There
are now controlled trials supporting the effectiveness
of chiropractic management for each of these forms
of headache.1-6
While
the evidence for tension type headache and cervicogenic
headache has been available for a longer period, some
further consistent findings have appeared to show
the effectiveness of chiropractic for migraine sufferers.
In 1998, a study of 218 patients with migraine found
that while amitriptyline (a well-established effective
drug for migraine) reduced headache scores by 24%
at a 4 week follow-up, spinal manipulation reduced
the headache score by 42%.3
Macquarie
University has also completed a trial of chiropractic
spinal manipulative therapy for migraine in 2000.
They found that a high proportion of people report
a significant improvement in migraines (reduction
in pain, reduction in light sensitivity, decreased
nausea and less likely to need a dark quiet area)
after chiropractic.6
In
a study, published in 2001, of 105 patients with cervicogenic
headache it was found that cervical manipulation increased
active range of motion of the neck.7 It has also been
found that there is a sustained benefit.8
Once
anatomical pathologies are ruled out chiropractors,
and an increasingly large number of medical specialists,
argue that dysfunctional structures in the neck frequently
play a major role in these headaches.
Two
recent discoveries relating to the neck or cervical
spine are of particular interest:
1.
The facet joints of the cervical spine are a source
of head and neck pain.9 The facet joints, found in
pairs on the back of the cervical vertebrae, are rich
in pain receptors. Chiropractic cervical manipulation
is aimed primarily at gapping these facet joints to
restore normal mechanics or movement.
2.
The existence of bridges of connective tissue between
the muscles and ligaments of the upper cervical spine
and the dura of the base of the skull. This discovery
by dental researchers in the U.S.10 and chiropractic
researchers in the U.K.11 in 1995 and 1998 provides
a much clearer anatomical basis for tension in the
cervical spine as a cause of headache. The dura (thick
covering of the brain and spinal cord) encloses the
central spinal cord and is extremely pain sensitive.
It is now known to be directly connected to muscles
and ligaments in the neck.
Obviously
there are also many lifestyle and behavioural factors
that may also play a role and can even trigger neck
pain as well as headache. Your chiropractor is trained
to help you identify possible factors that may be
involved in your headaches. Some examples include:
Physical
· Repetitive posture
· Prolonged activity
· Clenching of teeth (jaw problems)
Chemical
· Food allergies or sensitivities (e.g. chocolate,
sugar, orange juice, coffee, smoking, milk, wheat,
alcohol)
· Sinus related problems
· Constipation
· Menstrual cycle
Emotional
· Stress related to work or home
· Tension
References
1. Parker, G., Tupling, H., Pryor, D. (1978) A controlled
trial of cervical manipulation for migraine. Aust.
NZ. J. Med. 8: 589-593.
2. Parker, G.B. et al. (1980) Why does migraine improve
during a clinical trial? Further results from a trial
of cervical manipulation for migraine. Aust. NZ. J.
Med. 10: 192-198.
3. Nelson, C.F., Bronfort, G. et al. (1998) The efficacy
of spinal manipulation, amitryptiline and the combination
of both therapies for the prophylaxis of migraine
headache. J. Manip. Physiol. Ther. 21: 511-519.
4. Boline, P., Kassak, K., Bronfort, G., Nelson, C.,
Anderson, A. (1995) Spinal manipulation vs amitryptiline
for the treatment of chronic tension-type headaches.
J. Manip. Physiol. Ther. 18: 148-154.
5. Nilsson, N., Christensen, H.W., et al. (1997) The
effect of spinal manipulation in the treatment of
cervicogenic headache. J. Manip. Physiol. Ther. 20:
326-330.
6. Tuchin, P.J., Pollard, H., Bonello, R. (1999) A
randomised controlled trial of chiropractic spinal
manipulation therapy for migraine. Proceedings of
the 5th Biennial Congress of the World Federation
of Chiropractic. 183-184, Abstract.
7. Whittingham & Nilsson (2001) Active range of
motion in the cervical spine increases after spinal
manipulation (toggle recoil). J. Manip. Physiol. Ther.
24: 552-555.
8. Chapman-Smith, D. (2002) Notes for state association;
Jan: 4.
9. Lord, S.M., Barnsley, L. et al. (1996) Chronic
cervical zygapophyseal joint pain after whiplash.
A placebo controlled prevalence study. Spine 21: 1737-1745.
10. Hack, G.D., Koritzer, R.T. et al. (1995) Anatomic
relation between the rectus capitus posterior minor
muscle and the dura mater. Spine 20: 2484-2486.
11. Mitchell, B.S., Humphreys, B.K., Sullivan, E.
(1998) Attachments of the ligamentum nuchae to posterior
to cervical posterior spinal dura and the lateral
part of the occipital bone. J. Manip. Physiol. Ther.
21: 145-148.
