Tension-Type Headaches – Management Strategies

            Headaches (HA) can significantly alter a person’s quality of life. Moreover, they can interfere and sometimes even prevent an individual from performing important activities such as going to work, attending school, or participating in group activities such as sports, music programs, holiday gatherings, and more. The focus of this month’s Health Update is on Tension-Type Headaches (TTH), a common “primary headache” with tremendous socioeconomic impact.

            Compared with migraine headaches, tension-type headaches are actually more common and can be equally as disabling. A recent study reviewing popular treatment approaches for TTH reported that establishing an accurate diagnosis is important prior to beginning treatment and finding “…non-drug management is crucial.” Recommendations regarding treatment also include becoming educated about TTH, obtaining reassurance, and identifying trigger factors that can precipitate a TTH. Psychological treatments with scientifically-proven benefit include relaxation training, EMG biofeedback, and “cognitive-behavioral therapy” (CBT). Physical therapy, chiropractic, and acupuncture are widely used, but further research supporting these approaches is needed. The researchers state “simple analgesics” are the primary drug choice for TTH, but they strongly oppose the use of combination analgesics, triptans, muscle relaxants, and opioids, “….and it is crucial to avoid frequent and excessive use of simple analgesics to prevent the development of medication-overuse headache.”  They state that the tricyclic antidepressant amitriptyline is “drug of first choice” when treating chronic TTH, but they point out side effects can be significant, thus hampering their use. The researchers conclude that the treatment of frequent TTH is often difficult, and multidisciplinary approaches can be helpful. THIS IS WHERE CHIROPRACTIC FITS IN! These researchers state that non-drug approaches as well as medications “…with higher efficacy and fewer side effects [are] urgently needed.” They advise that future studies need to focus on optimizing treatment programs to best suit the individual patient utilizing psychological, physical, and pharmacological-treatment approaches.

            So, what can chiropractic bring to the table in this “team” treatment approach? First of all, it is non-drug oriented, the need of which clearly was emphasized in this study. Second, the presence of muscle tension at the base of the skull/top of the neck can be addressed VERY SPECIFICALLY with spinal manipulation of the cervical spine, active release, myofascial release, trigger point therapy, manual cervical traction, and more! Third, the use of NON-PRESCRIPTION nutrients such as ginger, tumeric, boswellia, Bromelain, white willow bark, fish oil/omega-3 fatty acids are all non-drug (with fewer potential side effects) options that facilitate in controlling inflammation. Using a home cervical traction device can also be VERY HELPFUL! Specific exercise training aimed at muscle relaxation, stretching, and strengthening (especially the deep neck flexors) can ALL BE MANAGED by a doctor of chiropractic!!!

Headaches: How Does Chiropractic Help?

            Headaches (HA) can be tremendously disabling, forcing sufferers away from work or play into a dark, quiet room to minimize any noise and light that intensifies the pain. According to the National Headache Foundation, there are over 45 million Americans who suffer from chronic, re-occurring headaches, of which 28 million are of the migraine variety. Also, approximately 20% of children and adolescents deal with headaches that can interfere significantly with their daily routines. There are many different types of headaches and many sub-types within the main categories. Here are a few: Tension HA (also, called cervicogenic HA), migraine, mixed headache syndrome (a mixture of migraine and tension HAs), cluster (less common but the most severe), sinus headaches, acute headaches, hormone headaches, chronic progressive headaches (traction or inflammatory HAs), and MANY more! Just “GOOGLE” “headache classification” for the daunting list! Let’s take a look at how chiropractic manages these headaches!

            According to a study completed in 2005, a review of the published literature revealed good evidence that intensity and frequency of HAs are indeed helped by chiropractic intervention. They limited their review to cervicogenic headaches and spinal manipulation and noted the need for larger scale studies. The well-respected Cochrane database reported spinal manipulation (SM) as an effective treatment option with short-term benefits similar to amitriptyline, a commonly prescribed medication for migraine HA patients.

