It would be a rare chiropractor who hasn’t witnessed an apparent correlation between chiropractic care and improvements in the frequency or severity of headaches and migraines. It may happen in one patient or several, but is there a connection, and if so what are the mechanisms behind it? While it is true that headaches and migraines can have a myriad of triggers and causes, it is also apparent from a range of recent case reports that chiropractic may have something to offer.

In the past year, the Annals of Vertebral Subluxation Research have carried four separate case reports involving improvements in headaches following chiropractic care. The first featured a 59-year old male presenting with headaches, neck pain and rheumatoid arthritis. The case appeared in the Journal of Upper Cervical Chiropractic Research and hypothesized, “the upper cervical subluxation may be a contributing factor to rheumatoid arthritis-related pain [1].” While the case-report focused more attention on the rheumatoid arthritis (and the course of care lasted 12 sessions over 10.5 weeks), it is interesting to note that headaches and neck pain resolved after the first adjustment and the patient discontinued medication.

The second case report, authored by chiropractors Laura Stone and Joel Alcantara and appearing in the Journal of Pediatric, Maternal and Family Health, looked at a fascinating and somewhat complex case. The patient was an 11-year old male with autism. He presented for care with headaches that were affecting sleep and school attendance. He also had ADHD and obsessive-compulsive disorder. His case was indeed a complex one, but among the vast improvements noted was a marked improvement in his headaches.

Again, care was focused on the reduction of vertebral subluxations, several of which were noted in the case report (referenced below [2]). With this case, the chiropractor utilized Gonstead and Thompson Techniques.

A third case report involved a 13-year old who had been in a motor vehicle collision and had developed chronic neck pain along with headaches and dizziness following the accident. The case report presented with a number of interesting factors: the first being the fact that he had a significant cervical kyphosis and that resolution of the headaches occurred in tandem with a return to lordosis. The second interesting factor was a gradual return of symptoms in the year following the patient’s discontinuation of care. He was cared for using Chiropractic Biophysics.

It certainly prompts the question: what happens when we allow these familiar subluxation patterns to return unencumbered for a significant length of time?

These three case reports, all of which featured literature reviews and clinical details well worth perusal, featured male patients and different chiropractic techniques. The final case report was a female patient who, at age 23, had a 10-year history of headaches and migraines. Her current management plan was medication-based and reported as “essentially ineffective.” She was cared for using Diversified, Grostic and Thompson Techniques as well as upper cervical technique only on a number of visits. Of specific note to the headaches (as opposed to her other complaint of low back pain), the authors stated:

“For a month thereafter, the patient remained completely migraine-free after only being adjusted upper cervically on two separate visits. Her cervicalgia and low back pain continued to steadily improve as well. She was only experiencing slight headaches intermittently throughout the week that were rated as 3/10 on the VAS. After 10 weeks of continued care like previously mentioned, the patient reported that all her presenting complaints of chronic migraines, neck pain, and low back pain had completely resolved. The patient had a quarterly check-up visit with her neurologist who had prescribed her medication for her migraines. After a discussion with her neurologist about how upper cervical chiropractic care had resolved her migraine episodes, the neurologist agreed she could discontinue the prescription medication regime. The patient has not required the use of pharmacological intervention for migraines since then.“

Once again, her care was directed at reducing vertebral subluxations and featured a variety of techniques.

All of these are case reports and literature reviews and thus we can’t generalize findings. All of them follow headaches with different etiologies. But all of them indicate a significant improvement in headaches within a short amount of time under chiropractic care. They are not the first, nor will they be the last. But the thing that makes them refreshing is that they are focused on subluxation-based care. The reduction in headache symptoms simply follows closely on those heels.

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The Neck  – Headache Link

While it is perhaps entirely unsurprising, it is nonetheless noteworthy that a number of basic science research studies have linked neck pain to headaches. As chiropractic has a proven record with neck pain, and many chiropractic patients present with such complaints, it is an easy in-road to conversations about the effects of vertebral subluxation on health more broadly.

In 2017, JMPT published an article looking at the effects of upper cervical translatoric mobilization on cervical range of motion and headache symptoms. It was a randomized controlled trial involving 82 volunteers with cervicogenic headaches. The study looked specifically at pressure pain thresholds from C2-C3, suboccipital muscles, and trapezius muscles. The study found that “upper cervical translatoric spinal mobilization intervention increased upper, and exhibited a tendency to improve general, cervical range of motion and induce immediate headache relief in subjects with CEH [cervicogenic headaches.]

The trapezius muscle correlation may not be an isolated concept either, with a 2018 study indicating “a strong association between trapezius muscle tenderness and the level of intensity and the number of days with a headache among female office workers [6].” While the study was a basic science article that did not comment on vertebral subluxations, the issues of neck pain, associated muscle pain and even the effect of office ergonomics or stressors on posture, neck pain, and subluxation could be more common than we think.

