Headaches/Migraine
Vectored upper cervical manipulation for
chronic sleep bruxism, headache and cervical spine pain in
a child. Knutson, G.J Manipulative Physiol Ther Vol 26 No.
6 July/August 2003.
This is the case of a six-year-old who had
chronic sleep bruxism (causing abnormal tooth wear), morning
headaches and cervical spine (neck) pain.
Adjustments to the
upper cervical spine using the atlas transverse process as
the contact point. There was “complete
relief” of her chronic symptoms along with elimination
of abnormal joint and structural problems.
Occipital headaches
stemming from the lateral atlanto-axial (C1-2) joint. Aprill
C, Axinn MJ, Bogduk N. Cephalalgia 2002 Feb;22(1):15-22
The lateral atlanto-axial joints (C1-2) are capable of causing
pain in the occiput, but few clinical studies have validated
this source of occipital headache.. Patients presenting with
occipital pain underwent diagnostic blocks of their lateral
atlanto-axial joints if they demonstrated clinical features
presumptively suggestive of a C1-2 origin for their pain.
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%.
A randomized controlled trial of chiropractic spinal manipulative
therapy for migraine. Tuchin PJ, Pollard H, Bonello R. Journal
of Manipulative and Physiological Therapeutics Feb. 2000:23(2),
PP.91-5.
This was a six month study of 127 migraine sufferers
half of whom had diversified chiropractic adjustments. The
other half was the control group. Subjects in the manipulation
group demonstrated statistically significant improvement
in migraine frequency, headache duration, disability and
medication use. 22% of those undergoing chiropractic care
reported more than 90% reduction in migraines after two months.
About 50% reported significant improvement in severity of
migraine episodes.
Evidence report: behavioral and physical
treatments for tension type and cervicogenic headache. McCrocy
D and Gray R Duke University. 2001.
This report from Duke University
compares the effectiveness of drug and other therapies for
the most common type of headache – the
cervicogenic headache. The report stated that chiropractic
is more effective for headache (both in frequency and severity)
than other soft tissue therapies and that chiropractic is
superior to drug therapy, providing markedly superior long-term
results.
Encephalgia/Migraine. Bofshever, H. International Chiropractic
Pediatric Newsletter Jan/Feb 2000
A ten year-old girl with chronic,
severe migraine (6 times a week for the past 3 years) was unable
to go to school due to the severity of her condition. She was
treated at a Children’s
Hospital by a neurologist.
Chiropractic examination revealed VSC at C1/C2. The patient’s
headaches improved following her 3rd adjustment (one week)
at which time she stopped using Periactin™ Syrup (prescribed
by her pediatrician). By the third week she was back in school
and started dance classes for the first time in 2 years, “and
actually began to smile again.” She was leading a normal
and healthy life for a child her age by the end of the 5th
visit.
The anatomic basis for the effectiveness of chiropractic
spinal manipulation in treating headache. Hack, GD Abstracts
from the 15th annual upper cervical spine conference Nov.
21-22, 1998. CRJ, Vol. VI, No. 1, Spring 1999.
This paper is
by the same doctor who led the team that discovered a musculo-ligamentous
relationship between the cervical spine (neck) and the dura
mater (covering of the brain stem). The author writes:
An increasing
body of literature relates headaches to pathology affecting
the cervical spine and a number of clinical trials have demonstrated
that chiropractic spinal manipulation directed at the neck
is valuable for managing headache.
Mobilization of the Spine.
Grieve GP (1984) Churchill Livingston, London/New York, 4th
edition, 22-23.
All those experienced in manipulation can report
numerous examples of migrainous headaches, disequilibrium (vertigo),
subjective visual disturbances, feelings of retro-orbital
pressure, dysphagia, dysphonia, heaviness of a limb, extra
segmental paraesthesia. Restriction of respiratory excursion,
abdominal nausea and the cold sciatic leg being relieved
by manual or mechanical treatment of the vertebral column.
Unconventional
medicine in the United States, Eisenberg, DM et al., NEJM 28
May 1993. Pp.246-252.
Twenty-seven percent of Americans who
visit alternative health care providers do so for headache
relief.
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 with chiropractic care,
the anti-depressant/anti-anxiety drug amitriptyline (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.
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.
Patients were diagnosed with cervicogenic
headache (headache arising from neck structures) and received
chiropractic care. The patients reported improvement.
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.
This
report describes a 13 year old female who had suffered from
severe headaches and neck pain for five days. Following a series
of four chiropractic treatments over a two week period, her
headache and neck pain resolved.
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.
