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Integrating Chiropractic Care Into the Treatment of Migraine Headaches in a Tertiary Care Hospital

By |April 7, 2019|Headache, Migraine|

Integrating Chiropractic Care Into the Treatment of Migraine Headaches in a Tertiary Care Hospital: A Case Series

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SOURCE:   Glob Adv Health Med. 2019 (Mar 28)

Carolyn Bernstein, MD, Peter M Wayne, PhD, Pamela M Rist, ScD, Kamila Osypiuk, MS, Audrey Hernandez, MS, and Matthew Kowalski, DC

Osher Clinical Center,
Brigham and Women’s Hospital,
Boston, Massachusetts.



This case series illustrates an integrated model of care for migraine that combines standard neurological care with chiropractic treatment. For each patient, we describe the rationale for referral, diagnosis by both the neurologist and chiropractor, the coordinated care plan, communication between the neurologist and chiropractor based on direct face-to-face “hallway” interaction, medical notes, team meetings, and clinical outcomes. Findings are evaluated within the broader context of the multicause nature of migraine and the impact of integrative chiropractic. Suggestions for future areas of research evaluating integrative approaches are discussed.

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Diagnosis and Chiropractic Treatment of Infant Headache Based on Behavioral Presentation and Physical Findings

By |March 23, 2019|Headache, Pediatrics|

Diagnosis and Chiropractic Treatment of Infant Headache Based on Behavioral Presentation and Physical Findings: A Retrospective Series of 13 Cases

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SOURCE:   J Manipulative Physiol Ther. 2009 (Oct); 32 (8): 682–686

Aurélie M. Marchand, MChiro, DC, Joyce E. Miller, BS, DC, Candice Mitchell, MChiro

Private Practice,
Brussels, Belgium



OBJECTIVE:   This case series presents information on diagnosis and treatment of 13 cases of benign infant headache presenting to a chiropractic teaching clinic.

CLINICAL FEATURES:   A retrospective search was performed for files of infants presenting with probable headache revealing 13 cases of headache from 350 files.

INTERVENTION AND OUTCOMES:   Thirteen cases (6 females, 7 males) from 2 days old to 8.5 months old were identified by behavioral presentation, parental, or medical diagnosis. In the cohort, historical findings included: birth trauma, assisted birth, familial headache history and feeding difficulty. Examination and behavioral findings were grabbing or holding of the face, ineffective latching, grimacing and positional discomfort, rapping head against the floor, photophobia and anorexia. Posterior joint restrictions of the cervical spine were found in these cases. No cases of malignant headache were found. All infants received a trial of chiropractic care including manual therapy.

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The Management of Common Recurrent Headaches by Chiropractors

By |November 5, 2018|Headache|

The Management of Common Recurrent Headaches by Chiropractors: A Descriptive Analysis of a Nationally Representative Survey

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SOURCE:   BMC Neurol. 2018 (Oct 17); 18 (1): 171

Craig Moore, Andrew Leaver, David Sibbritt, and Jon Adams

Faculty of Health,
University of Technology Sydney,
Level 8, Building 10,
235-253 Jones Street Ultimo,
Sydney, NSW, 2007, Australia.


BACKGROUND:   Headache management is common within chiropractic clinical settings; however, little is yet known about how this provider group manage headache sufferers. The aim of this study is to report on the prevalence of headache patients found within routine chiropractic practice and to assess how chiropractors approach key aspects of headache management applicable to primary care settings.

METHODS:   A 31-item cross-sectional survey was distributed to a national sample of chiropractors (n = 1050) to report on practitioner approach to headache diagnosis, interdisciplinary collaboration, treatment and outcome assessment of headache patients who present with recurrent headache disorders.

RESULTS:   The survey attracted a response rate of 36% (n = 381). One in five new patients present to chiropractors with a chief complaint of headache. The majority of chiropractors provide headache diagnosis for common primary (84.6%) and secondary (90.4%) headaches using formal headache classification criteria. Interdisciplinary referral for headache management was most often with CAM providers followed by GPs. Advice on headache triggers, stress management, spinal manipulation, soft tissue therapies and prescriptive neck exercises were the most common therapeutic approaches to headache management.