            For cervicogenic HA, the combination of neck exercises and SM was found to be effective in both the short- and long-term, and SM was superior to massage or placebo (sham or “fake” manipulation). Regarding the question of treatment frequency of SM plus up to two modalities (heat and soft tissue therapy), a preliminary study found that when comparing patients receiving one, three, or four visits per week for three weeks, those receiving 9-12 treatments during the three weeks had the most benefit. Regarding the questions, “what is affected by SM” and, “why does SM work” for cervicogenic HA patients, a study describes the intimate relationship between the upper cervical nerve roots (C1-3), the trigeminal (cranial nerve V), the spinal accessory (cranial nerve XI), and the vascular system. Inflammation within these structures and their relationship with the trapezius and SCM muscles help us understand the “why” and “how” of SM and referred pain pattern to the face and head in those with cervicogenic HAs. Realizing this is a bit “technical”, feel free to GOOGLE these structures and you’ll appreciate the close proximity they have to each other and how adjustments, or SM, applied to the upper cervical spine can affect this region. It has also been reported that SM and strengthening of the deep neck flexor muscles benefits the cervicogenic HA patient. Many HA sufferers have combinations of symptoms including dizziness, neck pain, concentration “fog”, fatigue, and others, which were found to also respond to SM applied to the upper cervical spine. One study reported a 36% reduction in pain killer medication use in a group of cervicogenic headache patients receiving SM but no reduction in the patient group receiving soft-tissue therapy. The list of research studies goes on and on! So WHAT are you waiting for? TRY CHIROPRACTIC for your headache management!!!  

Chiropractic and Sinus Headaches

            Sinus headaches refer to pain in the head typically in and around the face. Most of us are knowledgeable about two of our four sinuses: the frontal (forehead) and maxillary (our “cheek bones”). The other two sinuses (called ethmoid and sphenoid) are much less understood. As chiropractors, many patients ask us about sinus problems, as all of us have had a stuffy nose due to a cold and have felt this pain in our face and head. Those of us who have suffered from sinus infections REALLY know how painful sinusitis can get! This month, let’s take a look at our sinuses and what we can do to self-manage the problem.

            First, an anatomy lesson... As stated above, there are four paired, or sets, of sinuses in our head: Maxillary: Pain/pressure in the cheekbones, sometimes referring pain to the teeth. These drain sideways (if you lay on your side, the side “up” drains down into the downside maxillary sinus and into the nose). Frontal: Pain/pressure in the forehead. These drain downward (when we’re upright, looking straight ahead). Ethmoidal: Pain/pressure between and/or behind the eyes. These drain when we lean forwards. Sphenoidal: Cause pain/pressure behind the eyes, top of the head and/or back of the head (which can be extreme). These drain best when lying face pointing down towards the floor, but they can be stubborn to drain!

            Sinusitis, or rhinosinusitis, by definition is an inflammation of the sinus lining (mucous membrane) and is classified as follows: Acute – a new infection which can last up to four weeks and are divided into two types: severe and non-severe; Recurrent acute – four or more separate acute episodes within one year; Subacute – an infection lasting 4-12 weeks; Chronic infections lasting >12 weeks; and Acute exacerbation of chronic sinusitis – recurring bouts of chronic sinusitis.

            One cause of sinusitis can include an “URI” (upper respiratory tract infections) most often in the form of a virus (such as rhinovirus -- there are over 99 types have been identified, or better known as “the common cold”). Bacteria can also cause a sinus infection. These infections tend to last longer and can follow a viral infection. A third cause is a fungal infection. These are more common in diabetic and other immune deficient patients. Chemical irritants such as cigarette smoke and chlorine fumes can also trigger sinusitis. Chronic sinusitis can be caused by anything that irritates the sinuses for >12 weeks (viruses, bacteria, environmental irritants, tooth infections, and more). Allergies are also a common cause of sinusitis whether they are environmental and/or food/chemical induced.

            Chiropractic care for sinusitis includes primarily symptomatic care with sinus drainage techniques such as facial and cranial bone manipulation/mobilization, lymphatic pump and drainage techniques, instruction in self-stretch of the sinuses (such as an outward pull of the cheek bones in different positions of the head), nutritional counseling (such as 1000mg of vitamin C every 2-4 hours) and anti-inflammatory herbs and vitamins (see prior Health Updates), cervical and mid-back manipulation, training in nasal saline rinsing (Nasaline, Nettie Pot), moist heat (towels, steam), and of course, chicken soup! Co-management with your primary care doc may be needed at times, if medications are warranted.

What Kind of Headache Do I Have?

