HEADACHES AND CHIROPRACTIC
Headache arising from the neck (i.e. Cervicogenic)
Chiropractors acknowledge that there are many causes of headaches. Where they are related to dysfunction in the cervical spine (neck), there is evidence to show the benefit of spinal manipulation. Headaches of this nature can be unilateral (one-sided) or bilateral (both-sided) and are often located in the back of the head and above the eyes. They are mild-moderate in intensity. Certain activities and posture can worsen the headache, including sustained head position or external pressure over the cervical spine or occipital region.
What is Cervicogenic Headache?
Cervicogenic Headache is caused by misalignments in the neck (the cervical spine) and can also result from reduced mobility in the upper cervical area. The term is used to refer to headaches where the primary causative agent is the neck. Pain may radiate to the forehead (frontal region), the eyes (orbital region), the temple and the ears. The presentation varies. Most people with a pure Cervicogenic Headache may present with a complaint of daily headaches with no neurological signs.
Cervicogenic Headache Causes
Generally speaking Cervicogenic Headaches are more common in females. The current theory is that abnormal movements and postures of the neck result in irritation to the upper 3 cervical nerve roots. Pain referral can be from muscles, ligaments, joint capsules and discs.
Treatment of Cervicogenic Headaches
Chiropractors treat Cervicogenic Headache using a package of care that may include manual therapies, exercise, acupuncture, therapeutic advice and postural advice.
Chiropractic care is very helpful for this type of headache because it can correct the source directly. It is also suggested as a helpful treatment for other types of headaches that share the same cervical element.
Chiropractic was found to have more supportive evidence than any other treatment and was recommended by the Quebec Task Force in the early 1990’s.
Chiropractic treatment includes:
- Spinal manipulation to restore proper joint motion
- Trigger Point Therapy to reduce muscular tension
- Exercises to improve neck mobility
- Postural advice
- Lifestyle advice
There is evidence to support this approach to patient management:
- Boline PD, Kassak K, Bronfort G, Nelson C, Anderson AV Spinal manipulation versus amitriptyline for the treatment of chronic tension-type headaches: a randomised clinical trial. Journal of Manipulative & Physiological Therapeutics, Mar-Apr 18(3), 148-54, 1995.
- Bronfort G, Nilsson N, Haas M, Evans R, Goldsmith CH, Assendelft WJJ, Bouter LM. Non invasive physical treatments for chronic/recurrent headache (review). Cochrane Database of Systematic Reviews 2004 issue 3.
- Bronfort G Effectiveness of non-pharmacological treatments for headache. European Journal of Chiropractic, 49, 2002, pp54-
Dalby BJ Chiropractic diagnosis and treatment of closed head trauma: review of the literature .
Journal of Manipulative & Physiological Therapeutics. Volume 16(6) Jul/Aug 1993, pp392-400.
- Fernandez-de-las-Penas C, et al. Are manual therapies effective in reducing pain from tension-type headache: a systematic review. Clinical Journal of Pain 22(3) Mar-Apr 2006, pp278-85.
- Gesztelvi G, Bereczki D Determinants of disability in everyday activities differ in primary and cervicogenic headaches and in low back pain. Psychiatry and Clinical Neurosciences, Volume 60(3) May 2006, pp271-276.
- Heikkila H, Johansson M, Wenngren BI Effects of acupuncture, cervical manipulation and NSAID therapy on dizziness and impaired head repositioning of suspected cervical origin: a pilot study. Manual Therapy 5(3) 2000, pp151-7.
Nelson CF, Bronfort G, Evans R, Boline P, Goldsmith C, Anderson AV
The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. Journal of Manipulative & Physiological Therapeutics, Volume 21(8) October 1998, pp511-9.
- Nilsson N, Christensen HW, Harvigsen J The effect of spinal manipulation in the treatment of cervicogenic headache. Journal of Manipulative & Physiological Therapeutics, Volume 20(5) June 1997, pp326-30.
- Norton PJ, Asmundson, GJG Anxiety sensitivity, fear and avoidance behaviour in headache pain. Pain, Volume 111(1) September 2004, pp218-223.
Steiner TJ, MacGregor EA, Davies, PTG Guidelines for all healthcare professionals in the diagnosis and managment of migraine, tension-type, cluster and medication-overuse headache.
British Assocation for the Study of Headache (BASH), 2007.
- Vernon H, Jansz G, Goldsmith CH, McDermaid C A randomized, placebo-controlled clinical trial of chiropractic and medical prophylactic treatment of adults with tension-type headache: results from a stopped trial. Journal of Manipulative & Physiological Therapeutics, Volume 32(5) June 2009, pp344-351.
- Vernon H Spinal manipulation in the management of tension-type migraine and cervicogenic headaches: the state of the evidence. Topics in Clinical Chiropractic, 9(1) 2002, pp14-20.
- Wight S, Osborne N, Breen, AC Incidence of ponticulus posterior of the atlas in migraine and cervicogenic headache. Journal of Manipulative & Physiological Therapeutics, Volume 22(1) January 1999, pp15-20.
- Yucel B, Ozyalcin S, Sertel HO, Camlica H, Ketenci A, Talu GK Childhood traumatic events and dissociative experiences in patients with chronic headache and low back pain. The Clinical Journal of Pain 18, 2002, pp394-401.