whittingham, W, Ellis WB, and Molyneux TP, JMPT, July/August 1994, 17(6): 369-375.

• Twenty-six patients (16 males, 10 females) all had chronic headaches with upper cervical joint dysfunction. Significant diminishing of the severity and frequency of headaches was reported in a large majority of the subjects (24 out of 26).

8) Diagnosis and treatment of TMJ, head, neck and asthmatic symptoms in children. Gillespie BR, Barnes JF, J of Craniomandibular Practice, Oct. 1990, Vol 8, No. 4.

• From the abstract: “Pathologic strain patterns in the soft tissues can be a primary cause of headaches, neckaches, throat infections, ear infections, sinus congestion, and asthma.”

9) Manipulative therapy in the chiropractic treatment of headaches: a retrospective and prospective study. Vernon H. JMPT, 1982; 5:109-112.

10) Trauma of the cervical spine as cause of chronic headache. Braaf M. & Rosner SJ. Trauma, 1975, 15:441-446.

11) Results of manipulative treatment on childhood migraine. Hippocrates, 1963, pp. 308- 316.

12) Chiropractic Management of Migraine Without Aura: A Case Study. Lenhart, L.J. JNMS 1995: 3(10: 20-26.

• A case of migraine is discussed. The author has done a number of tests to objectify his care. The patient continued his improvement two months post-spinal (cervical) adjustments.

13) Mobilization of the cervical spine in chronic headaches. Turk Z. & Ratkolb O. Manuel Medizin, 1987:15-17.

Headache and the Upper Cervical Spine

It's known that the lateral atlanto-axial joints (C1-2) can cause occipital pain. However researchers wanted to know if C1-2 can also be the source of occipital headaches. So they got patients presenting with occipital pain to undergo diagnostic blocks of their lateral atlanto-axial joints. Of 34 patients investigated, 21 obtained complete relief of their headache following diagnostic blocks, indicating that a C1-2 source of occipital pain is not rare. [21/34 = 62%]
The clinical features used to select patients for blocks, however, had a positive predictive value of only 60% (maybe they should have used a chiropractic protocol?).

From Occipital headaches stemming from the lateral atlanto-axial (C1-2) joint. Cephalalgia 2002 Feb;22(1):15-22 April l C, Axinn MJ, Bogduk N.

Additional Publications:

1) Chiropractic Treatment of Chronic Episodic Tension type Headache in Male Subjects: A Case Series Analysis. Mootz RD, Dhami MSI, Hess JA, et al. Journal of the Canadian Chiropractic Association, 1994; 38(3): 152-159.

• Ten male outpatients 18-40 years old with a history of chronic headache of at least six months in duration occurring at least once a week were seen in the Palmer College of Chiropractic- West Outpatient clinic. Diversified technique was the primary care. Results showed an over 50% decrease in headache frequency and duration. Mean anchored pain scale intensity ratings changed from 5.05 to 3.37 which was “just beyond statistical significance....there was no significant changes in any McGill Pain Questionaire scores pre and post treatment. A large sampling size is suggested for a larger study.

2) Headache following whiplash. Kreeft, J. In Spine: State of the art reviews: Cervical Flexion- Extension/Whiplash Injuries, Sept. 1993, p. 395.

3) Spinal curvatures-visceral disturbances in relation thereto. Ussher NT. California and Western Medical Journal, 1933, 38:423.

• Ussher has written that spinal abnormalities could be causing visceral disorders and that X-rays could be a help in diagnosing the spine/internal organ relationship. Ussher urged “A careful neurological examination of the spine” as part of differential diagnosis.

4) Spinal manipulation and headaches of cervical origin. Vernon HT.JMPT,1989,12:455- 468.

5) Occipital headaches; statistical results in the treatment of vertebragenous headache. Droz JM, Crot F. Swiss Annals Vlll, 1985; 127-36.

• 332 patients received an average of 8.6 chiropractic adjustments. Results: 80% of patients had excellent (pain-free) and good (almost pain-free) outcomes with 10 reporting a 75% decrease in pain.

6) Migraine: a statistical analysis of chiropractic treatment. Wright JS. J Am Chiro Assoc 1978; 12:363-67.

7) Upper cervical vertebrae and occipital headache. Ng SY. JMPT, 1980; 3:137-41.

8) Chiropractic adjustment in the management of visceral conditions: a critical appraisal. Jamison JR, McEwen AP, Thomas SJ. JMPT, 1992; 15:171-180.

• This was a survey of chiropractors in Australia. More than 50% of the chiropractors stated that asthma responds to chiropractic adjustments; more than 25% felt that chiropractic adjustments could benefit patients with dysmenorrhea, indigestion, constipation, migraine and sinusitis.

9) Chiropractic treatment of chronic episodic tension type headache in male subjects: a case series analysis. Mootz, RD, Dhami MSI, Hess JA, et al. Journal of the Canadian Chiropractic Association, September 1994; 38(3): 152-159.

• This study was conducted at the Palmer College of Chiropractic-West Outpatient Clinic. It involved 11 men between the ages of 18 and 40 who suffer from headache. The patients reported consistent and significant reduction in the frequency and duration of headaches. However, the intensity of the headaches in this group was unchanged. The adjustments used were diversified with myofascial trigger point therapy, and moist hot packs. This study reflects a serious limitation of studies found in nearly all research on the effects of spinal care. There is no inter-technique study. Would another adjusting technique be more effective? Less effective? Unfortunately that research was not done.

Case Studies:

1) Chiropractic care of a 13-year-old with headache and neck pain: a case report. Hewitt, EG, Portland, Oregon. Proceedings of the National Conference on Chiropractic and Pediatrics. Oct, 1993 Palm Springs, CA. Pub. International Chiropractors Assoc., Arlington, VA.

• From the abstract: Headaches are the most frequent cause of visits to primary care practitioners. Standard medical care for headaches is prescription of pain reliving medication.

2) Chiropractic care of children with headaches: five case reports. Anderson-Peacock, ED, Journal of Clinical Chiropractic Pediatrics, Vol.1, No.1, Jan. 1996.

• From the abstract: In this case series, five children presented with varying types of head-aches to a family-based chiropractic practice. In each case, spinal subluxations were present. Following reduction of those subluxations through chiropractic adjustments the child’s chief complaint remised. Adjunctive therapy (education on diet, posture and exercise) was not given until the headaches remised. Thus, it was felt that the headache reduction may have been due to the restoration of nervous system function through the chiropractic adjustment. Chiropractic management of headaches should be further researched in children.