            Rebound headaches are the result of pain killer overuse. Of course, one would think of pain killers like aspirin, acetaminophen (Tylenol), or ibuprofen (Advil, Motrin, Nuprin, etc.) as well as many prescription drugs as being “friendly” and commonly reached for when a headache or any other ache or pain occurs. But, as the old saying goes, "…too much of a good thing can be bad!" These culprits, instead of helping, can actually hurt you! One theory for the cause of rebound headaches is that too much of these meds can cause the brain to shift into an excited state that triggers the headache. Another theory is that these headaches result from too sudden of a drop of the medicine in the bloodstream, which would only occur if the medication was being taken at a high dose for a relatively long period of time. According to the Migraine Research Foundation, EVERY 10 SECONDS, someone in the United States goes to the emergency room with a migraine or headache due to the intense pain, severe nausea or dehydration, drug interactions, or side effects from headache medications! DON’T BE ONE OF THEM!!!

            As mentioned last month, PLEASE FIRST try an anti-inflammatory herb like ginger (Zingiber officinale), turmeric (Curcuma longa), Feverfew, passionflower (Passiflora alata), Peppermint (menthe piperita), ginko (ginko biloba), caffeine  (Coffea Arabica), black or green tea, Valerian (Valeriana officinalis), Coriander Seed (Coriandrum sativum), Dong Quai (Angelica sinensis), Lavender Oil (Lavandula angustifolia), Rosemary (Rosmarinus officinalis), Lime or Linden (Tilia spp.), horseradish (Armoracia rusticana), honeysuckle (Lonicera japonica), and more!

           

            So what triggers headaches? Here are a few of the more commonly researched triggers: weight [in females, a BMI of 30 (mild obesity) = 35% greater risk, and BMI of 40 (“severe obesity”) = 80%]; personality (traits such as rigidity, reserve, and obsessivity); “let-down” or weekend headaches (breaking your routine, like staying in bed until noon); odors and fumes (e.g., fresh paint); dehydration (drink water AND eat fruits / veggies to get more water); skipping meals (hunger is a common trigger); physical exertion (certain sports like running, weight lifting); too much caffeine (small amounts help, but too much can trigger headaches); inactivity (sedentary lifestyles trigger – 30 min./day cardio, 5x/week is ideal); sleep deprivation (those averaging six hours have more frequent & severe headaches); and certain foods like red wine, beer, MSG, chocolate, aged cheese, sauerkraut, and processed meats like pepperoni, ham, and salami. Foods that can reduce headaches include those high in magnesium-- spinach, tofu, oat bran, barely, fish oil, olive oil, white beans, sunflower, and pumpkin seeds. In addition to GOOD CHIROPRACTIC CARE, headache management requires a multidimensional approach for best results!

Do Chiropractors Help Patients With Headaches?

            This seems like an easy question to answer, doesn’t it? The answer of course being, YES!!! However, there are many people who suffer with headaches who have never been to a chiropractor or have not even ever considered it as a “good option.”

            So, rather than having me “reassure you” that chiropractic works GREAT for headache management, let’s look at the scientific literature to see if “they” (the scientific community) agree or not.

            In a 2011 meta-analysis, researchers reviewed journals published through 2009 and found 21 articles that met their inclusion criteria and used the results to develop treatment recommendations. Researchers discovered there is literature support utilizing Chiropractic care for the treatment of migraine headaches of either episodic or chronic migraine. Similarly, support for the Chiropractic treatment of cervicogenic headaches, or headaches arising from the neck region (see last month’s Health Update), was reported. In addition, joint mobilization (the “non-cracking” type of neck treatment such as figure 8 stretching and manual traction) or strengthening of the deep neck flexor muscles may improve symptoms in those suffering from cervicogenic headaches as well. The literature review also found low load craniocervical mobilization may be helpful for longer term management of patients with episodic or chronic tension-type headaches where manipulation was found to be less effective.

            Okay, we realize this is all fairly technical, so sorry about that. But, it is important to “hear” this so when people ask you why are going to a chiropractor for your headaches, you can say that not only that it helps a lot, but there are a lot of scientific studies that support it too!

            Bottom line is that it DOES REALLY HELP and maybe, most importantly, it helps WITHOUT drugs and their related side effects. Just ask someone who has taken some of the headache medications what their side-effects were and you’ll soon realize a non-drug approach should at least be tried first since it carries few to no side effects.

            We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for headaches, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future. 

What Are Cervicogenic Headaches?

            Headaches are a very common problem that can have multiple causes ranging from stress to trauma.  To make matters worse, there are MANY different types of headaches. One such type is the “cervicogenic headache” (others include migraines, cluster headaches, etc.).

