Headache

Your Headaches are treatable

Tension headaches are the most common type of headache. Stress and muscle tension are often factors in these headaches. Tension headaches typically don't cause nausea, vomiting, or sensitivity to light. They do cause a steady ache, rather than a throbbing one, and tend to affect both sides of the head. Tension headaches may be chronic, occurring often, or every day (1). 

Evidence suggests that chiropractic care, including spinal manipulation, improves migraine and cervicogenic headaches. The type, frequency, dosage, and duration of treatment(s) should be based on guideline recommendations, clinical experience, and findings. Evidence for the use of spinal manipulation as an isolated intervention for patients with tension-type headache remains equivocal (2). 

The core treatment philosophy at Portland Chiropractic Neurology is a multi-modal therapy, evaluating and treating the Proprioceptive, Vestibular, and Oculomotor System

A combination of cervical and vestibular physiotherapy dedreased time to medical clearance to return to sport in youth and young adults with persistent symptoms of dizziness, neck pain and/or headaches following a sport-related concussion (3). 

Cervicogenic Headaches- headaches that are as a result of neck problems

Although cervicogenic headache (CGH) has been described as a “final common pathway” of cervical spine dysfunction (7), its true prevalence is difficult to determine due to inconsistent use of diagnostic criteria in the literature. Incidence of cervicogenic headache has been reported to range from 0.7% to as high as 13.8% in populations of patients suffering from headache disorders (8). Others have reported cervicogenic origins of higher values (14% to 18%) in all chronic headaches (9).

The anatomical basis for CGH is the convergence of the afferent input of the upper cervical spine nerve roots (C1-C3) with the afferent tracts of the trigeminal nerve in the trigeminocervical nucleus. This convergence results in cervical spine nociceptive input being expressed in the sensory distribution of the trigeminal nerve, most commonly the ophthalmic branch of the trigeminal nerve, which innervates the forehead, temple, and orbit and has its greatest topographic representation near the dorsal horns of spinal nerves C1-C3 (4-5). Therefore, any structure innervated by C1, C2, or C3 spinal nerves can be implicated in the etiology of CGH. This includes the atlanto-occipital, median atlanto-axial, lateral atlanto-axial, and C2-3 zygapophyseal joints as well as the C2-3 intervertebral disc, suboccipital, upper posterior cervical, and upper paravertebral musculature, the trapezius and sternocleidomastoid muscles, upper cervical spinal dura mater, and the vertebral arteries (4-6). Because of the ability of afferent nerves to travel up to three segments cephalically or caudally in the cervical spinal cord, bony and soft tissue structures of the middle and lower cervical spine cannot be excluded from contributing to CGH (4-5).

 

How can we diagnose what's causing your Headache? 

By evaluating the brain, spine and nervous system in its entirety, specifically within the cervical spine, occipital region, trigeminal nuclear complex, and thoracic/rib regions, we can localize regions that are dysfunctional and misrepresenting sensory information to the brain. Autonomic dysregulation may be involved and we perform careful evaluation of this potential involvement. Oxygenation is an important aspect of Nervous System and Headache pain and is also evaluated very carefully. We're essentailly looking at your headache from an integration perspective, ensuring all regions are sending appropriate pain afferent information to the brain, including the vestibular system, proprioceptive system, visuomotor system, autonomic system, oxygenation system. Our core model of care is multi-modal, ensuring that all potential regions that may contribute to Headache are properly assessed and treated to allow proper gating and function to occur along the Trigeminal nerve pathway and cervicovestibular regions. In order to do this, we must reset the Central Integrated State of the dysfunction neuronal regions of the brain to reduce their resting membrane potential to an appropriate level that is healhy and approximately -65 mV, reducing hyperexcitablity and decreasing pain. We attempt to achieve this through a specialized program that combines Neurology, Chiropractic, Physical Therapy, Vestibular Rehabilitation, Occupational Therapy and Oxygen. 

Potential Headache Core Testing:

  • Videooculography (VOG, sometimes referred to as VNG) that measure eye movements that relate to specific regions of the brain, brain stem and vestibular system.
  • Sensitive balance and coordination testing of proprioception and brain using Computerized Assessments of Posturography Systems (CAPS) that allow us to measure dysfunctional areas sensory input related to Migraine.
  • Tilt Table Testing
  • Autonomic Assessment
  • Clinical Examination (Neurology, Proprioceptive, Respiration)
  • Gait analysis
  • Oxygen evaluation
  • Metabolic capacity
  • Objective measures
  • Spatial and Temporal Summation (Treatment Plan)

Potential Headache Core Treatment:

