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An Alternative to Pharmacologic Treatment of Headache Pain - Making the Case for Primary Spine Practitioner Care

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Health & Medicine

Published on March 8, 2014

Author: rad1dc

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Patient centered and evidence-based treatment of headache. Making the case for Primary Spine Practitioner care.
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An Alternative to Pharmacologic Treatment of Headache Pain ___________________________________________________ Making the Case for Primary Spine Practitioner Care

There are more than 129 different classification of But only one matters to you.... YOURS!

_____________________________________________________________________________________ The Epidemic! ___________________________________________________________________________________  50 MILLION people in the US experience headaches  28 MILLION experience migraine headaches  12 MILLION suffer with chronic daily headaches  20% OF CHILDREN report experiencing headaches  157 MILLION workdays are missed due to headaches  $24.7 BILLION in costs to U.S. employers due to headaches

Yes headaches are common, but no, they are not normal.

& You can break free from the bondage of your headaches! Headaches are the #1 reason why people take over the counter medications

& You can break free from the bondage of your headaches! For most, it seems as though no matter how many pills they take, the headaches keep returning, and in many cases the headaches increase in severity and frequency.

& You can break free from the bondage of your headaches! At times, the pounding and throbbing seem almost unbearable

What would you Do? To Get Rid of Your You definitely don't have to do backflips to . Our office has had the hundreds of people in our community, and . for

You can break free from the bondage of your headaches! It's no wonder most choose the quick - albeit – found in over-the-counter and prescription pain relievers

& You can break free from the bondage of your headaches! Productivity in the when you're suffering with

& You can break free from the bondage of your headaches! Feeling hopeless about your never get rid of them? There are may help you to overcome your ? Like you'll just that for good.

& You can break free from the bondage of your headaches! A full suffer with There are many causes for the food hypersensitivity, posture, . including and more.

You can break free from the bondage of your headaches! people suffer from !

Those experiencing fully understand that they can be a debilitating problem: Jeopardize your Decrease your Interrupt family EMPLOYMENT POTENTIAL LIFE

You can break free from the bondage of your headaches! What price would you pay to for good?

Medication Overuse: Many people are taking both prescription and over-the-counter pain relievers. . They’re in pain, and even if they’re already on a prescription, they’re for medications designed to treat headaches.

Source vs. Symptom: “When Medicine Makes Worse” , a chemical in the brain. A decreased level of serotonin can change how a person experiences pain. Seymour Diamond, MD [“Headache Godfather”] Founder, Diamond Headache Clinic Chicago, IL Adjunct Professor of Cellular and Molecular Pharmacology & Clinical Professor in the Department of Family Medicine Chicago Medical School at Rosalind Franklin University of Medicine and Science Lecturer, Department of Family Medicine (Neurology) Loyola University Chicago/Stritch School of Medicine

Source vs. Symptom: “When Medicine Makes Worse” The typical patient with rebound headaches will come in and complain that . The pain will escalate to a point where it’s and they are and simply not feeling like themselves anymore. R. Michael Gallagher, D.O. [“Dr. Headache”] Founder, Center for Headache Care Melbourne, FL “TOP DOC” National Headache Foundation, “Philadelphia” Magazine, “South Jersey” Magazine, “SJ” Magazine Veteran [Ret. Colonel] U.S. Army, USAF Reserve, & Delaware Air Guard

Source vs. Symptom: “When Medicine Makes Worse” It is suspected that of headache medication will of sensory receptors and certain pain pathways in the brain. containing aspirin, acetaminophen (Tylenol), and ibuprofen (Motrin) , especially if not taken as directed (i.e. > 3 days per week).

Source vs. Symptom: “When Medicine Makes Worse” The of OTC use increases if the medication . While beneficial in the treatment of headaches, when combined with caffeine consumption (coffee, tea, soda, or chocolate) your susceptibility to rebound headaches proliferates.

Source vs. Symptom: “When Medicine Makes The Worse” of an intermittent headache to a often results from the or .

