Chiropractic Efficacy for the Treament of Headache 1233808203798876 1

8/14/2019 Chiropractic Efficacy for the Treament of Headache 1233808203798876 1

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CHIROPRACTICEFFICACY

Spinal Manipulation in theTreatment of Migraine and

Tension Type Headaches


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HERE IS A SECRET FOR YOUOver 70% of patients

who use alternativetherapies never informedtheir medical providersthat they used suchtherapies

Eisenberg DM. Ann Intern Med. 1997; 127:61-69


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RECENT SURVEY

A recent survey of medical doctors asked:

If you knew a Chiropractor you could trust, would you refer to them?

OVER 70%SAID YES


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RECENT SURVEY

When asked:Do you know a Chiropractor you can trust?

OVER 80% SAIDNO


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TODAYS AGENDA

A Review of the Literature.The Theory of Cervicogenic HeadacheSelecting a Patients for SpinalManipulationIs Spinal Manipulation Safe?


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THE EFFICACY OF SPINAL

MANIPULATION IN THETREATMENT OF

MIGRAINE HEADACHES


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THE EFFICACY OF SPINALMANIPULATION FOR MIGRAINE

22% of the participants reported more than a90% reduction of their migraines

50% more participants reported significantimprovement in the intensity of the migraines

Tuchin PJ. A randomized control trial of chiropracticmanipulative therapy for migraine. J ManipulativePhysiol Ther 2000;23:91-95


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After one week of treatment they reportedcomplete relief of headache in 75% of their

subjects.They also noted a significant increase in cervicalROM and a reduction in dizziness

Stodolny J. Manual Therapy in the treatment of patients with cervical manipulation for migraine. AustNZ J Med 1989;4:49-51


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Spinal manipulation was as effective as awell established and efficacious treatment

(amitriptyline), and on the basis of abenign side effects profile, it should beconsidered a treatment option for patientswith frequent migraine headaches

Nelson CF. J Manipulative Physiol Ther.1998;21(8):511-9


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THE EFFICACY OF SPINALMANIPULATION IN THETREATMENT OF

TENSION TYPE HEADACHES


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THE EFFICACY OF SMT FOR TENSIONTYPE HEADACHES

Spinal manipulation is an effectivetreatment for Tension Headaches

Amitriptyline was slightly more effective inreducing pain at the end of the treatmentperiod but was associated with more side

effects.In addition


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Four weeks after the cessation of treatment, the patients who received SMT

experienced a sustained therapeuticbenefit in all major outcomes in contrast topatients that received amitriptyline, who

reverted to baseline values.And.


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The sustained therapeutic benefitassociated with SMT seemed to result in a

decreased need for over the counter medication.

Boline PD. Spinal manipulation vs.amitriptyline for the treatment of chronictension type headaches. J ManipulativePhysiol Ther. 1995 18(3):148-54


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Almost without exception, chiropracticmanipulation of the neck was found to be

superior in terms of reducing tensionheadache frequency, intensity, andimproving functional status of patients

when compared to other standard medicaltreatments.Hurwitz. Spine 1996;21:1746-1760


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CERVICOGENIC HEADACHE

Although migraine, and tension type headachesare generally considered to be separateconditions, there is support in the literature thatthey represent a continuum with severalcommon underlying mechanisms includingcervical spine dysfunction

Featherstone HJ. Headache 1985;25:194-8


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Which Patients Should beConsidered for SpinalManipulation

The International HeadacheSociety Diagnostic Criteria for

Cervicogenic Headaches


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CERVICOGENIC HEADACHEDiagnostic Criteria

HEADACHE ACCOMPANIED BY ONE OR MOREOF THE FOLLOWING:

Pain precipitated by neck movement or sustained neckpostureNeck muscle tendernessAbnormal postureDecreased neck range of motion

International Headache Society


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The question stillremains:

HOW CAN CERVICALDYSFUNCTION CAUSE A

HEADACHE?


