Headaches - Chiropractic Treatment for Headache

Headaches
By Dr. Vic Weatherall
ADVANCE CHIROPRACTIC

The three most common types of headaches are cervicogenic, tension, and migraine. These are explained below followed by information on how chiropractic may help. Some important information on headaches is provided at the end of this article.

Cervicogenic headache
Cervicogenic headache (headache originating from the neck) pain is typically dull or aching in quality, not stabbing, and is located in the back, upper sides and top, temple, forehead, or eye regions of the head, or in any combination of these regions, and on one or both sides. There is also some neck involvement such as neck pain, local tenderness, reduced neck motion, aggravation of the headache by neck movements, or a history of neck injury.

The sources of pain in cervicogenic headache are injured neck joints, ligaments, muscles, and discs, all of which have complex nerve endings. The nerve endings in the injured areas send pain signals up the upper nerves of the neck to the brain. During this process these nerves intermingle with the nerve fibers of the trigeminal nerves, the nerves responsible for perceiving head pain, thereby causing the patientÌs headache.

While many patients who are diagnosed with cervicogenic headache have the traditional symptoms of tension headache, some of the patients who have the traditional symptoms of migraine (and cluster migraine) headache also respond to cervicogenic headache diagnosis and treatment.

References
Proposed Taxonomical Definition of Cervicogenic Headache. North American Cervicogenic Headache Society.
Rothbart P. The Cervicogenic Headache: A Pain in the Neck. The Canadian Journal of Diagnosis; Feb 1996:64-76.
The World Cervicogenic Headache Society.

Tension headaches
Tension headaches are characterized by frequent, intermittent, moderate "band-like" pain at the back and front of the of the head. Suffers often complain of poor concentration and other non-specific symptoms. These headaches may be worsened with stress, fatigue, noise, or glare. The cause of tension headaches is unknown. Although the tight neck and scalp muscles found in tension headaches gave them their name, they are probably secondary effects.

References
Current Medical Diagnosis and Treatment 1998.
The Merck Manual of Medical Information.
Clinical Neurology, 3rd Edition.

Migraine headaches
Migraine headache pain is usually generalized (but it may be one-sided), throbbing, beginning in and about the eye, and spreads to involve one or both sides. The headache may be accompanied by loss of appetite, nausea, vomiting, and intolerance to light. The attacks may last hours or days. The symptoms generally follow a particular pattern in each individual. There is usually a family history of migraines. Prior to headache onset a person may experience mood change, decreased appetite, changes in vision, and occasional one-sided paralysis.

There are two general types of migraines: classic and common. Classic migraines usually affect one side of the head and are preceded by an aura of transient neurologic effects, most commonly decreased vision in one eye and irregular outlines around luminous bright patches. Common migraines usually affect both sides of the head and around both eyes. There is no aura, and the headache may be accompanied by tight neck muscles and scalp tenderness.

Migraine headache pain is caused by changes in blood flow in the head. Migraines can be triggered by many things. Dietary triggers include wine, cheeses, meat (such as hot dogs and bacon), chocolate, monosodium glutamate (MSG). Other triggers include fasting, emotional upset, menstrual cycles, drugs, weather, and bright lights.

References
The Merck Manual, 16th Edition.
Clinical Neurology, 3rd Edition.

Chiropractic treatment for headaches
Chiropractic treatment (including spinal manipulation, soft tissue therapy, or both) has been found to be effective in the treatment of cervicogenic, tension, and migraine headaches. In the studies cited below, amitriptyline is a drug commonly prescribed for chronic pain and depression.

References
Nilsson N, Christensen HW, Hartvigsen J. The effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther 1997; 20(5):326-30.
Boline PD; Kassak K; Bronfort G; Nelson C; Anderson AV. Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. J Manipulative Physiol Ther 1995; 18(3):148-54.
Nelson CF; Bronfort G; Evans R; Boline P; Goldsmith C; Anderson AV. The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. J Manipulative Physiol Ther 1998; 21(8):511-9

Some important facts on headaches
The Canadian Medical Guidelines for the Diagnosis and Management of Migraine in Clinical Practice (.PDF document) include important information for distinguishing migraines from other sources of head pain. This information is also applicable to other types of headaches. People displaying such symptoms should seek medical treatment without delay.

Features of a headache that should raise concern about a more serious underlying problem--possibly requiring more detailed investigation--include the following:

The first or worst headache of the patient's life, particularly if the headache came on quickly.
A change in the frequency, severity, or clinical features of the attack from what the patient has commonly experienced; that is, not the usual symptoms.
The new onset of headache in middle-age or later, or a significant change in a long-standing headache pattern.
The a new or progressive headache that lasts for days.
The head pain initiated following the coughing, sneezing or bending down.
The presence of systemic symptoms such as muscle pain, fever, malaise, weight loss, scalp tenderness, or jaw pain.
The presence of localized neurological symptoms, of any abnormalities found on subsequent neurological examination, confusion, seizures, or any impairment in the level of consciousness.
References
William E.M. et al. Canadian Medical Guidelines for the Diagnosis and Management of Migraine in Clinical Practice. CMAJ 1997; 156:1273-87.