Headaches & Chiropractic
Headaches affect almost 50% of adults globally, and are listed as third highest for years lost due to disability (1). Our most common headaches have traditionally been classified as migraines, and tension-type headaches. More recently the International Headache Society (IHS) recognizes cervicogenic headaches as a distinct diagnosis, which makes up 15 to 20% of chronic headaches in the general population (2, 3). Let’s break down common headaches we treat in the Chiropractic clinic, and talk about more serious headaches to watch out for.
Migraine headaches affect 11% of adults globally (4). They can broken down into two categories, migraine with and without aura. An aura is described as reversible focal neurological symptoms that develop over 5-20 minutes prior to a migraine HA. This can consist of fully reversible sensation, visual, or speech disturbance. Migraines without aura are considered “common migraines”, and exist only as an intense headache.
In addition to the criteria, migraines also present with at least one of nausea or vomiting, or sensitivity to light or sound. In the chiropractic clinic we often treat migraines with a multimodal approach. This starts with looking at mechanical contributors in the neck through adjusting, soft tissue, and exercise. We also consider nutrition and stress management, as both can play a large role in migraines. This approach has been shown to be beneficial for both chronic (>15 days a month for up to 3 months), and episodic (<15 days a month) migraines in research (5, 6). Adjusting (spinal manipulation) on it’s own is also very beneficial. It has been proven to decrease headache frequency, intensity, and disability as well as decrease over the counter medication use over 8 weeks of treatment (5, 7).
Cervicogenic, or headaches coming from the neck, are increasingly being recognized as a common headache (3). In the chiropractic clinic we see these associated with mechanical issues in the neck. Typically this is decreased range of motion (particularly rotation), headache following trauma, and headache following repetitive or prolonged postures (3).
Most of our common headaches are diagnosed mainly through the history, but to differentiate cervicogenic and tension-type headaches we often try to recreate the source of your headache. This is done by assessing the joints in your upper neck, as well testing common headache generating muscles throughout the neck. As with migraines multiple studies show improvement of these headaches with chiropractic care (5). Adjusting and mobilization of the neck joints reduce headache intensity, frequency, and duration in addition neck pain over a 3 week treatment plan (8). Exercises targeting the deep neck musculature has also shown substantial improvements when performed over a 6 week period (5, 9).
The most popular musculoskeletal headache, tension-type headaches are essentially cervicogenic headaches with only soft tissue involvement. This means that the neck joints themselves are not a significant contributor to pain. Theoretically this makes sense with what research has concluded, which is that “a recommendation cannot be made for or against the use of spinal manipulation for patients with chronic tension-type headaches” (5). In these cases, it seems that soft tissue therapy and low-load mobilization is most effective! While there is no increased risk or detriment to also performing adjustments to someone with these headaches, it doesn’t seem to be the most effective way to reduce headache symptoms.
Red Flag Headaches
In our last section we’ll touch on more serious headaches. These headaches exist with “red flags” that warn you when more serious pathology exists. If you see your chiropractor and report these symptoms they will promptly refer you, so save yourself precious time by knowing the following. Symptoms to watch our for include (4):
- Sudden onset new headache that is severe and progressing
- Headache that wakes you from sleep
- Headache following head or neck trauma
- Progressive and unrelenting headache in those over 50
- Headache associated with neurological deficits such as dizziness, weakness in the arms or facial muscles, and trouble swallowing or speaking
We hope this introduction to headaches has helped you get an idea of type of headache you may have, and what symptoms to watch out for. If you suffer from headaches, or have other health concerns visit your Chilliwack Chiropractor for a treatment plan unique to you!
Written by: Cornelius van de Wall and Spencer Devenney, DC
- WHO: http://www.who.int/mediacentre/factsheets/fs277/en/ Accessed online 3/9/2017
- IHS-ICHD-II Full Version: http://www.ihs-headache.org/ichd-guidelines Accessed online 3/9/2017
- Haldeman, Scott, and Simon Dagenais. “Cervicogenic Headaches.” The Spine Journal 1.1 (2001): 31-46.
- DynaMed: Headaches. Accessed online 3/9/2017
- Bryans, Roland, Martin Descarreaux, Mireille Duranleau, Henri Marcoux, Brock Potter, Rick Ruegg, Lynn Shaw, Robert Watkin, and Eleanor White. “Evidence-Based Guidelines for the Chiropractic Treatment of Adults With Headache.” Journal of Manipulative and Physiological Therapeutics 34.5 (2011): 274-89.
- Lemstra, Mark, Brad Stewart, and W. P. Olszynski. “Effectiveness of Multidisciplinary Intervention in the Treatment of Migraine: A Randomized Clinical Trial.” Headache: The Journal of Head and Face Pain. Blackwell Science Inc, 25 Oct. 2002. Web. 09 Mar. 2017.
- Tuchin, Peter J., Henry Pollard, and Rod Bonello. “A Randomized Controlled Trial of Chiropractic Spinal Manipulative Therapy for Migraine.” Journal of Manipulative and Physiological Therapeutics 23.2 (2000): 91-95.
- Organization, Chiropractic Resource. “THE EFFECT OF SPINAL MANIPULATION IN THE TREATMENT OF CERVICOGENIC HEADACHE.” THE EFFECT OF SPINAL MANIPULATION IN THE TREATMENT OF CERVICOGENIC HEADACHE. N.p., n.d. Web. 09 Mar. 2017.
- Vishwanatham, S. “Exercises for Mechanical Neck Disorders: A Cochrane Review Update.” Manual Therapy. N.p., n.d. Web. 09 Mar. 2017.