Source vs. Symptom: “When Medicine Makes Worse” Sufferers of rebound headaches can gradually get to the point where they are . We see patients who use upwards of My alltime record holder was a patient taking !I simply don’t know how he tolerated them. Timothy R. Smith, M.D., R.Ph. Medical Director, Mercy Health Research Mercy Medical Group, St. Louis, MO Vice President of Research, Mercy’s Center for Innovative Care Mercy Medical Group, St. Louis, MO Board of Directors, National Headache Foundation Chicago, IL

Source vs. Symptom: “When Medicine Makes Worse” Non-steroidal anti-inflammatory (NSAIDs) , potentially damage the kidneys. ; they can also Acetaminophen (Tylenol) has its own dangers and , especially when combined with alcohol.

: “How does the medicine I take make it from ?” : The medication is and small intestine. 1. Gastrointestinal 2. Liver 3. Kidney

! _____________________________________ You can break free from the bondage of your headaches! Are you ready to start ? You can really from your headaches!

The – Cycle ______________________________________________ Medication Overuse Headache Would you like to or ?

______________________________________________

Strong smells, even nice ones, The drop in blood The preservatives sugar levels due to in cold cuts called in some people Is a common cause of headaches The Journal Headache reported Overcoming your headaches for good is factor precipitating tension headaches Smoke contains which causes blood vessels in the brain to narrow. are a common trigger for headaches , and your . Like aged cheese, ,a common headache trigger in many people Poor posture causes and can provoke tension headaches The occurs when braids or pony tails are worn for too long Aged cheese triggers headaches - the . The older the cheese the more tyramine. Caffeine’s plays an important role as a headache trigger mechanism

____________________________________________________________ FOOD ADDITIVES ____________________________________________________________ The Food and Drug Administration (FDA) maintains a list of over . Some of these additives have . Food additives are a common trigger for many headache sufferers. Food Dyes #5; # 3,40; Aspartame 1,2 MSG

Studies show that Knowing that our water makes it easy to understand the relationship between . A brisk walk can Studies show reductions in frequency and intensity of migraine following Emotional & Psychological health are very important aspects to overcoming . Surveys have shown that 1. Meditation 2. Spiritual Practice 3. Relaxation training 4. Biofeedback 5. Cog-B training over several weeks. Sleep plays a vital Eliminate the role in managing your following from your . diet: 1. Stick to a sleep schedule 2. Take a warm bath 3. Decrease or better yet – eliminate caffeine Current scientific evidence suggests that cigarette smoke may in reducing your . Magnesium Riboflavin (B2) Vitamin D CoQ10 Alpha Lipoic Acid Melatonin To reduce the potential of postural related , be mindful of your , holding the phone between your & , and .

& ________________________________________ Making the Case for Primary Spine Practitioner Care “For every inch of Forward Head Posture, it can increase the weight of the head on the spine by an additional 10 pounds.” 1 “Over time poor posture results in pain, muscle aches, tension and and such as osteoarthritis. Forward head carriage may promote accelerated aging of intervertebral joints resulting in degenerative joint disease.” 2 1 Kapandji, I.A. The Physiology of the Joints - The Vertebral Column, Pelvic Girdle and Head Vol 3. 6th Ed. London: Churchill Livingstone, 2008. Print 2 31st Annual International Conference of the IEEE Engineering in Medicine and Biology Society. Minneapolis, MN; USA, Sept. 2009.

& ________________________________________ Making the Case for Primary Spine Practitioner Care “The extra pressure imposed on the neck from poor posture flattens the normal cervical curve resulting in abnormal strain on muscles, ligaments, fascia and bones.” Ultimately, chronic low back pain, and stress-related illnesses occur. American Journal of Pain Management, January 2008, 4:36-39 ,

& ________________________________________ Making the Case for Primary Spine Practitioner Care “Constant force applied to (i.e. annular fibers of vertebral disc, ligaments, muscle fascia, joint capsules) for prolonged periods of time results in creep.” 1 The result of creep is the rearrangement of collagen fibers and its associated proteins as well as the water being squeezed from the tissue which causes it to lengthen. If the applied force isn’t excessive, upon release of the force the tissue will begin to recover. 2 1 Bogduk, N. Clinical Anatomy of the Lumbar Spine and Sacrum. 3rd Ed. New York: Churchill Livingstone, 1997. Print 2McKenzie R, May S. The Cervical & Thoracic Spine – Mechanical Diagnosis & Therapy 2 nd Ed. Raumati Beach: Spinal Publications, 2006. Print.