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Before 1995 No New Muscles had beendiscovered since the 16 th Century


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TMJ Research Leads to Discovery

Led by assistant professor Gary HackDDS, scientists at the University of

Maryland performed a special type of dissection on 10 cadavers.His goal was to identify another muscle

of mastication


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TMJ Research Leads to Discovery

In addition to a new muscle of mastication, healso discovered a connective tissue bridge that

attaches the rectus capitus posterior minor muscle to the dura at the atlanto occipital junction. (it was present in all 10 cadavers)

Hack GD. Anatomic relation between the rectuscapitus posterior minor muscle and the dura matter.Spine 1995: 20:2484-2486


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The Neuromuscular Connection

Dr. Hack stated:Maryland Scientists speculate thatthe newly described muscle duraconnection may transmit forcesfrom the neck muscles to the painsensitive dura.


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Cadaver SpinalCord

Dura

TheConnection

Occiput

C 1 T.P.

C 2


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Stained SlideDura

Occiput

RectusCapitus

Posterior Minor

TheConnection

AtlasAtlas


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DuraDura

OcciputOcciput

CC 11 Transverse ProcessTransverse Process

Connective

Tissue

Rectus CapitusRectus CapitusPosterior Posterior (RCPM)(RCPM)MuscleMuscle


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Chiropractic for headaches?

Spinal Manipulation as a treatment for headache is predicated upon the assumptionthat the dysfunction in the neck muscles

contributes to the head pain.

The muscle dura connection may represent at least in part the underlying anatomical

basis for the effectiveness of this treatment.

1998 Encyclopedia Britannica Medical and Health Annual


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How would chiropractic help?Spinal manipulation, as performed by achiropractor, would decrease muscle

tension and thereby reduce or eliminatepain by reducing the potential force exertedon the dura via muscle dura connection.

1998 Encyclopedia Britannica Medical and Health Annual


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Weve been able to put together ascientific explanation for how neck

structure causes some types of headaches

Chiropractors have been saying that for years. Unfortunately, many (medical)Doctors tend to have a jaundiced view of Chiropractors, but (Chiropractors) were

right about headaches.

Peter Rothbart, MD, FRCPC. President NorthAmerica Cervicogenic Headache Society


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SPINAL MANIPULATION

IS IT SAFE?


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MANIPULATIONA SAFE PROCEDURE

In 1996, Vick et al.performed a 68 year review of the medical literature from 1926-1993 for injuriesrelated to manipulation.

Of the estimated several hundred thousandmanipulative treatments performed each year,

only 185 reports of injury were found during the68 year period.


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Comparing these figures with theincidence of adverse effects (including

death) associated with manypharmaceutical agents, manipulationremains an extremely safe modality whenperformed by a skilled practitioner.

Vick DA. The safety of manipulative treatment.JOA 1996;96:113-115


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An article by Dabbs and Lauretti in 1996,compared the risks of serious

complications or death for patientsreceiving a course of manipulativetreatment or non-steroidal anti-

inflammatory drugs.


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Based on the available evidence, wecalculate the risk of serious complications

or death is 100 to 400 times greater for theuse of NSAIDs than for the use of cervicalmanipulation in the treatment of similar conditions.

Dabbs V, Lauretti WJ. J Manip Physiol Ther 1995;18:530-536


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In addition, an article published in themedical journal, Spine compared the risks

for :Cervical Spine ManipulationNSAIDs

Cervical Spine Sugery


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In this article, Hurwitz reports:Risk of vertebrobasilar accident as 7.5 per

10,000,000 manipulationsRisk of severe gastrointestinal bleedingresulting in hospitalization or death from theuse of NSAIDs as 1 in 1000 subjectsAnd.


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They report an average incidence rate of neurological complication or death fromcervical spine surgeries as 11.25 per 1000

Hurwitz EL. Manipulation and mobilization of the cervical spine: A systematic review of theliterature. Spine 1996;21:1746-1760


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IS CHIROPRACTICMANIPULATION

A SAFE PROCEDURE

The most logical source for assessing therisk of any profession can be found by

examining the malpractice insurancepremiums for that profession


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Precision Pain Relief Center: 6316 Spalding

Drive, Norcross, GA30092

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Chiropractic Efficacy for the Treament of Headache 1233808203798876 1