Headache is one of the most frequent reasons people seek medical advice, and is the main complaint of about 10% of chiropractic patients. The great majority of headaches are “benign”, meaning not linked to any specific injury or disease and are known as Primary Headaches. Benign does not mean mild; symptoms may be frequent and severe.
The three most common types of primary headaches are migraine, tension-type and cervicogenic headaches. The anatomical basis for cervicogenic headaches has been explained by Hack et al in 1995, where researchers at the University of Maryland in Baltimore, established new evidence of bridges of connective tissue between the posterior muscles of the cervical spine (neck), and the pain-sensitive dura (myodural bridges) in the upper cervical spine.
New research from the respected Duke University Evidence-Based Practice Center in 2001, found that the most common form of primary headaches are cervicogenic headaches; similar in prevalence with migraine, and that the one treatment with proven effectiveness was spinal manipulation.
Manipulation has two distinct advantages over the use of medication; first it targets the source of pain rather than controlling symptoms, and second, it is safer with fewer side effects. Migraine, tension-type, and cervicogenic headaches are known to have a cervical (neck) and/or an upper thoracic (upper back) mechanical component (intervertebral\costovertebral joint dysfunction). When these mechanical restrictions are corrected with manipulation, associated muscle tension is resolved.
There is now abundant evidence that migraine and tension-type headaches are part of a continuum rather than separate entities and that the cervical and thoracic spine dysfunction plays a role in both. However, at different ends of the continuum, there are still pure tension-type and pure migraine type headaches that remain difficult to treat.
The latest available research lead by Mitchell Hass DC (Chiropractic researcher) at the Center for Outcome Studies, Western States Chiropractic College, found that on average patients suffering from primary headaches, reduced their headache frequency by half in 8-weeks with spinal corrective care (manipulation), along with significant reduction in pain intensity.
Chiropractic investigation of headaches identifies whether a patient’s headache is primary or secondary. In the presence of red flags; including recent onset, positional headaches, focal neurological signs, cognitive changes and progressive headaches; secondary headaches, which have a more ominous origin, need to be ruled out and require immediate medical investigation.
Finally, the optimal management of primary headaches for many patients may often be achieved through a multidisciplinary approach. However, given the established implication of spinal pathomechanics with primary headache, a chiropractic consultation is warranted given the established scope of chiropractic as expert in the evaluation and treatment of spinal and\or neuromusculoskeletal disorders.