There is a
common structural variation of the atlas vertebra 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 had migraine with aura (classical migraine), migraine
without aura (common migraine), cervicogenic headache, neck
pain only, and other problems. 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 tension exerted on the dura may result
in excruciating head pain of a type experienced in migraine.
A
case series of migraine changes following a manipulative therapy
trial. Tuchin PJ. Australasian Chiropractic & Osteopathy,
Nov. 1997; 66(3), pp. 85-91.
This report discusses four cases
of migraine that responded dramatically to chiropractic adjustments.
Many self reported symptoms were either eliminated or substantially
reduced.
Average frequency of episodes was reduced by 90% with
the length of each headache reduced by 38%. Medication use
dropped 94%. Other symptoms associated with migraine were reduced
including nausea, vomiting, photophobia and phonophobia.
Evaluation
of the Toftness system of chiropractic adjusting for subjects
with chronic back pain, chronic tension headaches, or primary
dysmenorrhea. Snyder, BJ, Sanders, GE Chiropractic Technique,
1996;8:3-9.
This is the study of 24 subjects with chronic back
pain, 19 subjects with chronic tension headaches and 26 subjects
with dysmenorrhea who underwent a series of Toftness adjustments
or sham interventions. Toftness adjustments had significant
clinical benefit, whereas those receiving sham interventions
did not improve.
Chronic pediatric migraine-type headaches treated
by long-term Inderol prior to chiropractic care, a case report.
Haney, VL, Colorado Springs, CO. Proceedings of the National
Conference on Chiropractic and Pediatrics. Oct, 1993 Palm Springs,
CA. Pub. International Chiropractors Assoc., Arlington, VA
An
11-year-old pediatric female had an eight year history of severe
migraine-type headaches, and a four year history of 20 mg.
intake of Inderol daily. The headaches were still incapacitating
the child approximately two times per week, despite medication.
The child had been a hit and run victim at 18 months, with
her first “known” headache
occurring at about the age of three.
Cervical and thoraco-lumbo-pelvic
x-rays revealed cervical hypolordosis, C1/C2 hyperextension
subluxation and pelvic unleveling. Correction was accomplished
using diversified style adjustment. The patient’s initial
complaint of severe headaches resolved.
Follow-up x-rays show
that there has been a decrease in thoracic and lumbar curvatures.
She has slowly been weaned from Inderol, and is off all pain
medications as well.
The effect of spinal manipulation in the
treatment of cervicogenic headache. Nilsson N, Christensen
HW, Hartvigsen J. Journal of Manipulative and Physiological
Therapeutics, 1997; 20:326-330.
This is a randomized controlled
trial performed at the University of Odense, Denmark by chiropractors
and medical doctors.
Of 53 patients suffering from frequent
headaches, 28 received high-velocity, low-amplitude cervical
manipulation twice a week for three weeks. 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.
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.
Spinal manipulation
vs. Amitriptyline for the treatment of chronic tension-type
headaches: a randomized clinical trial. Boline PD, Kasaak K,
Bronfort G, Nelson C, Anderson AV, Journal of Manipulative
and Physiological Therapeutics 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.
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 were studied.
Eighty-five
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.
Functional disorders (fixations)
of the spine in children. Lewit K. Manuelle Therapie, J.A.
Barth, Leipzig, 1973. Chap.2.7. Pp.50-54.
In a total of 57 children’s
migraine cases, 48 had excellent results from manipulative
therapy. Functional disorders in children may manifest themselves
as sleep disorders, loss of appetite, psychic problems or dysmenorrhea
and may not exist as spinal pain. Studies on healthy children
revealed pelvic subluxations in 40% of all school children,
cervical fixation in 15.8%. After manipulative treatments,
the problems rarely recurred.
The effect of manipulation (toggle
recoil technique) for headaches with upper cervical joint dysfunction:
a pilot study. Whittingham, W, Ellis WB, and Molyneux TP,J
Manipulative Physiol Ther, July/August 1994, 17(6): 369-375.
Twenty-six
patients (16 males, 10 females) had chronic headaches with
upper cervical joint dysfunction. Significant reduction in
the severity and frequency of headaches was reported in a large
majority of the subjects (24 out of 26).
Chiropractic care of
a 13 year-old with headache and neck pain: a case report. Hewitt
EG. Journal of the Canadian Chiropractic Association, Sept.
1994; 38(3): 160-162.
Patient had injured her neck in gymnastics.
A 13 year-old female suffered from unremitting headache and
neck pain for five days. She described them as a throbbing
and stabbing pressure that normally occurred once per week
and lasted approximately one hour. She had missed one week
of school. Her family MD had recommended seeing a chiropractor.
After
four chiropractic treatments over a two-week period, her headache
and neck pain resolved.” At a four-week
follow-up, she remained pain free.
