The last three “Health Updates” reviewed the differences between tension-type headaches, migraine headaches and dangerous types of headaches. Keeping in mind those differences, the history and examination will focus on differentiating between these three types of headaches.

The presenting patient will be given the “usual” paper work to fill out that includes biographical information (name/address, type of insurance, HIPAA forms, and so forth), as well as a history, past history, medication list, family history, current habits, and systems review. Specific questionnaires about headaches that can be scored and compared to future scores are particularly helpful in determining the percentage of change in the condition. The main historical piece of information that differentiates the tension vs. migraine headache is the presence or absence of nausea or vomiting, which is unique to migraines. Migraine headaches are usually preceded with an “aura” or, a pre-headache symptom such as ringing in the ears, flashes of light in the visual field, a numbness or tingling sensation – some odd type of “hint” that a migraine may soon strike, often within 30 minutes after the aura. This is important as a chiropractic treatment given prior to the onset of the migraine can sometimes stop the migraine from starting or progressing. Migraines will often occupy half the head vs. tension-type headaches that often occupy both sides. The history can also give us information about things that may trigger a headache (primarily migraines) such as odors, certain foods (like chocolate, nuts, spicy food), and this can lead to specific diet oriented treatment recommendations.

The physical exam include observing the patient’s posture, head carriage, skin color/moisture and touching the muscles (palpation) feeling for spasm/tightness, temperature/moisture, pain location or radiation. Various “orthopedic tests” include movements of the head and neck in attempt to reduce, reproduce or increase symptoms with the primary goal of trying to figure out which structures may be generating the pain. Cervical range of motion tests are performed to see which movements increase or decrease the pain. The neurological exam – testing reflexes, muscle strength, sensation (sharp/dull) may reveal areas of the skin on the head that are either increased / hypersensitive or reduced in sensation (numb). Looking in the back of the eyes is a unique place where blood vessels can be viewed and increased blood pressure, diabetes, increased pressure in the head and more can sometimes be detected, which can help determine if a dangerous headache is lurking. A cranial nerve exam is also sometimes done as part of the neurological examination.

The chiropractic treatment protocols for headaches include (but are not be limited to): Spinal manipulation or mobilization (this is applied to the areas of the neck and/or upper back where the joints are either fixed, displaced, or are applied to a region where the neurological function may be compromised), exercise training, traction, electrical current, ultrasound, stress and diet management.

We realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for headaches, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

The most important factor to consider is when the “typical” headache is suddenly “different.” Some of these “different” symptoms may include slurred speech, difficulty communicating or formulating thought, seizures, fainting or loss of consciousness (even for a few seconds), memory lapses, double or blurred vision, profound dizziness, numbness in the face or half of the body, an “alarm” should sound off telling you to get this checked ASAP as these symptoms, when they deviate from “the norm” may be indicative of a more serious condition. This can be challenging as seizures are often related to migraines and might be a common symptom of a migraine headache for some migraine sufferers.

Signs of a dangerous headache include:

1. A headache that starts suddenly, especially if it’s of a severe degree.
2. Headaches that start later in life, especially after the age of 50.
3. A change in the quality of headaches.
4. Visual changes, including double vision or loss of vision.
5. Weakness, numbness, or any other neurological symptoms.
6. Fevers – especially of rapid onset.
7. Change in mental status including sleepiness, hallucinations, speech changes or confusion.
8. Weight loss.

If there is ever ANY doubt about a dangerous headache, your physician should be contacted. Typically, the migraine patient will notice a fairly consistent set of symptoms and even though the headaches can vary in intensity, the sequence of events is fairly consistent. Dangerous headaches are the ones that deviate significantly from that migraine sufferer’s “norm.” For example, suppose a patient’s “typical” migraine is: aura (bright, flashy lights in the visual field or, a strange odor precedes the migraine about 30 min. before the headache strikes), followed by a gradually increasing pain in half of the head which worsens to a point of nausea and sometimes vomiting if something isn’t done to stop it (such as a chiropractic adjustment and/or some form of medication). If this is that patient’s “usual,” IF any of the 8 items previously listed above accompany the headache, it should be further evaluated – often requiring an EEG (electroencephalogram) and/or MRI (Magnetic Resonant Image). The EEG will test for any electrical signal changes in the brain and the MRI will show space occupying structures such as tumors, bleeding, infection, aneurism, and if performed with a contrast agents, arterial malformations (that is, abnormal networks of blood vessels).

We realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for headaches, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Tension-type headaches (TTHA) are defined by the Mayo Clinic as “a diffuse, mild to moderate pain that’s often described as feeling like a tight band around your head.” Ironically, even though this is the most common form of headache, the causes of TTHA are not well understood. These are sometimes described as muscle contraction headaches but many experts no longer think muscle contractions are the cause. They now feel that “mixed signals” coming from nerve pathways to the brain are the cause and may be the result of “overactive pain receptors.”