& ________________________________________ Making the Case for Primary Spine Practitioner Care SET: difference between initial and final length of tissue . If interval between episodes of creep loading is adequate the tissue can its original shape. McKenzie R, May S. The Cervical & Thoracic Spine – Mechanical Diagnosis & Therapy 2nd Ed. Raumati Beach: Spinal Publications, 2006. Print

& ________________________________________ Making the Case for Primary Spine Practitioner Care If creep loading frequency increases, thereby not allowing sufficient time for collagen fibers to recover, may persist indefinitely. Therefore the collagenous tissues (i.e. vertebral disc, ligament, joint capsule, etc.) will remain lengthened with decreased ability to carry out their mechanical function making them . McKenzie R, May S. The Cervical & Thoracic Spine – Mechanical Diagnosis & Therapy 2nd Ed. Raumati Beach: Spinal Publications, 2006. Print.

& ________________________________________ Making the Case for Primary Spine Practitioner Care : Structural malfunction of tissue, due to sustained or repetitive mechanical stress, after a solitary application of force by a load that is substantially less than what is needed to cause damage. “The clinical importance of fatigue failure is that damage to tissues may occur of major or obvious trauma.”1 1 Bogduk, N. Clinical Anatomy of the Lumbar Spine and Sacrum. 3rd Ed. New York: Churchill Livingstone, 1997. Print McKenzie R, May S. The Cervical & Thoracic Spine – Mechanical Diagnosis & Therapy 2 nd Ed. Raumati Beach: Spinal Publications, 2006. Print.

- A hyperirritable spot in skeletal muscle that is associated with a hypersensitive nodule that can be felt upon examination in an associated taut band within the muscle.1 - Area of congestion within a muscle due to sustained shortening of muscle fibers.2 1 Travell and Simons’. Myofascial Pain and Dysfunction - The Trigger Point Manual Vol 1. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 1999. Print 2 Liebenson, Craig’. Rehabilitation of the Spine – A Practitioner’s Manual. 2nd ed. Baltimore: Lippincott Williams & Wilkins, 2007. Print

- The spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, , and .1 - Trps are common pain generators that are a result of dysfunction.2 1 Travell and Simons’. Myofascial Pain and Dysfunction - The Trigger Point Manual Vol 1. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 1999. Print 2 Liebenson, Craig’. Rehabilitation of the Spine – A Practitioner’s Manual. 2nd ed. Baltimore: Lippincott Williams & Wilkins, 2007. Print

________________________________________ Making the Case for Primary Spine Practitioner Care Active TrPs within the suboccipital, upper trapezius, sternocleidomastoid, temporalis, superior oblique and lateral rectus muscles have been associated with and forms. Alonso-Blanco C, de-la-Llave-Rincón AI, Fernández-de-las-Peñas C. Muscle trigger point therapy in tension-type headache. Expert Review of Neurotherapeutics. March 2012, Vol. 12, No. 3, Pages 315-322 Fernandez-de-Las-Peñas C1, Cuadrado ML, Gerwin RD, Pareja JA. Referred pain elicited by manual exploration of the lateral rectus muscle in chronic tension-type headache. Pain Med. 2009 Jan;10(1):43-8.

________________________________________ Making the Case for Primary Spine Practitioner Care “Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous (CTTH) in , supporting a relevant role of active TrPs in CTTH in .” Fernández-de-las-Peñas C, et al. Referred pain from myofascial trigger points in head and neck-shoulder muscles reproduces head pain features in children with chronic tension type headache. J Headache Pain (2011) 12:35–43

________________________________________ Making the Case for Primary Spine Practitioner Care “Headache can at least partly be explained by referred pain from trigger points (TrPs) in the posterior cervical, head, and shoulder muscles.” Fernández-de-las-Peñas C, Cuadrado ML, Arendt-Nielsen L, Simons DG, Pareja JA. Myofascial trigger points and sensitization: An updated pain model for tension-type headache. Cephalagia. 2007;27:383-93 “Headache subjects with active TrPs reported a and . Headache subjects with active TrPs also tended to have a greater forward head posture.” Fernández-de-Las-Peñas C1, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache. Headache. 2006 Sep;46(8):1264-72.