            The main distinction between the symptoms associated with cervicogenic headaches and those associated with migraine headaches are a lack of nausea, vomiting, aura (pre-headache warning that a headache is about to strike), light and noise sensitivity, increased tearing with red eyes, one sided head, neck, shoulder and/or arm pain, and dizziness. The items listed above are primarily found in migraine headache sufferers.

            The following is a list of clinical characteristics common in those struggling with cervicogenic headaches:

1. Unilateral (one-sided) head or face pain (rarely is it on both sides).
2. Pain is localized or stays in one spot, usually the back of the head, frontal, temporal (side) or orbital (eye) regions.
3. Moderate to severe pain intensity.
4. Intermittent attacks of pain that last hours to days.
5. Pain is usually deep, non-throbbing, unless migraines occur at the same time.
6. Head pain is triggered by neck movement, sustained awkward head postures, applying deep pressure to the base of the skull or upper neck region, and/or taking a deep breath, cough or sneeze can trigger head pain.
7. Limited neck motion with stiffness.

            Infrequently, the cervicogenic headache sufferer can present with migraines at the same time and have both presentations making it more challenging to diagnose.

            The cause of cervicogenic headaches can be obvious such as trauma (sports injury, whiplash, slip and fall), or not so obvious, like posture. A forward head posture can increase the relative weight applied to the back of the neck and upper back as much as 2x-4x normal. Last month, we discussed the intimate relationship between the upper 2 cervical vertebra (C1 & C2) and an anatomical connection to the covering of the spinal cord (the dura) as giving rise to cervicogenic headaches. In summary, the upper 3 nerves innervate the head and any pressure on those upper 3 nerves can result in a cervicogenic headache. As chiropractors, we are trained to examine, identify, and treat these types of potentially debilitating headaches.

Chiropractic and Sinus Headaches

            Sinus headaches refer to pain in the head typically in and around the face. Most of us are knowledgeable about two of our four sinuses: the frontal (forehead) and maxillary (our “cheek bones”). The other two sinuses (called ethmoid and sphenoid) are much less understood. As chiropractors, many patients ask us about sinus problems, as all of us have had a stuffy nose due to a cold and have felt this pain in our face and head. Those of us who have suffered from sinus infections REALLY know how painful sinusitis can get! This month, let’s take a look at our sinuses and what we can do to self-manage the problem.

            First, an anatomy lesson... As stated above, there are four paired, or sets, of sinuses in our head: Maxillary: Pain/pressure in the cheekbones, sometimes referring pain to the teeth. These drain sideways (if you lay on your side, the side “up” drains down into the downside maxillary sinus and into the nose). Frontal: Pain/pressure in the forehead. These drain downward (when we’re upright, looking straight ahead). Ethmoidal: Pain/pressure between and/or behind the eyes. These drain when we lean forwards. Sphenoidal: Cause pain/pressure behind the eyes, top of the head and/or back of the head (which can be extreme). These drain best when lying face pointing down towards the floor, but they can be stubborn to drain!

            Sinusitis, or rhinosinusitis, by definition is an inflammation of the sinus lining (mucous membrane) and is classified as follows: Acute – a new infection which can last up to four weeks and are divided into two types: severe and non-severe; Recurrent acute – four or more separate acute episodes within one year; Subacute – an infection lasting 4-12 weeks; Chronic infections lasting >12 weeks; and Acute exacerbation of chronic sinusitis – recurring bouts of chronic sinusitis.

            One cause of sinusitis can include an “URI” (upper respiratory tract infections) most often in the form of a virus (such as rhinovirus -- there are over 99 types have been identified, or better known as “the common cold”). Bacteria can also cause a sinus infection. These infections tend to last longer and can follow a viral infection. A third cause is a fungal infection. These are more common in diabetic and other immune deficient patients. Chemical irritants such as cigarette smoke and chlorine fumes can also trigger sinusitis. Chronic sinusitis can be caused by anything that irritates the sinuses for >12 weeks (viruses, bacteria, environmental irritants, tooth infections, and more). Allergies are also a common cause of sinusitis whether they are environmental and/or food/chemical induced.

            Chiropractic care for sinusitis includes primarily symptomatic care with sinus drainage techniques such as facial and cranial bone manipulation/mobilization, lymphatic pump and drainage techniques, instruction in self-stretch of the sinuses (such as an outward pull of the cheek bones in different positions of the head), nutritional counseling (such as 1000mg of vitamin C every 2-4 hours) and anti-inflammatory herbs and vitamins (see prior Health Updates), cervical and mid-back manipulation, training in nasal saline rinsing (Nasaline, Nettie Pot), moist heat (towels, steam), and of course, chicken soup! Co-management with your primary care doc may be needed at times, if medications are warranted

How Does Chiropractic Help Headaches?