Regardless of the cause, the triggers of tension headaches are well known and include stress, depression/anxiety, poor posture, faulty awkward work station set-ups, jaw clenching and many others. Risk factors for TTHA include being a woman (studies show that almost 90% of woman experience tension headaches at some point in life) and being middle aged (TTHA’s appear to peak in our 40s, though TTHA’s are not limited to any one age group). Complications associated with TTHA’s may include job productivity loss, family and social interaction disruption, and relationship strain. The diagnosis is typically made by excluding other dangerous causes of headaches and when all the test results return “normal,” the diagnosis of TTHA is made.

Treatment utilizing over the counter medications are often effective so long as side effects of stomach irritation and/or liver and kidney issues don’t arise. The use of heat and/or cold is often helpful as some prefer one over the other. Alternating between ice and heat is sometimes most effective. Controlling stress by trimming out less important duties or “…taking on less” can help. Yoga, meditation, biofeedback and relaxation therapy are also great! An “ergonomic” assessment of a workstation and how it “fits” the headache patient can also yield great results. Other highly effective therapies include acupuncture, massage therapy, behavior and/or cognitive therapy as well as of course, chiropractic! Chiropractic is a GREAT choice compared to standard medical care, especially when side effects to medications exist. This is because manipulation of the cervical spine addresses the cause of the headache and doesn’t just try to “cover up” the pain. In 2001, Duke University reported compelling evidence that spinal manipulation resulted in almost immediate improvement for those with headaches that originate in the neck with significantly fewer side effects and longer-lasting relief compared to commonly prescribed medication. Chiropractic treatment approaches include (partial list): spinal manipulation, trigger point therapy, mobilization techniques, exercise training, physical therapy modality use, dietary and supplementation education / advice, lifestyle coaching and ergonomic assessments.

We realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for headaches, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

So “how does chiropractic work?” To answer this, let’s first discuss what we do when the headache patient comes in. First, the history is very important! Here, we’ll ask “how/when did the headaches start. This may glean the actual cause of headaches such as a car accident or injury of some sort. Next, we’ll ask about activities that increase or create the headache, which gives us ideas of how we might help manage the headache patient. For example, when certain activities precipitate the onset of a headache, we will modify the work station and/or give specific exercises on a regular schedule to keep the neck tension under control. When information gathered about what decreases or helps the neck pain and headaches, we will recommend treatments often that can be done at home such as a home traction unit. This would be suggested if we are told that “…pulling on my neck feels great!” The quality of pain (throbbing = vascular, ache and tightness = neck), intensity of pain (0-10 pain scale), and timing (worse in the morning vs. evening) help us track change after treatment is rendered, usually gathered once a month. The examination includes blood pressure which can in itself create headaches when high, looking in the eyes to view the blood vessels in the back of the eye to make sure there is no evidence of increased pressure against the brain, ears – to see if there is an infection or wax blockage. This can help if there is dizziness and/or balance loss. We will sometimes listen to the throat as well as the heart to see if there may be a blockage, a valve problem, or other issues. Neck muscle tightness (spasm) will be evaluated along with the range of motion, paying particular attention to the positions/directions that increases and decreases pain, especially those that decrease pain. Nerve function by checking reflexes, sensation and muscle strength as well as correlating information like positions that decrease arm or leg pain will be included as any position that reduces pain in the arm or leg must be incorporated into an exercise. X-rays may include bending “stress” views so that ligaments (that hold bones together) can be evaluated for “laxity” (torn and unstable). When this is found, we avoid adjustments to these vertebrae.

As you can see, if is very important do a thorough evaluation so headache patients can be properly managed. Treatment approaches include: 1. Adjustments; 2. Soft tissue therapy (trigger point stimulation, myofascial release); 3. Posture correction exercises and other exercises; 4. Education about job modifications; 5. Co-management with other health care providers, if medication or injection therapy is needed.

We realize you have a choice in healthcare providers. If you, a friend or family member requires care for headaches, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Usually, there is not one specific cause of headaches so treatment can focus on various areas. For example, muscles that attach to the base of the skull in the neck and upper back are often very short and tight, resulting in pressure or a squeezing effect on the surrounding nerves and blood vessels — resulting in headaches. Chiropractic treatment includes methods aimed at reducing the tightness found in the joints and muscles. One of these approaches is called spinal manipulation or “adjustments” where the joints in the neck are moved to restore motion and reduce joint fixations. By relaxing the muscles and tension between the joints, the nerves in the neck are less pressured which, in turn, can reduce headaches. The top three nerves that exit the upper neck travel into the head and are often the culprit behind the onset of headaches. The second nerve from the top is the one responsible for causing radiating pain over the top of the skull which communicates with other nerves sometimes causing the pain behind the eye.

Another chiropractic approach in the management of headaches includes soft tissue therapy where trigger points found in tight muscles are addressed through various forms of massage and mobilization methods. Manual traction of the head and neck can also be highly effective in reducing the tension found in headache sufferers. Exercises are often taught to the headache patient with significant benefits reported. Some of these, such as range of motion exercises with and without resistance (example: pushing your head into your hand during neck movements) and posture re-training (chin tucks – reducing the forward head position), help address the limited motion problems of the neck. Cervical (neck) traction performed by placing a rolled up towel placed behind the neck while lying on the back so that the head can hang off the side of the bed can also be very helpful. Another neck traction approach is the use of a unit that hangs off a door where water is placed in a plastic bag calibrated for weight for 15 minutes at a maximum tolerated weight. This can be of great benefit as it can be performed at home at your convenience multiple times a day or, as needed.

