1. The Truth About Headaches

2. Are Headaches Normal?
Many people believe that it is okay to have headaches.
Some even think that headaches are normal.
This can be a dangerous misconception as headaches can be an important warning sign that something else may be wrong.

3. What is a “Normal” Headache?
“Normal” headaches are typically associated with a specific incident or stressful event.
If a headache goes away quickly after rest or sleep, it is a normal response.
Headaches that occur more than once per month or last longer than 3-4 hours are not normal.

4. The Burden of Headaches
According to a study by the Mayo Clinic, headaches are the 9th most common reason patients see a doctor.
The World Health Organization estimates that 50-75% of adults have had a headache in the last year and 30% or more have reported a migraine.
In the Global Burden of Disease Study, updated in 2013, headache disorders were the 3rd highest cause of years lost due to disability.

5. Side Effects of Medication
Many people who regularly have headaches reach for medication to relieve the pain.
They often develop dependencies on these medications, which have harmful side effects over time such as stomach, liver or kidney problems.

6. There is a Better Way
Relying upon pain numbing medications on a regular basis for headaches is not justified if you know about the latest research and treatments that are available to you.

7. Did You Know?
Over 70% of patients who use alternative therapies never informed their medical providers that they used such therapies?
Eisenberg, DM. Ann Intern Med. 1997; 127:61- 69

8. Common Headache Types
Migraine
Tension Type
Cervicogenic

9. Migraine Headaches
Contrary to popular belief, migraine is not just a bad headache.
It’s an extremely incapacitating collection of neurological symptoms that usually includes a severe throbbing recurring pain on one side of the head.
It’s often accompanied by nausea, vomiting and extreme sensitivity to light and sound. 

10. Migraine Headaches Female:Male – 75:25
Lateralization – 60% unilateral with sideshift
Location – frontal, periorbital, temporal
Frequency – 1-4 per month
Severity – moderate/severe
Duration – 4-72 hours
Pain Character – throbbing, pulsating
Triggers – multiple, neck movement not typical
Associated Symptoms – nausea, vomiting, visual changes, phonophobia, photophobia

11. What Happens During a Migraine?

12. The Efficacy of Spinal Manipulation for a Migraine
22% of the participants reported more than a 90% reduction of their migraines.
50% more participants reported significant improvement in the intensity of the migraines.
Tuchin PJ. A randomized control trial of chiropractic manipulative therapy for migraine. J Manipulative Physiol Ther 2000;23:91-95

13. The Efficacy of Spinal Manipulation for a Migraine
After one week of treatment 75% of the subjects reported complete relief of headache.
They also noted a significant increase in cervical ROM and a reduction of dizziness.
Stodolny J. Manual Therapy in the treatment of patients with cervical manipulations for migraine. Aust NZ J Med 1989;4:49-51

14. The Efficacy of Spinal Manipulation for a Migraine
“Spinal manipulation was as effective as a well established and efficacious treatment (amitriptyline), and on the basis of a benign side effects profile, it should be considered a treatment option for patients with frequent migraine headaches.”
Nelson CF. J Manipulative Physiol Ther. 1998:2:511-9

15. Tension-Type Headaches
Tension-type headaches are the most common form of headache, occurring in about three-quarters of the general population. 
Tension-type headache is usually described as a pain that feels like a tight band round your head or a weight on top of it.
Your neck or shoulder muscles may also hurt along with the headache.

16. Tension-Type Headaches
Female:Male – 60:40
Lateralization – diffuse bilateral
Location – diffuse
Frequency – 1-30 per month
Severity – mild/moderate
Duration – days to weeks
Pain Character – dull
Triggers – multiple, neck movement not typical
Associated Symptoms – occasionally decreased appetite, phonophobia or photophobia

18. The Efficacy of Spinal Manipulation for Tension-Type Headaches
Spinal manipulation is an effective treatment for Tension Headaches.
Amitriptyline was slightly more effective in reducing pain a the end of the treatment period but was associated with more side effects.
In addition…

19. The Efficacy of Spinal Manipulation for Tension-Type Headaches
Four weeks after the cessation of treatment, the patients who received spinal manipulative therapy (SMT) experienced a sustained therapeutic benefit in all major outcomes in contrast to patients that received amitriptyline, who reverted to baseline values.
And…

20. The Efficacy of Spinal Manipulation for Tension-Type Headaches
The sustained therapeutic benefit with SMT seemed to result in a decreased need for over the counter medication.
Boline PD. Spinal manipulation vs. amitriptyline for the treatment of chronic tension type headaches. J Manipulative Physiol Ther. 1995;18(3):148-54

21. The Efficacy of Spinal Manipulation for Tension-Type Headaches
Almost without exception, chiropractic manipulation of the neck was found to be superior in terms of reducing tension headache frequency, intensity, and improving functional status of patients when compared to other standard medical treatments.
Hurwitz. Spine 1996;21:

22. Cervicogenic Headaches
A cervicogenic headache starts in the cervical spine—your neck.
Sometimes these headaches mimic migraine headache symptoms.
Initially, pain may begin intermittently, spread to one side of the head, and become almost continuous.
Pain can be exacerbated by neck movement or a particular neck position (e.g., eyes focused on a computer monitor).

23. Cervicogenic Headaches
Female:Male – 50:50
Lateralization – unilateral without sideshift
Location – occipital to frontoparietal and orbital
Frequency – chronic, episodic
Severity – chronic, episodic
Duration – 1 hour to weeks
Pain Character – non-throbbing, and non-lancinating pain, usually starts in neck
Triggers – neck movement and posture, limited ROM, pressure over C0-C3
Associated Symptoms – usually absent or similar to migraine but milder, decreased ROM

24. Cervicogenic Headaches
110 participants with cervicogenic headache were randomized to receive both cervical and thoracic spinal manipulation, or combined mobilization and exercise.
The findings indicated that manipulation was more effective at reducing headache intensity and disability.
Additionally, the manipulation group experienced significantly reduced duration and frequency of headaches.
Dunning et al. (2016) BioMed Central Musculoskeletal Disorders

25. Cervicogenic Headaches
Evidence suggests that chiropractic care, including spinal manipulation, improves migraine and cervicogenic headaches.
Bryans et al. (2011) Journal of Manipulative and Physiological Therapeutics

26. Headaches at a Glance

27. Chiropractic Care
Spinal manipulation has been proven effective for many types of headaches and it does not involve medication to cover up the pain.
Doctors of chiropractic are well educated in this field and can also diagnose the condition to recommend the most effective treatment, which typically includes exercise and nutrition.

28. Healthy Ergonomics

29. The Best Approach
If you have headaches, be sure to check with a health professional for a thorough evaluation.
The best approach is to not develop the problem in the first place.
Take preventive steps:
Maintain proper body weight
Exercise regularly
Each nutritious food
Reduce stress
Practice healthy ergonomics
Maintain proper posture and spinal function