            Headaches are one of the most common reasons people seek chiropractic care. Many patients with headaches benefit significantly from adjustments made to the upper cervical region. So, the question is, how does adjusting the neck help headaches? To help answer this question, let’s look at a study that was recently published that examined this exact issue…

            It’s been said that if one understands anatomy, determining WHERE the problem is located becomes easy. So, let’s take a look at the anatomy in the upper most part of the neck. In the study previously mentioned (http://www.ncbi.nlm.nih.gov/pubmed/21278628), the authors found an intimate relationship between the muscles that connect the upper 2 cervical vertebra (C1 and 2) together and their anatomical connection to the dura mater (the covering of the spinal cord). They identified this anatomical connection between the muscles that span between the back aspect of C1/2 and the dural connection as having a significant role in the development of headaches usually referred to as cervicogenic headaches.

            There are several reasons why chiropractors adjust or manipulate the upper cervical vertebrae in patients with headaches. The obvious reason is simply because it helps to reduce the intensity, frequency and duration of headaches. The reason it works is this: If one or both of the upper 2 vertebrae (C1 and C2, also referred to as the atlas and axis, respectively) are either blocked or fixed and cannot properly move independently, then there is an abnormal change in the biomechanics in that region. Similarly, if one of the two vertebrae is rotated or shifted in reference to the other, a similar biomechanical “lesion” or problem occurs (often referred to as a “subluxation”). You can take all the ibuprofen, Aleve, Tylenol or other perhaps stronger, prescription medication for the headache, but it is not logical that the biomechanical problem at C1 and/or C2 is going to change by inducing a chemical change (i.e., taking a pill). All you’re doing is masking the symptoms for a while, at best.

            Many people find that after a several chiropractic adjustments, their headaches are significantly improved. This is because restoring proper biomechanics to the C1/2 region reduces the abnormal forces on the vertebrae as well as any abnormal pull or traction of the posterior cervical muscles on the dural attachment. It has been reported that the function of this muscle/dura connection is to resist excessive movement of the dura towards the spinal cord when we look upwards and forwards. During neurosurgery, observation of mechanical stress on the dura was found to be associated in patients with headaches. In chronic headache sufferers, adjustments applied to this area results in significant improvement. There is no other treatment approach that matches the ability that adjustments or manipulation have in restoring the C1/2 biomechanical relationship thus, helping the headache sufferer. Another treatment option that has been shown to benefit the headache patient is injections to this same area. However, given the side effects of cortisone, botox, and other injectable chemicals, it’s clear that chiropractic should be utilized first. It’s the safest, most effective, and fastest way to restore function in the C1/2 area, thus relieving headaches.

            We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for headaches, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future. 

Is it a Migraine?

            There are MANY different types of headaches, of which migraines are a common type. This discussion will concentrate on some unique characteristics that are associated with migraine headaches. This information may help you understand what type of headache you’re having. A unique feature of migraine headaches is that prior to the start of the headache, there is often a pre-headache “warning” that the migraine is about to commence. This is often referred to as an “aura,” and it can vary from a few minutes to a few hours, or in some cases, two days prior to the start of the migraine. Here are some of the more common “warning signs” that you are having, or are about to have, a migraine:

·         Neck pain. In an online survey, the National Headache Foundation found that 38% of migraine patients “always,” and 31% “frequently” had neck pain accompany their migraine headache.

·         Frequent urination. This can precede the migraine by an hour or as much as two days.

·         Yawning. A 2006 article in the journal Cephalgia reported that about 36% of migraine sufferers describe yawning as a common pre-migraine warning. This can occur quite frequently, such as every few minutes.

·         A “sensory aura” may occur on half of the body, moving from the finger tips through the arm, across the face, or elsewhere and usually includes a temporary lack of feeling as if the body region is “half asleep.”

·         Nausea and vomiting. This is a common aura. According to the American Migraine Study II (a mail survey of more than 3,700 migraine patients) 73% reported nausea and 29% vomiting. Another study reported that migraine sufferers who have nausea/vomiting usually have more severe migraine headaches and get less relief from migraine medications compared to those who do not get nausea or vomiting.