___________________________________ Making the Case for Primary Spine Practitioner Care In 1995, a team of medical doctors at Syracuse University established neck problems as the "with scientific, anatomical proof." Subsequently, in an article entitled "A Pain in the Neck" and subtitled “Chiropractors were right” published in the Toronto Star, Canadian anesthesiologist, Peter Rothbart, MD – former president of the North American Cervicogenic Headache Society, made the following comments: "We couldn't believe it at first. We've been able to put together for how -- not all , but a significant number of them.“ "It's true that chiropractors have been saying this for years. Unfortunately, many (medical) doctors tend to have a jaundiced view of chiropractors, but they were right about .“ "Chiropractic's Role in Treating Headaches." Chiropractic's Role in Treating Headaches. Editorial Staff. Dynamic Chiropractic, 10 Feb. 1997. Vol. 15, Issue 04 Web. 02 Mar. 2014.

___________________________________ Making the Case for Primary Spine Practitioner Care , , and (upper cervical joint dysfunction) abnormalities were found to be common in those patients suffering from migraine and tension-type . Jull G, et al. Inter-examiner reliability to detect painful upper cervical joint dysfunction. Aust J Physiother. 1997;43(2):125-129. Marcus DA, et al. Musculoskeletal abnormalities in chronic headache: a controlled comparison of headache diagnostic groups. Headache. 1999 Jan;39(1):21-7. Jull G, et al. Cervical musculoskeletal impairment in frequent intermittent headache. Part 1: Subjects with single headaches. Cephalalgia. 2007 Jul;27(7):793-802.

___________________________________ Making the Case for Primary Spine Practitioner Care Investigators conducted a randomized control trial of one hundred fifty (150) participants where spinal manipulation was compared to the drug amitriptyline for the treatment of chronic tension-type . Data collected four (4) weeks after the study concluded found that people who had exhibited in and as well as a decreased usage of than those who had received amitriptyline treatment during the study. The difference in the amount of improvement between the groups was statistically significant. Boline PD, Kassak K, Bronfort G, et al. Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. J Manipulative Physiol Ther. 1995;18:148-154.

___________________________________ Making the Case for Primary Spine Practitioner Care A randomized, parallel-group comparison of 218 people suffering from was conducted to measure the relative prophylactic efficacy of amitriptyline, spinal manipulation, and the combination of both therapies. Subjects were randomly divided into 3 groups, all of which experienced comparable benefits during the eight (8) week treatment period. However, during the four (4) week post-treatment follow-up period, the group was found to have experienced a compared to the other two groups. Nelson CF, Bronfort G, Evans R, et al. The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. J Manipulative Physiol Ther. 1998;21:511-519.

___________________________________ Making the Case for Primary Spine Practitioner Care 200 participants who were diagnostically determined to be suffering from took part in a randomized control trial that compared the treatment efficacy of manipulative therapy and exercise therapy for neck-related headache. The researchers found that while neither therapy alone was clinically significant, found relief from their when the therapies were combined, and this result was also prevalent during the 3, 6, and 12 month follow-up assessments. Jull G, et al. A Randomized Controlled Trial of Exercise and Manipulative Therapy for Cervicogenic Headache. Spine: 1 September 2002 - Volume 27 - Issue 17 - pp 1835-1843

___________________________________ Making the Case for Primary Spine Practitioner Care Established in 2000 and given official status by the Steering Committee of the Bone and Joint Decade, an initiative of the United Nations and World Health Organization, came to the following conclusion regarding their study of vertebrobasilar stroke: “There was an association between chiropractic services and subsequent vertebrobasilar artery stroke in persons under 45 years of age, but a among patients receiving general practitioner services. This is likely explained by patients with vertebrobasilar artery dissection-related or .” Haldeman S, et al. The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders - Executive Summary. Eur Spine J (2008) 17 (Suppl 1): S5-S7