  • Tilt Table Treatment (TTT)
  • Non-Invasive Nerve Stimulation (NINS)
  • Vagus Stimulation (VS)
  • Oculomotor retraining (eye movement exercises) (OMR)
  • Vestibular Rehabilitation (VR)
  • Occupational Therapy (OT)
  • Rib Manipulation (RM)
  • Cervicovestibular rehabilitation (CVR)
  • Specific Chiropractic Neurological Manipulations for Oxygenation L/S/T (SCNM-O)
  • Mild Hyperbaric Oxygen Therapy (mHBOT)
  • Postural Restoration (PR)
  • Physical Therapy (PT)
  • Functional Neurological Rehabilitation/Neuroplasticity Retraining Exercises (FNR/NRE)
  • Co-treatment (Botox, Medications, etc..) (CT)
  • Migraine dietary recommendations (MDR)

How can our treatments change your Headache? 

Through treatments that combine Chiropractic, Neurology, Physical Therapy, Occupational Therapy and Oxgyenation, we can balance and improve all symptoms involved in your headache. Neurons require Activation, Oxygen and Fuel (glucose) to maintain a healthy state of -65 mV and undergo Immediate Early Gene Response to create more cellular contents such as sodium/potassium pumps, mitochondria for ATP formation, axonal and dendritic connections with neighboring cells, etc. The list you saw is how we target the dysfunctional areas with activation, oxygen and carry fuel to those cells. This has to be done in a very graded, careful manner so as to not exceed the metabolic rate of the neurons involved. We observe metabolic capacity for each individual and maintain levels of treatment that stay below those levels so as to keep a steady progression of healthy return to a normal state of function. Neurons respond through Temporal and Spatial Summation, so we can develop treatment plans based on your severity that will allow maximal response and long-term changes. This is known as Neuroplasticity and is at the core of our Headache Program. I often tell people, I don't know how much I can help you, but in most cases, we're able to improve Headache at least 50% with the understanding that our goal is much higher. Your response depends on multiple factors, including genetics, central sensitization (chronicity), following our treatment plan and so forth. We are very open and honest with our patients and do our best to provide accurate information, but it is a functional issue and it is sometimes difficult to be exacting in our predictions. 

Can Portland Chiropractic Neurology treat my Headaches successfully? 

For many individuals, yes we can, and we've been doing it for over 12 years. However, that can range from 25% improvement to as close to 100% as possible, although most people will agree that an improvement of 50% is life changing. The rest we hope to control through lifestyle changes, dietary changes, Medical intervention such as medications, botox, etc.  Our goal is for your results to be long-lasting and permanent without our continued care because we utilize Neuroplasticity appropriately along all aspects of our treatment plan, patients don't return to their previous state when they are finished treatment. That being said, genetics and many other aspects play a role in your Headache physiology, so it is difficult to determine or know for sure at the beginning of treatment if you are a 50% improved patient or a 100%, or anything in between. With the proper diagnosis, we can treat the areas that are the primary source of your Headaches through Neuroplasticity Retraining Excercises that will change your dysfunction involved with Headache. 

Please reach out to ask specific questions that you may have at info@portchiro.com or call us at 207-699-5600 to set up a free consult with a doctor. 

References: 

(1) https://www.hopkinsmedicine.org/health/conditions-and-diseases/headache/tension-headaches

(2) Bryans et al. Evidence-Based Guidelines for the Chiropratic Treatment of Adults With Headache. Journal of Man and Physol therapy. Vol 35, issue 5. 274-289. 

(3) Scheider KJ, et al. Cervicovestibular rehabilitation in sport-related concussion: a randomized controlled trial. Br J Sports Med 2014; 48:1294-1298

(4) Biondi DM. Cervicogenic headache: Mechanisms, evaluation, and treatment strategies. J Am Osteopathic Assoc. 2000;100(9Suppl):S7–S14. [PubMed[Google Scholar]

(5) Bogduk N. The neck and headaches. Neurologic Clinics. 2004;22(1):151–171. [PubMed[Google Scholar]

(6) Sizer PS, Phelps V, Brismee J. Diagnosis and management of cervicogenic headache and local cervical syndrome with multiple pain generators. J Man Manipulative Ther. 2002;10:136–152. [Google Scholar]

(7) Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: Diagnostic criteria. The Cervicogenic Headache International Study Group. Headache. 1998;38:442–445. [PubMed[Google Scholar]

(8) Martelletti P, van Suijlekom H. Cervicogenic headache: Practical approaches to therapy. CNS Drugs. 2004;18:793–805. [PubMed[Google Scholar]

(9) Zito G, Jull G, Story I. Clinical tests of musculoskeletal dysfunction in the diagnosis of cervicogenic headache. Man Ther. 2006;11:118–129. [PubMed[Google Scholar]