Occipital Neuralgia is an easily treated condition at our office. It involves compression of the nerves that run from the top of the spinal cord through the scalp, called the occipital nerves, and causes inflammation or injury. Patients often feel pain at the base of the skull and can be confused with migraine or other types of headache (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 for Occipital Neuralgia at Portland Chiropractic Neurology is a multi-modal, combination of therapies, evaluating and treating all systems involved, including 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).
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 Migraines 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 firstname.lastname@example.org or call us at 207-699-5600 to set up a free consult with a doctor.
(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