Headaches

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Headaches

 

HEADACHES:  Aren't something you just have to endure. Chiropractic Care can help some of the various kinds of headaches.

headaches(Vertigo is discussed below, after Headaches)

Let's Find out more below:

There are many types of headaches and that has caused much confusion among patients and doctors over the years. In 1988 the International Headache Society held a conference and a paper resulted from this. The paper is called "Classification and Diagnostic Criteria for Headache Disorders, Cranial Neuralgias and Facial Pain." Virtually all medical publications since then have referred to this paper and the criteria contained in it to classify and diagnose headaches syndromes. Not surprisingly, chiropractic research and published papers were left out of this huge discussion. The general classification system from the IHS is as follows:

  1. Migraine
  2. Tension Headache
  3. Cluster Headache
  4. Misc. Headaches unassociated with structural lesions
  5. Headaches associated with head trauma
  6. Headaches assoc. with vascular disorders
  7. Headaches assoc. with non-vascular intra-cranial disorder
  8. Headaches assoc. with substance or their withdrawal
  9. Headaches assoc. with non-cephalic (head) infections
  10. Headaches assoc. with metabolic disorders
  11. Headache or facial pain assoc. with disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cranial structures
  12. Cranial neuralgias, nerve trunk pain and de-afferentation pain
  13. Non-classifiable headaches

Dr. Haberstroh is a Boston and Somerville Chiropractor.

 

Untitled-3HEADACHE FACTS AND DIAGNOSIS:

In chiropractic diagnosis of headaches, we take a careful history of the headache syndrome and more often than not, barring trauma or tumors, our research points to stress, bad posture, toxic fumes, food triggers and alcohol as the main external offending elements causing the headache a patient feels. Frequently overlooked by our medical counterparts as a cause of headaches is the misalignment of the vertebrae in the spine, specifically the neck (cervical) and upper mid back (thoracic). Chiropractors call this subluxation complex or pathomechanics of the spine. (see the "Chiropractic Care" section, sub-tab "Subluxation" on our WEB site for more information)."Cervical spine manipulation was associated with significant improvement in headache outcomes in trials involving patients with neck pain and/or neck dysfunction and headache." - Duke Evidence Report, McCrory, Penzlen, Hasselblad, Gray (2001). See also, more recently: Bryans R, Descarreaux M, et. al., "Evidence-Based Guidelines for the Chiropractic Treatment of Adults with Headaches," JMPT, Vol. 34 (5), June 2011.

Research varies but many studies suggest that between 25%-35% of the population has a headache on any given day. These numbers are staggering. 1%-3% of emergency room (ER) patients seeking care are there for headaches. Of those patients, only 1%-5% have a serious underlying pathology such as cancer, vascular or toxic poisoning. The challenge for any doctor is to determine what the underlying cause is of the headache and once again, a careful history gleaned from the patient helps us tremendously. The potential headache patient is urged to keep track of details such as timing, rapidity of onset, quality of pain and location of headache pain. Also maintain your own history of headaches as all of this information will help the doctor diagnose the headache. Although we would like to know the location of the head pain, be advised, location is helpful but rarely diagnostic.

Untitled-4

 

The "BIG 3": Interesting FACTS about the 3 most common HEADACHES:

MIGRAINE:

  1. True migraines are often caused by food "triggers." These triggers include caffeine, chocolate, coffee, Red wine and nuts. 
  2. Migraines tend to begin unilaterally (one sided) and stay that way.
  3. They often have a "field of fortification" around the field of vision.
  4. Migraines tend to be constant, pounding and can last for days.

TENSION:

  1. Are the most common type of headache.
  2. Tension headaches are frequently "bandlike" around the head or some aspect of the skull. 
  3. Tension headaches tend to be intermittent, hurt a lot less than migraines and wax and wane.