Other treatment approaches that chiropractic utilizes include stress management (such as biofeedback, relaxation instructions, meditation, visualization and others), diet modifications (as certain foods can trigger headaches), nutritional supplementation (such as fish oil, Vit. D, feverfew and others), and sleep restoration.

If you, a family member or a friend require care, we sincerely appreciate the trust and confidence shown by choosing our service. We are proud that chiropractic care has consistently scored the highest level of satisfaction when compared to other forms of health care provision and we look forward in serving you and your family presently and in the future.

“I notice as the day goes on, tightness in my neck worsens and I get a headache usually by 2-3pm.”

“I don’t know if I can do my work with my headaches.”

These are common patient history entries we frequently receive at our clinic. Headaches are one of the most common complaints prompting patients to visit a health care provider. Many patients ask, “…what is a headache?” The National Institutes of Health (NIH) describe four types of headache: vascular, muscular contraction or tension, traction and inflammatory.

The most common form of a vascular headache is migraine. Migraine sufferers usually complain of severe pain on one or both sides of the head, nausea or vomiting and sometimes visual changes. There is often a heightened sensitivity to light or noise prompting migraine sufferers to lay in a dark, quiet room until the migraine passes. Women are more likely to suffer from migraines than men and the severity of symptoms can be so extreme that all activity must be stopped until it passes.

The next most common type of vascular headache is the toxic headache produced by a fever. Other vascular headache types include “cluster” headaches, which are characterized by repeated episodes of intense pain that start in one spot and spread out from that spot. These may only last a few minutes to an hour but carry a very high level of pain and activity intolerance. Another common type of vascular headache is that resulting from high blood pressure.

Muscle contraction or tension headaches involve tightening of the facial and neck muscles. These often start in the neck and radiate over the top or to the sides of the head. The muscles in the neck are usually extremely tight and tender and often, moderate pressure applied with the finger or thumb to these muscles will prompt radiating pain into and/or over the top of the head. This can also result in significant activity intolerance but usually not as severe as migraine or cluster headaches.

Traction and inflammatory headaches result because of other conditions that range from a sinus infection to a stroke. These types of headaches can serve as a warning sign of a more significant or serious condition. Another example is meningitis as well as other conditions affecting the sinuses, spine, neck, ear, and teeth.

The NIH suggests, when headaches occur ≥3 times a month, that “… preventive treatment is usually recommended.” Certainly, in some cases, medication may be indicated but only after ruling out a more serious condition and after exhausting less invasive treatments that carry fewer side effects.

The American Chiropractic Association recommends:

1. avoid long time periods of staying in one position (computer, sewing machine, reading, etc.) and take stretching/neck range of motion exercise breaks every ½ to 1 hour;

2. Exercise – walking, low impact aerobics;

3. Avoid teeth clenching (due to straining the temporomandibular – TMJ, or jaw joint);

4. Drink lots of water – stay hydrated.

Chiropractic care may include spinal manipulation (adjustments), nutritional advice (dietary suggestions, vitamin/mineral options such as a B complex), exercise, posture retraining, and relaxation techniques. If you, a family member or a friend require care, we sincerely appreciate the trust and confidence shown by choosing our service. If headaches are a problem, doesn’t a trial of chiropractic make sense prior to utilizing a more risk oriented treatment option? We look forward in serving you and your family.

In the October 2009 issue of The Spine Journal, Western States Chiropractic College, Center for Outcomes Studies, reported benefits are obtained with the utilization of spinal manipulation in the treatment of chronic cervicogenic headaches. The word “chronic” means at least 3 months of headache pain has been present. This new study compared 2 different doses of therapy using several outcome measures including the pain grade, the number of headaches in the last 4 weeks and the amount of medication utilized. Data was collected every 4 weeks for a 24 week period and patients were treated 1-2 times/week and separated into either an 8 or a 16 treatment session with half the group receiving either spinal manipulative therapy or a minimal light massage (LM) control group.

The results of the study revealed the spinal manipulation group obtained better results than the control group at all time intervals. There was a small benefit in the group that received the greater number of treatments with the mean number of cervicogenic headaches reduced by 50% in both pain intensity and headache frequency.

The importance of this study is significant as there are many side effects to medications frequently utilized in the treatment of headaches. Many patients prefer not taking medications for this reason and spinal manipulation therapy (SMT) offers a perfect remedy for these patients. Couple SMT with dietary management, lifestyle modifications, stress management, and a natural, vitamin/herbal anti-inflammatory (such as ginger, turmeric, boswellia) when needed, a natural, holistic approach to the management of chronic headaches is accomplished.

We are proud that chiropractic care has consistently scored the highest level of satisfaction when compared to other forms of health care provision and look forward in serving you and your family presently and in the future.