Complementary Therapies in Clinical Practice 2009 (Nov); 15 (4): 192–7
Joel Alcantara, D.C. and Martine Cossette, D.C.
International Chiropractic Pediatric Association,
327 North Middletown Dr,
Media, PA, USA.
The absence of hormone fluctuations and/or the analgesic effects of increased beta-endorphins are thought to confer improvements in headache symptoms during pregnancy. However, for a number of pregnant patients, they continue to suffer or have worsening headache symptoms. The use of pharmacotherapy for palliative care is a concern for both the mother and the developing fetus and alternative/complementary care options are sought. We present a 24-year-old gravid female with chronic migraine headaches since age 12years. Previous unsuccessful care included osteopathy, physical therapy, massage and medication. Non-steroidal anti-inflammatory medication with codeine provided minor and temporary relief. Chiropractic care involving spinal manipulative therapy (SMT) and adjunctive therapies resulted in symptom improvement and independence from medication. This document provides supporting evidence on the safety and possible effectiveness of chiropractic care for patients with headaches during pregnancy.
Background Lifetime prevalence of migraine headaches in women vary from 11 to 32 percent while 1-year prevalence varies from 9-22 percent. Women are three-times more likely to suffer from migraine headaches compared to men and peak during the reproductive years. Studies indicate an improvement in headaches symptoms during pregnancy due to the absence of hormone fluctuations and/or the analgesic effects of increasing ß-endorphins. Some however report worsening of symptoms regardless of non-pharmacological or pharmacological approaches. Risks of adverse events associated with medical care are of concern and are warranted. We present the successful care of a patient with intractable migraine headaches during pregnancy.
Clinical Features A 24 yr-old gravid female with chronic migraine headaches since age 12 years presented for chiropractic care. Previous care included osteopathy, physical therapy, medications and massage with unsuccessful outcome. Medical care consisted of non-steroidal anti-inflammatory medication with codeine at the maximum amount permitted during a pregnancy (i.e., 1000mg per day) as well as caffeine intake through coffee to potentiate the medication. This resulted in only minor and temporary relief.
Intervention and Outcome Chiropractic adjustments characterized as high-velocity, low amplitude thrusts and the Activator Instrument were applied to sites of vertebral subluxations. No reported adverse events were associated with this type of care. Massage, trigger point therapy, increase water intake and change in sleeping posture were adjunctive care. The intensity of her migraine headaches had significantly reduced following the first three visits from pain rating of 8-9/10 to 2/10 on the verbal pain scale and attack frequency improvement from once daily to once every 3 days. This resulted in self-withdrawal and decrease dependence on medication.
Conclusion This case study provides supporting evidence on the safety and effectiveness of chiropractic care during pregnancy with a chief complaint of migraine headaches.