Chiropractic care of children
with headaches: five case reports. Anderson-Peacock, ED, Journal
of Clinical Chiropractic Pediatrics, 1996 1(1) 1996:18-27.
Five
children presented with varying types of headaches 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 stopped.
Thus, it was felt that the headache reduction may have been
due to the restoration of nervous system function through
the chiropractic adjustment.
Chiropractic treatment of childhood
migraine headache: a case study. Proceedings of the National
Conference on Chiropractic and Pediatrics 1994, p. 85-90. As
abstracted by Masarsky Cs. Headache and Torticollis (Research
review) ICA International Review of chiropractic 1995; 51(1):
45-47.
This is the case of a 10-year-old male with a three-year-history
of migraine headaches. During the first month of chiropractic
care, it was reported that he only had two prodromal episodes,
but no full migraines.
13-year-old with headache, depression,
poor appetite, nausea, general muscular weakness, dizziness
and sensitivity to light and noise. Case reports in chiropractic
pediatrics. Esch, S. ACA J of Chiropractic December 1988.
This
is the case of a 13-day-old with a history of respiratory difficulty
since birth (home birth, uncomplicated). The infant had difficulty
nursing due to “stuffiness”.
Upon presentation patient
was in considerable pain, wearing dark glasses and ear plugs
to compensate for increased sensitivity to sound and light.
One week beforehand he had been injured in a football game
collision. Medical doctors had given the child painkillers.
Patient
was hospitalized in traction for two weeks with no improvement.
Chiropractic
examination: X-ray (Davis series) of the cervical spine showed
right lateral displacement of atlas with right rotation of
C-2.
Following initial adjustment the patient could ride home
without wearing his sunglasses and for the first time in
two weeks expressed an interest in food. He returned the
next day saying he felt, “The best I’ve felt
in six weeks”.
A holistic approach
to severe headache symptoms in a patient unresponsive to regional
manual therapy. Stude, DE and Sweere, JJ. Journal of Manipulative
and Physiological Therapeutics 1996; 19:202-7.
This case history
deals with a woman who suffered from severe migraine headache
symptoms who found no relief from medical care or cervical
chiropractic adjustments.
The patient, suffering from severe
headache complaints previously unresponsive to regional cervical
spine care, had chiropractic spinal adjustments. After care
the patient reported no visits to the emergency room, even
after a 1-year follow-up, and the average visual analogue pain
decreased.
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.”
Headache following
whiplash. Kreeft, J. In Spine: State of the art reviews: Cervical
Flexion-Extension/Whiplash Injuries, Sept. 1993, p. 395.
A relationship
was noted between whiplash injury and headache.
Trauma of the
cervical spine as cause of chronic headache. Braaf M. & Rosner
SJ. Trauma, 1975, 15:441-446.
A relationship was found between
the cervical spine and chronic headache.
Results of manipulative
treatment on childhood migraine. Hippocrates, 1963, pp. 308-316.
Children
with migraine responded well to manipulation.
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
performed a number of tests to objectify his care. The patient
continued his improvement two months post-spinal (cervical)
adjustments.
Mobilization of the cervical spine in chronic headaches.
Turk Z. & Ratkolb O. Manuel Medizin, 1987:15-17.
Spinal
manipulation was seen as a successful treatment for headache.
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.
Spinal manipulation and headaches
of cervical origin. Vernon HT. J Manipulative Physiol Ther,1989,12:455-468
The
mechanism of cervical headache was discussed.
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, neck aches, throat infections,
ear infections, sinus congestion, and asthma.
Manipulative therapy
in the chiropractic treatment of headaches: a retrospective
and prospective study. Vernon H. J Manipulative Physiol Ther,
1982; 5:109-112.
Discusses the mechanism of headache and the
health of the cervical spine.
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. 80% of patients
had excellent (pain-free) and good (almost pain-free) outcomes
with 10 reporting a 75% decrease in pain.
Chiropractic adjustment
in the management of visceral conditions: a critical appraisal.
Jamison JR, McEwen AP, Thomas SJ. J Manipulative Physiol Ther,
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.
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.
Eleven men between the ages of 18 and
40 who suffer from headache received chiropractic care. 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 and included myofascial trigger point
therapy and moist hot packs. Would another adjusting technique
have been more effective? Less effective? Unfortunately that
research was not done.
Toftness Spinal Correction in the treatment
of migraine: a case study. Gemmell HA, Jacobson BH and Sutton
L Chiropractic Technique, May 1994; 6(2): 57-60.
Chiropractic
success using the light force Toftness technique.
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2004 Koren Publications, Inc. & Tedd Koren,
D.C.