After all, we have a veritable epidemic of people looking down at smartphones, laptops and handheld devices which may induce forward head posture and place huge amounts of undue stress on the cervical spine [7]. This is to say nothing of the postural ramifications of sedentary lifestyles if forward head posture and cervical hyperkyphosis is seen.

It seems the headache-neck pain connection is an easy one to argue, especially when there are cervicogenic connections. Headaches with such origins have long been a concern for post-whiplash patients, neck pain patients or even certain types of athletes [8]. 

The term “cervicogenic headache” is relatively new though, with diagnostic criteria including unilateral pain “starting from one side of the posterior head and neck, migrating to the front and sometimes associated with ipsilateral arm discomfort.”  It may also be aggravated by “certain neck positions.”

It has been suggested that cervicogenic headaches are a“final common pathway for pain generating disorders of the neck. Bogduk has proposed that the pathophysiology of CGH [cervicogenic headache] results from a convergence of sensory input from the upper cervical spine into the trigeminal spinal nucleus, including input from: Upper cervical facets, Upper cervical muscles, C2-3 intervertebral disc, Vertebral and internal carotid arteries, Dura mater of the upper spinal cord, [and] Posterior cranial fossa [8].”

We are growing in our understanding of the implications of neck pain far beyond simple discomfort. While the links to cerebellar processing and mental response times are making themselves increasingly clear in the world of chiropractic research (read more here), basic science seems to be indicating that when there is neck pain, headaches may be lurking somewhere close.

So what’s the take-away for chiropractors? When it comes to headaches and migraines, the best thing we can do is what we are known for: removing subluxations, enabling the body to achieve optimal neurological function and letting the body do the rest. Yes, we need more research. That is always a given. But as the bank of case reports and basic science articles mount up, linking either subluxations or neck dysfunction, the road forward seems pretty clear.

 

REFERENCES:

  1. Slagel J (2019), “Resolution of Headaches and Neck Pain in a 59-Year-Old Male with Rheumatoid Arthritis Undergoing Upper Cervical Chiropractic Care,” Journal Upper Cervical Chiropractic Research, March 14, 2019, pp. 19-27, https://www.vertebralsubluxationresearch.com/2019/03/13/resolution-of-headaches-neck-pain-in-a-59-year-old-male-with-rheumatoid-arthritis-undergoing-upper-cervical-chiropractic-care-a-case-report/
  2. Stone L, Alcantara J (2019), “Resolution of Chronic Headaches, Improved Sociability, Health and Physical Behavior in a Child with Autism, ADHD and Obsessive Compulsive Disorder Following Chiropractic Care to Reduce Vertebral Subluxation: A Case Report and Review of Literature,” Journal of Pediatric, Maternal and Family Health Chiropractic, 2019, pp. 63-70
  3. Underhill M, Oakley P, and Harrison D, (2019), “Improved Cervical Lordosis Following Chiropractic in an Adolescent with Chronic Cervicogenic Symptoms form a Motor Vehicle Collision: A Case Report and Review of the Literature,” Journal of Pediatric, Maternal and Family Health Chiropractic,2018, pp. 99-108 https://www.vertebralsubluxationresearch.com/2018/09/19/improved-cervical-lordosis-following-chiropractic-in-an-adolescent-with-chronic-cervicogenic-symptoms-from-a-motor-vehicle-collision-a-case-report-review-of-the-literature/
  4. Richerson A, Varnum C and Alcantara J (2019), “Resolution of Chronic Migraines and Neck Pain in a 23-Year-Old Female Following Chiropractic Care for Vertebral Subluxations: A Case Study and Review of the Literature,” Annals of Vertebral Subluxation Research, July 2019, pp. 90 – 103
  5. Malo-Urries M, Tricas-Moreno JM, Estebanez-de-Miguel E, Hildago-Garcia C, Carrasco-Uribarren A, Cabanillas-Barea S (2017), Immediate effects of upper cervical translatoric mobilization on cervical mobility and pressure pain threshold in patients with cervicogenic headache: a randomized controlled trial,” JMPT, Nov – Dec;40(9):649-658. DOI: 10.1016/j.jmpt.2017.07.007. 
  6. Lidegaard M, Anderse LL (2018), “Association Between Trapezius Muscle Tenderness and Tension-Type Headache in Female Office Workers: a Cross-sectional Study,” JMPT Jul – Aug;41(6):483-487. DOI: 10.1016/j.jmpt.2017.10.016. Epub 2018 Aug 8
  7. Staff writer (2016), “Stress on the Spine: the downside of prolific social media use.” Australian Spinal Research Foundation, https://spinalresearch.com.au/stress-on-the-spine-the-downside-of-prolific-social-media-use/
  8. Page P (2011), “Cervicogenic Headaches an evidence-led approach to clinical management,” International Journal of Sports Physical Therapy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201065/

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