Headaches are a common complaint that can be caused by a range of factors. Those that can be traced to disorders in the neck are called cervicogenic headaches, and this type of headache may affect as many as 20 percent1 of patients experiencing chronic head pain. Although their symptoms are similar to those of tension headaches and migraines, cervicogenic headaches are often a result of injury or other trauma. Because cervicogenic headaches often restrict a patient’s range of motion, this condition can seriously impact physical abilities and overall quality of life.
New research published in Chiropractic & Osteopathy supports the case for using chiropractic spinal manipulation to treat cervicogenic headaches. A team of researchers from the University of Pittsburgh and the University of Western States in Portland, Oregon, compared the effects of spinal manipulation treatment to light massage on a group of 80 patients suffering from cervicogenic headache. They found that over a 12-week period, 42% of study participants who received spinal manipulation treatment reported significant pain reduction compared to just 23% of those who received massage. During that same period, the chiropractic group experienced a greater reduction in the number of headaches (64% versus 46%) and reported that pain interfered less with their daily activities.
After 24 weeks, patients in the chiropractic group continued to experience greater benefit from their treatment, with 56% reporting that their head pain was less disabling compared to 38% improvement among the control group. Over three-quarters of participants who received spinal manipulation treatment noted some reduction in the number of headaches during the course of the study.
The study’s authors conclude that, “Spinal manipulation had a clinically important advantage over light massage in headache pain, number, and disability.” Their research shows that chiropractic treatment can have substantial and lasting benefits for a significant percentage of people suffering from cervicogenic headaches.
Haas M, Schneider M, Vavrek D. Illustrating risk difference and number needed to treat from a randomized controlled trial of spinal manipulation for
Check out the following articles to learn more about how our office can help you find relief from headaches:
Migraine headaches are estimated to cost the U.S. over $17 billion each year. While it is clinically recognized that migraines can be related to cervicogenic conditions, the exact nature of this relationship is unknown. This study set out to test the effectiveness of chiropractic treatment for migraines.
123 participants diagnosed with migraines according to the International Headache Society standard completed the study. Each participant experienced a minimum of 1 migraine per month, and had at least 5 of the following indicators: inability to maintain normal activities/need to seek dark and quiet, pain located around the temples, “throbbing” pain, symptoms of nausea, vomiting, aura, photophobia or phonophobia, migraine triggered by weather changes, migraine worsened by head or neck movement, diagnosis of migraine by a specialist, and a family history of migraine.
The study consisted of three stages. In the pretreatment stage, researchers collected data on migraine incidence, intensity, duration, disability and use of medications, this data was used as a baseline to compare with study results and data collection continued throughout the trial. For the second stage of research participants were split into a control group (40) that received a placebo treatment using electrodes and an experimental group (83) that received a maximum of 16 treatments of chiropractic spinal manipulative therapy (CSMT). The last 2 months of the study involved data collection for comparison purposes.
Results showed that those that received chiropractic treatment had significant improvement in migraine frequency, duration, disability and lowered medication use in comparison to the control group. Improvements in migraine frequency and duration for the chiropractic group are illustrated below. The area of greatest improvement was medication use, with a significant number of participants reporting that their medication use was down to zero by the end of the trial. Five participants reported that migraine symptoms were worse after 2 months of CSMT, but they did not report intensified symptoms at the post treatment stage.
The authors report that their study with a 6-month duration is more valid than some previous studies because studies with shorter durations are too short to allow for the cyclical nature of migraines. Limited sample size and lack of consideration for what aspect of CSMT caused the improvements are some limitations of this study. Researchers also suggest that an improved study method might be to treat the control group with a sham form of CSMT rather than a treatment that does not mimic chiropractic. Despite some limitations this research adds to the body of evidence that suggests chiropractic manipulative therapy can be an effective treatment for migraine and headaches. The authors conclude:
“A high percentage (83%) of participants in this study reported stress as a major factor for their migraines. It appears probable that chiropractic care has an effect on the physical conditions related to stress and that in these people the effects of the migraine are reduced. However, further studies are required to assess how chiropractic SMT may have an effect on migraine morbidity.”
Tuchin PJ, Pollard H, Bonello R. A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. Journal of Manipulative and Physiological Therapeutics 2000;23(2):91-95.
Psychological symptoms are often associated with both headaches and whiplash. This study examined patients who suffered from headaches (along with the neck pain) following whiplash by using the SCL-90-R, a self-report, psychological symptom checklist that is used to assess distress. In previous studies, patients with post-traumatic headaches had scored higher on the questionnaire than patients with no chronic pain; also post-traumatic patients have indicated a higher rate of psychological distress on the SCL-90-R than migraine and tension headache sufferers did.
The study’s goal was to get a psychological distress profile of patients who suffer from headache induced by whiplash injury, and to then compare those patients distress to that of previously published distress levels of traumatic and non-traumatic headache patients.
The authors found that patients with headache as a result of whiplash scored similarly to patients with other types of post-traumatic headache and to patients with whiplash but with no headache. When the whiplash patients were compared to non-traumatic headache sufferers, however, significant differences emerged. Patients with non-traumatic headache pain scored evenly on all of the test subscales, while whiplash patients scored higher in just a few different scales: somatization, obsessive-compulsive, depression, and hostility.
