Chiropractic investigation of headaches identifies whether a patient’s headache is primary or secondary.
Headaches are one of the most frequent reasons people seek medical advice and it the main complaint of about 10% of chiropractic patients. The great majority of headaches are “benign”, meaning not linked to any specific injury of 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 (muscular-contraction), 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.
Research from the respected Duke University Evidence-Based Center in 2001, found that the most common form of primary headaches is cervicogenic headaches; similar in prevalence to migraines, and also found 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, in other words, intervertebral/ costovertebral joint dysfunction or restriction. When these joint restrictions are corrected with manipulation, associated muscular 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 as 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.
Research lead by Mitchell Hass DC (Doctor of Chiropractic) at the Center for Outcome Studies, Western State Chiropractic College, found that on average patients suffering from primary headaches, reduced their headaches frequency by half in 8-weeks with spinal corrective care (manipulation), along with a significant reduction in pain intensity. In the presence of red flags; including abrupt 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 headaches, a chiropractic consultation is warranted.