·         Other common auras or “sensitivities” during the migraine include bright light, noise, and/or smells (like perfumes), and many migraine sufferers seek refuge in a dark, quiet room and try to sleep.

·         Physical activity. Routine activities such as walking, climbing steps, running, weight lifting, or sexual activity can trigger a migraine and/or increase the intensity of an existing migraine headache.

·         Trouble speaking. Difficulty “getting the words out” or formulating thought (staying on task) can be another warning sign of an impending migraine. Obviously, if this is the first time this symptom has occurred and it’s “…out of the ordinary,” we’ll have to make sure it’s not something more serious (…like a stroke)!

·         Weakness. This may occur in an arm or leg or entire half of the body (left or right side) and also could be a more serious sign of a stroke, but it is also a fairly common pre-migraine aura.

·         Visual aura. This can include double vision and / or vertigo (balance loss with a spinning feeling). This often occurs in a special type of migraine called a “basilar-type migraine” and symptoms can include dizziness, double vision or loss of vision. The balance loss is often associated with a “bad migraine” and occurs when the migraine is stronger or more intense than usual.

·         “Headache hangover.” This usually occurs after the migraine has passed and people describe a feeling of being “wiped out.” Symptoms can include fatigue, difficulty concentrating, weakness, dizziness, lightheadedness, and extreme energy loss.

            In many cases, adjustments applied to the neck and upper back, especially when delivered BEFORE the migraine, can reduce the intensity and in some cases STOP the migraine from even starting!

Headaches & Chiropractic Treatment

We are often asked, “..what do chiropractors do for headaches?” To answer this question, let’s look at what a patient might expect when they present with headache complaints.

The last three “Health Updates” reviewed the differences between tension-type headaches, migraine headaches and dangerous types of headaches. Keeping in mind those differences, the history and examination will focus on differentiating between these three types of headaches.

The presenting patient will be given the “usual” paper work to fill out that includes biographical information (name/address, type of insurance, HIPAA forms, and so forth), as well as a history, past history, medication list, family history, current habits, and systems review. Specific questionnaires about headaches that can be scored and compared to future scores are particularly helpful in determining the percentage of change in the condition. The main historical piece of information that differentiates the tension vs. migraine headache is the presence or absence of nausea or vomiting, which is unique to migraines. Migraine headaches are usually preceded with an “aura” or, a pre-headache symptom such as ringing in the ears, flashes of light in the visual field, a numbness or tingling sensation – some odd type of “hint” that a migraine may soon strike, often within 30 minutes after the aura. This is important as a chiropractic treatment given prior to the onset of the migraine can sometimes stop the migraine from starting or progressing. Migraines will often occupy half the head vs. tension-type headaches that often occupy both sides. The history can also give us information about things that may trigger a headache (primarily migraines) such as odors, certain foods (like chocolate, nuts, spicy food), and this can lead to specific diet oriented treatment recommendations.

The physical exam include observing the patient’s posture, head carriage, skin color/moisture and touching the muscles (palpation) feeling for spasm/tightness, temperature/moisture, pain location or radiation. Various “orthopedic tests” include movements of the head and neck in attempt to reduce, reproduce or increase symptoms with the primary goal of trying to figure out which structures may be generating the pain. Cervical range of motion tests are performed to see which movements increase or decrease the pain. The neurological exam – testing reflexes, muscle strength, sensation (sharp/dull) may reveal areas of the skin on the head that are either increased / hypersensitive or reduced in sensation (numb). Looking in the back of the eyes is a unique place where blood vessels can be viewed and increased blood pressure, diabetes, increased pressure in the head and more can sometimes be detected, which can help determine if a dangerous headache is lurking. A cranial nerve exam is also sometimes done as part of the neurological examination.

The chiropractic treatment protocols for headaches include (but are not be limited to): Spinal manipulation or mobilization (this is applied to the areas of the neck and/or upper back where the joints are either fixed, displaced, or are applied to a region where the neurological function may be compromised), exercise training, traction, electrical current, ultrasound, stress and diet management.

Dangerous Headaches

This week's topic will address dangerous headaches. To keep this in perspective, most headaches are NOT dangerous. In fact, tension-type headaches and migraines are very common and remain the focus of most health care providers and patients who suffer from headaches. With that said, it’s important to discuss the signs and symptoms that might help all of us differentiate between headaches that are safe versus those which are not safe.

