Chiropractic for Migraines in Belfast

The medical definition of a migraine headache is (1):

The headache must last between 4 to 72 hours.

The headache is associated with either nausea / vomiting / phonophobia / photophobia.

The headache must be characterized by two of the following four symptoms:  throbbing pulsile quality; unilateral location; moderate or severe degree of pain; made worse by physical activity.

A diagnosis of Migraine is formed when these characteristics are present:

-Episodic headaches.
-Pain involves half of the head.
-An aura is present.
-Associated gastro-intestinal symptoms.
-There is phonophobia and or photophobia.
-Pain is aggravated by the Valsalva maneuver and or by the "head-low position".
-The migraines can be triggered by: The menstrual cycle; Oversleeping;  Fasting; Alcohol; Tyramine-containing foods (meats that are pickled/aged/smoked/fermented/most pork; chocolate; and fermented foods.
-Migraine relief occurs with sleep.

Nikoli Bogduk, MD, PhD, is one of the World's leading Musculoskeletal researchers. 

Dr. Bogduk’s expertise in clinical anatomy includes headaches. A literature search using the words “Bogduk + Headache” finds 25 separate citations. One of his most important contributions to the study of understanding headaches appeared in the scientific journal Biomedicine and Pharmacotherapy. The article is titled (2): "Anatomy and Physiology of Headache".

In this review, Bogduk notes that “all headaches are mediated by the trigeminocervical nucleus.”

This means that all headaches, including migraines, synapse in the upper aspect of the neck, in an area called the trigeminocervical nucleus. The trigeminocervical nucleus is housed in the brainstem and the upper cervical spinal cord. 

Upper cervical spine afferents to a second-order neuron that also receives trigeminal input may be a source of the electrical signal that is interpreted as headache in the brain, including migraine headache. Therefore structures that are innervated by C1/C2/C3, can cause headaches including migraine. Irritation or inflammation of structures supplied by C1/C2/C3 can all cause headaches. Such structures include:

The Dura mater.
Anterior and posterior upper cervical and cervical occipital muscles.
C1/2/3 cervical joints.
C2-C3 disc.
Vertebral and Carotid arteries.
Transverse and Alar ligaments.
The Trapezius muscle.
The Sternocleidomastoid muscle.

In 2017, researchers from Akershus University Hospital, Oslo, Norway, and the Department of Chiropractic, Macquarie University, NSW, Australia, published a study in the journal Musculoskeletal Science and Practice titled (3):

Adverse Events in a Chiropractic Spinal Manipulative Therapy: A Single-blinded, Placebo, Randomized Controlled Trial for Migraineurs

The authors note that migraines are a common challenge, and pharmacological management is often the first treatment of choice. However these drugs can have serious and undesirable side effects. In contrast, manual-therapy carried out by Chiropractors  appears to have a similar effect as common drugs on migraine frequency, migraine duration, and migraine intensity.

70 migrainers were randomized to chiropractic manipulation (Gonstead full-spine adjusting) or a placebo, with 12 intervention sessions over three months. The subjects in this study were randomly placed into three groups:

An active spinal manipulation group, using Gonstead technique: “Active treatment consisted of chiropractic spinal manipulation using the Gonstead method.

A placebo manipulation group, receiving sham manipulation: “The placebo intervention consisted of sham manipulation, i.e., a broad non-specific contact approach via a low-velocity, low-amplitude sham push manoeuvre in a non-intentional and nontherapeutic directional line.

A control group, using usual pharmacological management: “The control group continued their usual pharmacological management without receiving manual intervention.”

The participants were interviewed and physically assessed by a Chiropractor, “including meticulous investigation of the spinal column.” They also received a full spine X-rays. The subjects attended treatments over 12 weeks with follow-up at 3, 6 and 12 months post-treatment. The authors concluded:

This study “showed significant differences between the Chiropractic spinal manipulation group and the control group [drug group] at all post-treatment time points.”

“These findings are in accordance with the World Health Organization guidelines on basic training and safety in chiropractic spinal manipulation, which is considered to be an efficient and safe treatment modality (WHO, 2005).” (4)

Non-pharmacological management of migraine has the advantage of having mild and transient adverse events, “whereas pharmacological adverse events tend to be continuous.”

“Chiropractic spinal manipulation applying the Gonstead technique appears to be safe for the management of migraine headache and presents few mild and transient adverse events.”

 The group being treated by the chiropractor had the best long-term results.

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Summary

These studies explain what essentially every chiropractor has observed:

Improvement of the mechanical function of the upper cervical spine with spinal manipulation is an effective and safe treatment for patients suffering from migraine headache.

The presented data here suggests that manipulation actually addresses the cause of the migraine headache; in contrast, it appears that taking drugs is nothing more than temporary pain control with no improvement to the causative pathophysiology of migraine headache.

REFERENCES

1) Jones HR, MD; Netter’s Neurology; 2005.

2) Bogduk N; Anatomy and Physiology of Headache; Biomedicine and Pharmacotherapy; 1995, Vol. 49, No. 10, 435-445.

3) Chaibi A, Benth JS, Tuchin PJ, Russell MB; Adverse Events in a Chiropractic Spinal Manipulative Therapy Single-blinded, Placebo, Randomized Controlled Trial for Migraineurs; Musculoskeletal Science and Practice ; March 2017; Vol. 29; pp. 66-71.

4) WHO, 2005. Guidelines on Basic Training and Safety in Chiropractic. World Health Organization, Switzerland.