Monday, June 15, 2009
Why did not someone tell me that your neck could cause headache?
That was the question that my Russian patient asked me after about his tenth visit. This patient, whom I’ll call Ivan, was referred to my clinic with a complaint of chronic headache of ten years duration. He had never experienced relief from this constant pain in the back of his neck and head. Ibuprofen only took the edge off but it never went away.
“I feel blah all the time,” Ivan told me in his charming Russian accent. “I can do nothing. I come home. I can’t play with my children. I go to vacation. I don’t want to go out. Everything I do makes it hurt worse.”
Ivan had been through the medical gamut several times already. You know the drill, MRI’s, CT scans, blood tests, trial medications, etc. All to no avail. Nothing had helped, but at least he had ruled out some alternative reasons for his head pain. It was fair to say that the headaches were not coming from a brain tumor or infection.
I found when I examined him that the joints of the upper neck were malfunctioning, what chiropractic calls subluxations. This malfunction was causing irritation to the nerves and spasm of the neck muscles. This in turn was giving Ivan the headache from Hades that just would not go away. The irritated nerves and tender muscle bundles were referring pain to his head and possibly causing a reduction in blood flow to the brain.
The exam findings indicated that he was suffering from cervicogenic headache, or a headache that is caused by problems in the neck. Duke University studied the results of various conventional and alternative treatments for this condition. They concluded that chiropractic is a viable treatment alternative that lacks the harmful and sometimes fatal side effects of conventional treatments when it comes to managing tension and cervicogenic headache patients.
Two significant findings were:
Manipulation appeared to result in immediate improvement in headache severity when used to treat episodes of cervicogenic headache when compared with an attention-placebo control. Furthermore, when compared to soft-tissue therapies (massage), a course of manipulation treatments resulted in sustained improvement in headache frequency and severity
In another trial conducted among patients with tension-type headache, amitriptyline was significantly better than manipulation at reducing headache severity during the 6-week treatment period; there was no significant difference between the two treatments for headache frequency during the same period. Interpretation of these results is difficult because all patients received the same relatively low dose of amitriptyline (30 mg). Despite the uniform and relatively low dose of amitriptyline, however, adverse effects were much more common with amitriptyline (82% of patients)
than with manipulation (4%)
. During the 4-week period after both treatments ceased, patients who had received manipulation were significantly better than those who had taken amitriptyline
for both headache frequency and severity. Although amitriptyline is usually continued for longer than 6 weeks, the return to near-baseline values for headache outcomes in this group contrasts with a sustained reduction in headache frequency and severity in those who had received manipulation
. [emphasis added]
Compared to other physical treatment methods (including physiotherapy, acupuncture, and electrical stimulation), the evidence supporting chiropractic appears to be more robust. Consequently, this report is an invaluable resource for documenting chiropractic practice to practitioners in other health care professions, the public, and third-party payers.
Excerpted from: Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache Duke University Evidence-based Practice Center, Center for Clinical Health Policy Research
. This report is available exclusively from FCER. To order your copy, please call 800-622-6309. Evidence Report is available for $39 for non-FCER members, $35 for current members (plus shipping and handling). The Executive Summary of this report is available www.fcer.org
Happily for Ivan, he was helped by the first adjustment. He returned the next day for a report of my findings and a second adjustment. When I asked him how he was feeling he said that his pain had gone from a 9 out of 10 to a 2 out of 10 level of pain. By the tenth adjustment he said, “I cannot believe that I could feel this good!” He continued to improve.
I saw him once a week over the next two months. At his last visit, he turned as was walking out the door to say, “Thank you Doctor, you have saved my life.” A doctor cannot get a better compliment.
Ivan is a living example of what the Duke study found. It has been almost four years since he came to see me. I called recently to check on him and he says that he is still doing well and has not had any more trouble with headaches.