The most important factor to consider is when the “typical” headache is suddenly “different.” Some of these “different” symptoms may include slurred speech, difficulty communicating or formulating thought, seizures, fainting or loss of consciousness (even for a few seconds), memory lapses, double or blurred vision, profound dizziness, numbness in the face or half of the body, an “alarm” should sound off telling you to get this checked ASAP as these symptoms, when they deviate from “the norm” may be indicative of a more serious condition. This can be challenging as seizures are often related to migraines and might be a common symptom of a migraine headache for some migraine sufferers.

Signs of a dangerous headache include:
1. A headache that starts suddenly, especially if it's of a severe degree.
2. Headaches that start later in life, especially after the age of 50.
3. A change in the quality of headaches.
4. Visual changes, including double vision or loss of vision.
5. Weakness, numbness, or any other neurological symptoms.
6. Fevers – especially of rapid onset.
7. Change in mental status including sleepiness, hallucinations, speech changes or confusion.
8. Weight loss.

If there is ever ANY doubt about a dangerous headache, your physician should be contacted.
Typically, the migraine patient will notice a fairly consistent set of symptoms and even though the headaches can vary in intensity, the sequence of events is fairly consistent. Dangerous headaches are the ones that deviate significantly from that migraine sufferer’s “norm.” For example, suppose a patient’s “typical” migraine is: aura (bright, flashy lights in the visual field or, a strange odor precedes the migraine about 30 min. before the headache strikes), followed by a gradually increasing pain in half of the head which worsens to a point of nausea and sometimes vomiting if something isn’t done to stop it (such as a chiropractic adjustment and/or some form of medication). If this is that patient’s “usual,” IF any of the 8 items previously listed above accompany the headache, it should be further evaluated – often requiring an EEG (electroencephalogram) and/or MRI (Magnetic Resonant Image). The EEG will test for any electrical signal changes in the brain and the MRI will show space occupying structures such as tumors, bleeding, infection, aneurism, and if performed with a contrast agents, arterial malformations (that is, abnormal networks of blood vessels).

Chiropractic Manipulation: A New Study Regarding Headaches

Headaches are a common complaint in patients presenting for professional care, including chiropractic management. Patients with headaches seek chiropractic care because they find manipulation or adjustments applied to the cervical spine and upper back region are highly effective in reducing the intensity, frequency and duration of the headache pain. This is because the cervical spine / neck, is often the origin of the headache as the three nerves in the upper neck (C1, 2 and 3) pass through the thick, overly taught neck muscles in route to the scalp / head. When the muscles of the neck are in spasm, the nerves get “pinched” or squeezed by the overly tight muscles resulting in headache pain. Each nerve runs to a different part of the head and therefore, pain may be described as “…radiating over the top of head (sometimes into the forehead and eyes),” or, into the head and over the ear, sometimes reaching the temple. Also, an area located in the back and side of the head is the area where the C1 nerve innervates, so pain may also be reported in that location. When more than one of the C1-3 nerves is pinched, the whole side to the top of the head may be involved.

In the October 2009 issue of The Spine Journal, Western States Chiropractic College, Center for Outcomes Studies, reported benefits are obtained with the utilization of spinal manipulation in the treatment of chronic cervicogenic headaches. The word “chronic” means at least 3 months of headache pain has been present. This new study compared 2 different doses of therapy using several outcome measures including the pain grade, the number of headaches in the last 4 weeks and the amount of medication utilized. Data was collected every 4 weeks for a 24 week period and patients were treated 1-2 times/week and separated into either an 8 or a 16 treatment session with half the group receiving either spinal manipulative therapy or a minimal light massage (LM) control group.

The results of the study revealed the spinal manipulation group obtained better results than the control group at all time intervals. There was a small benefit in the group that received the greater number of treatments with the mean number of cervicogenic headaches reduced by 50% in both pain intensity and headache frequency.

The importance of this study is significant as there are many side effects to medications frequently utilized in the treatment of headaches. Many patients prefer not taking medications for this reason and spinal manipulation therapy (SMT) offers a perfect remedy for these patients. Couple SMT with dietary management, lifestyle modifications, stress management, and a natural, vitamin/herbal anti-inflammatory (such as ginger, turmeric, boswellia) when needed, a natural, holistic approach to the management of chronic headaches is accomplished.

We are proud that chiropractic care has consistently scored the highest level of satisfaction when compared to other forms of health care provision and look forward in serving you and your family presently and in the future.