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Referred Pain from Myofascial Trigger Points in Head and Neck-shoulder Muscles Reproduces Head Pain Features in Children With Chronic Tension type Headache

By |October 21, 2018|Headache, Myofascial Disorder, Pediatrics|

Referred Pain from Myofascial Trigger Points in Head and Neck-shoulder Muscles Reproduces Head Pain Features in Children With Chronic Tension type Headache

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SOURCE:   J Headache Pain. 2011 (Feb); 12 (1): 35–43

César Fernández-de-las-Peñas, Daniel M. Fernández-Mayoralas, Ricardo Ortega-Santiago, Silvia Ambite-Quesada, Domingo Palacios-Ceña and Juan A. Pareja

Department of Physical Therapy,
Occupational Therapy,
Rehabilitation and Physical Medicine,
Facultad de Ciencias de la Salud,
Universidad Rey Juan Carlos,
Avenida de Atenas s/n,
28922 Alcorcón, Madrid



Our aim was to describe the referred pain pattern and areas from trigger points (TrPs) in head, neck, and shoulder muscles in children with chronic tension type headache (CTTH). Fifty children (14 boys, 36 girls, mean age: 8 ± 2) with CTTH and 50 age- and sex- matched children participated. Bilateral temporalis, masseter, superior oblique, upper trapezius, sternocleidomastoid, suboccipital, and levator scapula muscles were examined for TrPs by an assessor blinded to the children’s condition. TrPs were identified with palpation and considered active when local and referred pains reproduce headache pain attacks. The referred pain areas were drawn on anatomical maps, digitalized, and also measured.

The total number of TrPs was significantly greater in children with CTTH as compared to healthy children (P < 0.001). Active TrPs were only present in children with CTTH (P < 0.001). Within children with CTTH, a significant positive association between the number of active TrPs and headache duration (r (s) = 0.315; P = 0.026) was observed: the greater the number of active TrPs, the longer the duration of headache attack. Significant differences in referred pain areas between groups (P < 0.001) and muscles (P < 0.001) were found: the referred pain areas were larger in CTTH children (P < 0.001), and the referred pain area elicited by suboccipital TrPs was larger than the referred pain from the remaining TrPs (P < 0.001). Significant positive correlations between some headache clinical parameters and the size of the referred pain area were found. 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 children, supporting a relevant role of active TrPs in CTTH in children.

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Prevalence of Neck Pain in Migraine and Tension-type Headache

By |October 20, 2018|Headache|

Prevalence of Neck Pain in Migraine and Tension-type Headache: A Population Study

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SOURCE:   Cephalalgia. 2015 (Mar); 35 (3): 211–219

Sait Ashina, Lars Bendtsen, Ann C Lyngberg, Richard B Lipton, Nazrin Hajiyeva and Rigmor Jensen

Department of Pain Medicine and Palliative Care,
Mount Sinai Beth Israel,
Icahn School of Medicine at Mount Sinai, NY, USA


BACKGROUND:   We assessed the prevalence of neck pain in the population in relation to headache.

METHODS:   In a cross-sectional study, a total of 797 individuals completed a headache interview and provided self-reported data on neck pain. We identified migraine, TTH or both migraine and TTH (M+TTH) groups. Pericranial tenderness was recorded in 496 individuals. A total tenderness score (TTS) was calculated as the sum of local scores with a maximum score of 48.

RESULTS:   The one-year prevalence of neck pain was 68.4% and higher in those with vs. without primary headache (85.7% vs. 56.7%; adjusted OR 3.0, 95% CI 2.0–4.4, p<0.001). Adjusting for age, gender, education and poor self-rated health, in comparison with those without headaches, the prevalence of neck pain (56.7%) was significantly higher in those with M+TTH (89.3%), pure TTH (88.4%) and pure migraine (76.2%) (p<0.05 for all three group comparisons). Individuals with neck pain had higher TTS than individuals without neck pain (15.1±10.5 vs. 8.4±8.0, p<0.001).

CONCLUSIONS:   Neck pain is highly prevalent in the general population and even more prevalent in individuals with primary headaches. Prevalence is highest in coexistent M+TTH, followed by pure TTH and migraine. Myofascial tenderness is significantly increased in individuals with neck pain.