___________________________________ Making the Case for Primary Spine Practitioner Care published the following conclusions on their website regarding chiropractic care: “Although attempts have been made to determine in advance who will experience strokes following chiropractic, they have not been successful.1 Thus, stroke must be considered an unpredictable, , side effect of chiropractic manipulation of the neck.” 1 Haldeman S, Kohlbeck FJ, McGregor M. Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy. Spine. 2002;27:49-55. "Chiropractic." NYU Langone Medical Center. Ed. Richard Glickman-Simon, MD and Jeffrey S. Geller, MD. EBSCO Publishing, Aug. 2013. Web. 02 Mar. 2014 EBSCO Complementary and Alternative Medicine (CAM) Review Board http://www.med.nyu.edu/content?ChunkIID=35926

___________________________________ Making the Case for Primary Spine Practitioner Care published the following conclusions on their website regarding chiropractic care: “To put this in perspective, however, the rate of complications from chiropractic is . According to one estimate, only individual sessions occurs.”2 “Among people receiving a course of treatment involving manipulation of the neck, the rate of stroke is perhaps ; the rate of death is .” 3 2 Coulter ID. The Appropriateness of Manipulation and Mobilization of the Cervical Spine. Santa Monica, CA: Rand Corporation; 1996 3 Dabbs V, Lauretti WJ. A risk assessment of cervical manipulation vs. NSAIDs for the treatment of neck pain. J Manipulative Physiol Ther. 1995;18:530-536. "Chiropractic." NYU Langone Medical Center. Ed. Richard Glickman-Simon, MD and Jeffrey S. Geller, MD. EBSCO Publishing, Aug. 2013. Web. 02 Mar. 2014

___________________________________ Making the Case for Primary Spine Practitioner Care published the following conclusions on their website regarding chiropractic care: “By comparison, s involving common drugs in the ibuprofen family (non-steroidal antiinflammatory drugs, or NSAIDs) are . Among people using them for arthritis, NSAIDs result in hospitalizations at a about people, and death at a .”1 1 Dabbs V, Lauretti WJ. A risk assessment of cervical manipulation vs. NSAIDs for the treatment of neck pain. J Manipulative Physiol Ther. 1995;18:530-536. "Chiropractic." NYU Langone Medical Center. Ed. Richard Glickman-Simon, MD and Jeffrey S. Geller, MD. EBSCO Publishing, Aug. 2013. Web. 02 Mar. 2014

___________________________________ Making the Case for Primary Spine Practitioner Care published the following conclusions on their website regarding chiropractic care: “To put it another way, the rate of complications with these is perhaps than with chiropractic.” "Chiropractic." NYU Langone Medical Center. Ed. Richard Glickman-Simon, MD and Jeffrey S. Geller, MD. EBSCO Publishing, Aug. 2013. Web. 02 Mar. 2014 EBSCO Complementary and Alternative Medicine (CAM) Review Board http://www.med.nyu.edu/content?ChunkIID=35926

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Bibliography "Chiropractic." NYU Langone Medical Center. Ed. Richard Glickman-Simon, MD and Jeffrey S. Geller, MD. EBSCO Publishing, Aug. 2013. Web. 02 Mar. 2014 Dalton, Erik, PhD. "Forward Head Posture." Forward Head Posture. Freedom From Pain Institute, 2011. Web. 28 Feb. 2014. “Headache Workshop." Waiting Room DVD. Dr. Frank Corbo. www.chiroworkshop.com. DVD. McKenzie R, May S. The Cervical & Thoracic Spine – Mechanical Diagnosis & Therapy 2nd Ed. Raumati Beach: Spinal Publications, 2006. Print. Murphy, Donald. “Principles of Primary Spine Care and the Cervical Spine.” Community Spine Pathway Training Part III. Excellus BC/BS, Rochester. 26&27 Oct 2013. Lecture. Samsung. “Over the Horizon." Samsung. 2014. MPEG.

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