The authors explain their findings:
“The reactive pattern of distress exhibited by patients with post-traumatic headache and whiplash-associated headache is more suggestive of a direct secondary response to pain and disability, resulting from trauma, rather than of a more diffuse etiology. Thus, somatization can be interpreted as belief by the patient that something in the head or neck does hurt; the obsessive-compulsive subscale elevation reflects the interference of pain with cognitive functioning and subsequent insecurity; depression occurs because the pain does not go away; and hostility arises when the accident is not the patient’s fault, or when doctors and solicitors cannot find and/or deny a cause or a cure.”
This study is the latest of a large group of studies that show that organic pain may be at the root of whiplash-related distress. As the authors state, “These differences [in distress patterns] are prima facie grounds to resist the temptation to ascribe whiplash-associated headache to situational stress and ‘tension,’ and, instead, to consider the possibility of an organic pain source.”
BJ Wallis, SM Lord, L Barnsley, N Bogduk.The psychological profiles of patients with whiplash-associated headache. Cephalalgia 1998;18:101-105.
Neck pain and headaches in kids:
More common than parents think
Preteens may experience headaches and neck pain far more often than their parents would expect. A Swedish study of 131 students ages 10-13 years old compared the spinal health of students with and without pain. A surprising finding was that parents significantly under-reported their child’s experience of pain.
The study found a wide discrepancy between what the children and parents reported regarding the child’s health. Children rated their experience and frequency of pain on surveys, prior to the assessment. Parents were asked separately to answer the same questions on behalf of their children.
31% of children reported that they “often” had neck pain and/or headaches, compared with 6% of parents. Similarly, 61% of children reported trauma to the head and/or neck region but only 20% of the parents said that their children had experienced such trauma.
Significance of these findings for chiropractors:
- 40% of students ages 10-13 may some experience neck pain and/or headaches
- Parents may not be aware of the presence of pain in their children or the history of head trauma
- Children reported that computer use and long period of reading made pain worse
To address the prevalence of headaches, chiropractors can:
- Educate adult patients about the high levels of neck pain and headaches among youth
- Encourage parents to talk with their children about neck pain and/or headaches and its origins
- Teach families techniques to prevent headaches following computer or reading time
Chiropractors who continue to educate themselves on the latest findings and techniques in pediatric chiropractic will be best equipped to protect the development of children’s spines.
Weber Hellstenius S A, Recurrent Neck Pain and Headaches in Preadolescents Associated with Mechanical Dysfunction of the Cervical Spine: A Cross-Sectional Observational Study With 131 Students. Journal of Manipulative and Physiological Therapeutics, October 2009. (32)8:625-634.
The study compared 90 headache patients to 51 control subjects in regard to neck range of motion. The headache patients were further divided into three groups by headache type: migraine (28), tension-type (34), and cervicogenic (28). Each test subject was given a thorough range of motion examination.
When the controls, migraine patients, and the tension-type patients were compared, the author found no significant difference in ROM between any of the groups; the cervicogenic patients, however, showed significantly lower ROM in flexion/extension and rotation. There was no difference in lateral flexion.
On average, the cervicogenic headache patients showed an approximately 13% reduction in rotation and a 17% reduction in flexion/extension. “The present findings indicate that there are pathophysiological differences between [cervicogenic headache], [tension headache], and [migraine].
The study concludes by stating that a careful examination of ROM is critical in confirming a diagnosis of cervicogenic headache.
Zwart JA. Neck mobility in different headache disorders. Headache 1997;37:6-11.
The researchers created four different test scenarios for the patients: stress, with no food; stress, with food; no stress, food; and no stress, no food. The 56 subjects were randomly assigned to one of the test groups.
When testing the triggers separately, 58% of the food-deprived subjects reported headaches. Previous studies had associated hunger with migraines, yet this study found that hunger can also trigger tension-type headaches. In fact, the researchers measured forehead EMG levels, and found that the “no food” patients had significantly elevated EMG readings.
The researchers found that stress was indeed a potent trigger for headache—93% of subjects reported the start or a worsening of headache symptoms during the “stress, with food” experiment.
Martin P, Seneviratne H. Effects of food deprivation and a stressor on head pain. Health Psychology 1997; 16(4): 310-318.
This study examined 100 consecutive patients who presented at neurological unit with headache of recent onset (described as headache that “appeared for the first time ever in the last 12 months. Patients with past history of headache were excluded except, if a change of character of the previous headache had been the reason for the referral.”) Every patient was examined by a physician and given a CT scan with and without intravenous contrast. Some of the patients were given lumbar puncture, blood tests, MRI, and magnetic resonance angiography, if needed.
90% of the patients had headaches for the first time, while 10% had previous—but now different—headaches.
The study reported that the neurological examination was normal in 80% of the patients. Further investigations, however, turned up some very serious conditions: Intracranial neoplasm (21%); subacute meningitis (5%); intracranial hematoma (3%); and hydrocephalus (2%). In all, “Headaches were considered organic in 39 (39%) of the 100 patients, and in 21 (26%) of the 80 with normal neurological examination.”
“It has been suggested that with recent-onset headache, a CT or MRI should be obtained if the headache is severe or occurs with nausea, vomiting or abnormal signs. However, headache in four patients with intracranial tumors in our study was mild, no nausea or vomiting occurred, and was not aggravated by Valsalva nor did it awake them during the night, and were unassociated with abnormal neurological signs.”
“We suggest that neuroimaging studies should be performed in all adult patients with non-vascular headache of recent-onset, and no previous history, irrespective of the characteristics of the headache…”
Duarte J, Sempere AP, Delgado JA, et al. Headache of recent onset in adults: a prospective population-based study. Acta Neurologica Scandinavica 1996;94:67-70.