CLUSTER:

  1. Cluster Headaches occur in groups or waves of pain hence the term Cluster. Episodes of cluster headaches occur in periods lasting 7 days to one year separated by pain free periods last 14 days or more. Cluster periods usually last between 2 weeks and 3 months. 
  2. Can be intense, acute, unilateral and often associated with lacrimation (tearing).
  3. They rarely last more than two hours.

 

 

Untitled-5Post-traumatic headache symptoms are reported in 40% - 70% of patients after head trauma such as whiplash injuries. Symptoms often include not only the headache itself but also dizziness, sleep disturbances, nausea and difficulty in concentrating.

In all cases like those mentioned above chiropractic has been highly successful in relieving the headache syndrome regardless of what type of headache it was. Again, this barring the oddities such as hidden tumors. Consider this true life scenario in one of our patients some time ago:

Ms. Smith (not her real name) called me by accident. She had misplaced her medical doctor's number. She was so delirious with pain that she called information and somehow got my number instead. She kept asking me to refill her script for medication. I kept telling her that I was not her doctor, I was a chiropractor and we don't prescribe medications. We chatted about her condition and she related to me that she was in the middle of a cluster headache attack and she could barely function. I told her to come in and see me. A careful case history revealed that her clusters began 15 years previously on the day that her son kicked her in the head with a soccer ball. I X-Rayed her and found the top vertebrae, known as cervical-1 or C1, was dramatically out of place. After 3 manipulative reductions that week, her clusters disappeared. She never got them again. True story and very typical.

In another true scenario, Marge (not her real name) came to my office complaining of true migraines. Upon further questioning, we found out that she loved to eat all the known food triggers: red wine, nuts, coffee, and chocolate. This together with her bad posture, sleeping on her stomach, cradeling the phone on her shoulder, a computer screen that was to her left side away from the keyboard, and a total lack of exercise conspired to add to the problem. X-Rays revealed pathomechanical vertebrae in the upper cervicals (neck). What was needed here was a WHOLISTIC approach to care: correcting the diet, correcting the posture, correcting the ergonomics at work (headphone instead of a handset) together with chiropractic adjustments to her spine. She took our advice and made all the changes we recommended. She was migraine free in 2 weeks. Chiropractic manipulation of her spine alone would not have solved this problem, but with a WHOLISTIC approach that included her lifestyle attitudes and habits, the problem was correctable.

 

Untitled-6If you have headaches of the common three variety as well as traumatically induced headaches, the sensible course of action is to have us physically examine you and take a careful careful case history. We'll also X-Ray your spine to determine any spinal misalignments and make a diagnosis based on what we find. Barring contra-indications or the need for more advanced imaging, chiropractic manipulative reductions of the spine will follow and more than likely bring you relief of your headaches.

X-Ray Discussion: In the top radiograph to the right, we see a relatively normal cervical spine (neck). This view is taken from the side and reveals the normal curve known as a "lordosis" to the area. This is not to be confused with scoliosis which is a side to side curve (when viewing the spine from front to back) and is not normal. In the second radiograph on the bottom, we see a spine with an abnormal curve when seen from the side. This is called a "kyphosis" and is never normal in the cervical spine. We see this most frequently in accident victims and often with headaches sufferers. Chiropractic manipulation of the spine is effective in reducing and remodeling kyphotic curves in the cervical spine. In cases like this we always recommend rehabilitation of the C-spine. This often includes instructing a patient on better sleep positions (never sleep on your stomach!!!) and the use of orthopedic pillows to help push the spine back into its normal alignment over the course of time.

See, Vernon H, Jansz G, et. al., "A Randomized, Placebo-Controlled Clinical Trial of Chiropractic and Medical Prophylactic Treatment of Adults with Tension-Type Headache: Results from a Stopped Trial," JMPT, Vol. 32 (5), June 2009.  Upshot: The study was stopped prematurely due to poor recruitment. However, it was noted that chiropractic care with amitryptyline in a combined treatment regime showed statistically relevent + results.