KEYWORDS:   Neck pain, migraine, tension-type headache, prevalence, population, tenderness


From the FULL TEXT Article:

Introduction

Neck pain and primary headaches are highly prevalent in the population. [1, 2] Estimated global one-year period prevalence is about 10% for migraine and about 38% for tension-type headache (TTH). [3, 4] One-year prevalence of neck pain ranges from 4.8% to 79.5% in population-based studies. [1] Variation in epidemiological studies of neck pain is attributable, at least in part, to differences in sample selection, ascertainment of symptoms and case definitions. [1] Neck pain can arise from many local structures, including muscles, ligaments, facet joints and visceral structures of the neck, through direct compression of upper cervical roots or it can be referred. [5] Thus, the differential diagnosis for neck pain includes various conditions such as spinal disease, whiplash-associated disorder, fibromyalgia, myofascial pain, rheumatic disease, direct trauma and neoplasms.

Neck pain is common in people with primary headaches, both in population-based studies and in the clinic. [6–10] Neck pain may occur as a premonitory manifestation or during the headache phase. [11] A better understanding of neck pain in primary headache is important. First, it will help facilitate more accurate diagnosis. Second, neck pain may influence the treatment response and result in increased disability in headache suffers. [12] Finally, neck pain may play a role in the pathophysiology of both migraine and TTH. [13, 14] It may arise because of convergent input from the first division of the trigeminal nerve and the upper cervical roots to the trigeminal cervical complex. [13]

The aim of our study was to assess the prevalence of self-reported neck pain in individuals with common primary headaches including migraine, TTH and coexistent migraine and TTH in a general population sample using the clear diagnostic criteria of the International Classification of Headache Disorders (ICHD).


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Manual Therapies for Primary Chronic Headaches

By |May 24, 2017|Headache|

Manual Therapies for Primary Chronic Headaches: A Systematic Review of Randomized Controlled Trials

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SOURCE:   J Headache Pain. 2014 (Oct 2); 15: 67 ~ FULL TEXT

Aleksander Chaibi and Michael Bjørn Russell

Head and Neck Research Group,
Research Centre, Akershus University Hospital,
1478 Lørenskog, Oslo, Norway.


This is to our knowledge the first systematic review regarding the efficacy of manual therapy randomized clinical trials (RCT) for primary chronic headaches. A comprehensive English literature search on CINHAL, Cochrane, Medline, Ovid and PubMed identified 6 RCTs all investigating chronic tension-type headache (CTTH). One study applied massage therapy and five studies applied physiotherapy. Four studies were considered to be of good methodological quality by the PEDro scale. All studies were pragmatic or used no treatment as a control group, and only two studies avoided co-intervention, which may lead to possible bias and makes interpretation of the results more difficult. The RCTs suggest that massage and physiotherapy are effective treatment options in the management of chronic tension-type headache (CTTH).

One of the RCTs showed that physiotherapy reduced headache frequency and intensity statistical significant better than usual care by the general practitioner. The efficacy of physiotherapy at post-treatment and at 6 months follow-up equals the efficacy of tricyclic antidepressants. Effect size of physiotherapy was up to 0.62. Future manual therapy RCTs are requested addressing the efficacy in chronic migraine with and without medication overuse. Future RCTs on headache should adhere to the International Headache Society’s guidelines for clinical trials, i.e., frequency as primary end-point, while duration and intensity should be secondary end-point, avoid co-intervention, includes sufficient sample size and follow-up period for at least 6 months.

KEYWORDS:   Randomized clinical trials, Primary chronic headache, Manual therapies, Massage, Physiotherapy, Chiropractic


From the FULL TEXT Article:

Introduction

Primary chronic headaches i.e. chronic migraine (CM), chronic tension-type headache (CTTH) and chronic cluster headache has significant health, economic and social costs. About 3% of the general population suffers from chronic headache with female predominance [1]. The International Classification of Headache Disorders III β (ICDH–III β) defines CM as ≥15 headache days/month for at least 3 months with features of migraine in ≥8 days/month, CTTH is defined as on average ≥15 days/month with tension-type headache for at least 3 months, and chronic cluster headache as attacks at least every other day for more than 1 year without remission, or with remissions lasting <1 month [2].

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