 

VERTIGO:

Vertigo refers to the sensation of spinning (subjective vertigo) or the preception that surrounding objects area moving or spinning (objective vertigo). It is a form of dizziness felt as a shift in a person's relationship to the environment or a sense of movement in space. Although dizziness and vertigo are often used interchangeably, they are not the same thing. While all vertigo is dizziness, not all dizziness is vertigo. True Vertigo, from the Latin word "vertere" - to turn, is a distinct and often severe form of dizziness that is basically a "Movement Hallucination."

Some patients describe the feeling of being pulled down towards to floor or in the alternative, toward one side of the room. Moving the head, changing position or perhaps turning while lying down often make the vertigenous episode worse. The sudden onset of vertigo usually indicates a peripheral "vestibular" issue such as an inner ear disturbance, Miniere's Disease, BPPV or more rarely vestibular neuritis).

There are FOUR Major types of dizziness: 1) Vertigo, 2) Presyncope, 3) Disequilibrium, 4) Lightheadedness.

Vertigo: Most people with true Vertigo have a peripheral vestibular disorder as we discussed above such as Benign Postural Vertigo. This is usually accompanied by tinnitus (ringing in the ear) and hearing loss. Central disorders such as a brain stem lesion or a cerebellar dysfunction tend to be more chronic but less intense than the peripheral disorders and are not associated with hearing loss. Central disorders account for only around 15% of all patients with vertigo. Vertigo is the illusion that you or your surroundings are moving. You may feel that you are spinning, tilting, rocking or hurtling through space and time. You may vomit and/or have ringing in the ears. The patient may also have Nystagmus (where one's eyes jerk back and forth uncontrollably).

Presyncope: This is an episode of near fainting which may include lightheadedness, dizziness, severe weakness, and blurred vision. This situation is a vertigo before syncope. It is also accompanied by impending blackout and tunnel vision all due to a decrease in blood to the brain.

Disequilibrium: Is a simple lack of equalibrium that can be caused by any number of common situations. Read below on the chiropractic neurology related to this and vertigenous episodes.

Lightheadedness: Is the feeling you are going to faint. It is different from Vertigo.

Causes and Risk Factors of Vertigo:

Benign Positional Paroxysmal Vertigo (BPPV): Is a disorder of the inner ear. the cause usually is unknown, but an upper respiratory tract infection or a minor blow to the head may be responsidble. This type of vertigo occurs abruptly when the patient moves his/her head up or down or when there is movement in bed. Symptoms can be distressing but they fade in a few seconds. Avoiding positions that bring this on is the simplest way to combat this situation. BPPV is the most common form of vertigo with attacks lasting between 30 and 60 seconds. Again, this kind of episode is commonly brought on by movements in bed, getting out of bed, moving the head from side to side or reaching for something. BPPV can follow an ear infection, head or ear injury and is thought to result from the dislogement of normal crystalline structures in the ear's balance mechanism.

Central Disorders that can cause vertigenous episodes include MS, epilipsy, neck injuries (like automobile whiplash) migraine headaches, acostic neuroma, cerebellar or brain stem lesions as we mentioned, transient ischemic attacks (TIA).   A patient may experience severe vertigenous episodes for days or even weeks. Nausea, vomiting and involuntary eye movements are common. The condition gradually improves but symtoms can persist.

In the "Textbook of Medical Physiology" by Guyton & Hall, 10th Ed., WB Saunders Co, Pub., @2000 on page 645 we find interesting information consistent with the chiropractic neurological approach to diagnosis of vertigo:

1) Vestibular Mechanisms for Stabilizing the Eyes: When a person changes direction of movement rapidly or even leans their head sideways/forward/back it would normally be impossible to maintain a stable image on the retinae of the eyes UNLESS the body possessed some form of automatic control mechanism to stabilize the direction of gaze. That is to say, the eyes must remain fixed on an object long enough to get a clear image. Fortunately for us humans, nature as seen fit to provide such a mechanism: thus, each time the head is suddenly rotated signals from the semi-circular ducts cause the eyes to rotate in a direction equal and OPPOSITE to the rotation of the head. This results from reflexes transmitted through the VESTIBULAR NUCLEI and the MLF (medial longitudinal fasciculus) to the occular nuclei. The vestibular nuclei is a key central nervous system proprioceptive organ to helps us find balance in time and space. Information is fed to this vestibular system from various sources where it is integrated, dissected and organized. This leads us to our next concept:

2) Neck Proprioceptors: The central vestibular apparatus detects the orientation and movements only of the head. It is thus imperative that the brain receive other balance input from other bodily sources. This information is transmitted from the huge body of proprioceptors known as MECHANORECEPTORS found in every joint of the body. The greatest population of MECHANORECEPTORS is found in the cervical spine (neck). This balance information is relayed to the vestibular and reticular nuclei of the brain stem and indirectly on to the cerebellum, another key balance organizer in the CNS. Among the most crucial proprioceptors in the body needed for optimal balance control are the MECHANORECEPTORS of the neck.

>Chiropractic Increases Balance and Coordination
As we age, balance and coordination become increasingly impaired. Studies have shown that the receptors located in the joints of the upper cervical spine are largely responsible for providing the brain with essential information important for balance and coordination. Research has also shown that injury to these "neck" receptors is a significant cause of balance and coordination problems in humans.

According to Dr. Caranasos, MD:

Mechanoreceptors in cervical facet joints provide major input regarding the position of the head in relation to the body. With aging, mild defects impair mechanoreceptor's function. Loss of proprioception can also involve the legs, especially with diabetes. With decreased proprioception, body positioning in time and space is impeded and the patient becomes reliant on vision to know the location of a limb or his/her very location. To compensate for the loss of proprioception in the legs, the feet are keep wider apart than usual. Steps become irregular and uneven in length. As impairment increases the patient becomes unable to compensate. With severe loss of proprioception, the patient is unable to get up from a chair or rise after a fall without assistance.
(See Caranasos, MD, Isreal, MD, Gait Disorders in the Elderly, Hospital Practice. 1991; June 15:67-94)

To reiterate: According to Guyton's Medical Physiology:

Among the most important porprioceptive information needed for maintenance of equilibrium is that transmitted by the joint receptors (MECHANORECEPTORS) of the neck. 
(See Guyton, MD, Textbook of Medical Physiology, 10th edition. WB Saunders, Philadelphia 2000; p. 645)

Studies have shown that chiropractic care can help restore balance and coordination by stimulating the joint receptors (mechanoreceptors) in the cervical spine. This stimulation is thought to restore or normalize joint receptor functioning which leads to improvements in balance and coordination.

Chiropractic Can Decrease Fall Injuries. Fall injuries are extremely prevalent in the elderly population and are one of the most detrimental events that can occur to the older individual. According to the Centers for Disease Control and Prevention (CDC), falls are responsible for 90% of the 850,000 bone fractures which occur annually among Americans past the age of 65.

Chiropractors reduce the risk of falls by (1) utilizing specific chiropractic adjustive techniques in the cervical spine to normalize cervical joint receptors which provide the brain with important balance and coordination information, (2) utilizing stretching and exercise programs to increase strength, flexibility, mobility, balance and coordination, and (3) utilizing diet and nutritional counseling to improve nutritional status, increase energy levels, and increase sense of well-being.

Clinical Note: Time and time again in practice, I have found that barring a serious condition such as an intercranial tumor or other space occupying lesion, pathomechanics of the neck cause the vast majority of vertigenous episodes that I have seen. Spinal manipulation of the C-spine most often corrects the vertigenous episodes my patients are going through. Note the following article:

Norregaard AR, Lauridsen HH, et. al., "Chiropractic Management of a Patient with Benigh Paroxysmal Position Vertigo: A Case Report," JMPT, Vol. 32:5, June 2009. Upshot: First DX the case correctly, in this case it was true BPPV, then apply a simple repositioning maneuver correcting or reducing the BPPV. The authors also pointed out that cervicogenic vertigo responds wonderfully to regular chiropractic manipulative techniques.

 

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