Wednesday, December 1, 2021

Tension headaches vs migraines

What’s a Normal Headache?

This is truly one of the more frustrating things that I hear is when someone tells me about their “normal headache”. 
From a physiology standpoint, it would seem silly for the human body to make head pain a normal part of body’s day to day functions.
How do you know what type of headache you have? What type of treatments are best for each headache? We’ll break all of that down today.

Tension Headaches

These are the most common headaches, and what most people classify as a “Normal Headache”. This type is known for having a band like compression around the temples, forehead, or back of the head. Many people call this a stress headache because it is exacerbated by a person’s response to stressful situations. These headaches are typically mechanical in nature (tight muscles, associated with neck pain)
There is a lot of variation in the duration and intensity of this type of headache. Even though the pain can become severe (as high as a 8 or 9/10 on the pain scale), the lack of neurological symptoms imply that the nature of the headache has a different origin.
Most people control these headaches with massage, over the counter medications, and conventional chiropractic to provide short-term relief. Things like Yoga and stress management techniques are also popular treatments.

Migraine Headaches

A severe headache is NOT the same as a migraine. It’s important to recognize this because the nature of a migraine headache goes beyond mechanical dysfunction. Migraines are characterized by abnormalities in blood flow to the brain, which creates some distinct neurological symptoms. Most migraines feature:
  • Severe headache
  • Sensitivity to light
  • Aura and other visual disturbances
  • Nausea
  • Pins and needle sensation
  • Post headache hangover

Treatments usually go beyond over the counter medications.
Other headaches
Of course there are several other types of headaches. Things like cluster headaches, sinus headaches, and trigeminal nerve pain fall into the spectrum of common headaches. Another emerging class of headache include those that come from chronic use of pain medication, which has led to a search for new drugs or non-drug therapies to try to manage this common debilitating problem.
The truth is, because headaches are experienced differently by so many people, it might be best to figure out where headaches have a commonality.

The Craniocervical Junction and the Trigeminal Nucleus

The craniocervical junction is a fancy term for where the head meets the neck. A tremendous amount of research is going on in this part of the body because of how big a role it plays on the brain and overall neurology. One of the things that they have found is that this part of the body has a big influence on a part of the spinal cord called the trigeminal nucleus.
The trigeminal nucleus is where the nerve cells exist that provide innervation for head, neck, face, jaw, the brain’s outer covering, and the blood vessels of the brain. Here’s a surprising fact:
The brain itself does not feel pain
When you feel pain in your head, it is coming from brain’s outer covering called the meninges, and the blood vessels. All of these structures feed into the trigeminal nucleus and this piece of anatomy tells our brain what it should feel.

Symmetry Matters

In the world of Chiropractic we find that symmetry of the cervical spine matters. When you lose your normal structural symmetry of the spine, then the trigeminal nucleus is less likely to work properly. That’s why headache patients usually respond so quickly to this unique type of care.
Of course it may not help every person with headaches. The truth is that headaches can be affected by tumors, chemicals, and even food for some select cases. However, a gross majority of the population’s headaches are likely secondary to a structural shift of the head and neck.

Monday, November 1, 2021

What a 10 mph car accident does to the neck?

Pain after a car accident can be very strange and confusing. Take a look at these examples and tell me if this reminds you of a situation that you or someone you know.

Person A: Healthy and fit 37-year-old man in a car and gets hit at 45 mph+. The impact drives his car into the car in front causing extensive damage.

Person B: Healthy and fit 29-year old woman. Sitting in line in a parking lot when another car runs into the back of her at 10 mph or less. Minimal damage to the car and wore a seat belt.

Which one do you think had a worse whiplash injury and had pain immediately and which do you think just had soreness that they wanted to get checked out?

Both had substantial biomechanical changes on their x-ray and MRI, but only one had a significant amount of pain immediately after the incident.

If you guessed that Person B with the parking lot bumper tap had the most pain, then you win! Congratulations!

The Deceptive Nature of Pain

Pain is one of medicine’s greatest tricksters. To this day, researchers and scientists don’t have a strong grasp on the nature pain disorders.

Why is it tricky? Because the pain someone feels isn’t necessarily related to the amount of damage in the body. Patients with fibromyalgia have crippling pain despite not having any visible damage to their bodies.
Pain is the most important factor to a patient, but it can be the most deceptive factor to a clinician. When it comes to taking care of people after an accident, we have to measure a patient’s function regardless of their pain status.

What Happens to the Neck After an Accident?

Insurance companies will only consider it an accident-related whiplash injury if you see a doctor within 14 days of the accident. So if you have no pain after the accident or the pain wasn’t bad enough to drive you to a physician until day 15, then you didn’t have a whiplash (I know how silly it sounds).

But going back to the previous example, we know that both Patients A and B had biomechanical flaws as a result from trauma to the spine. Despite the fact that there were 2 very different accidents and 2 different pain statuses, there are similarities in what can happen to the neck even after the smallest collisions. Take a look at the video below which simulates an accident less than 10 mph.


What Happens to the Neck in an Accident?

After watching the video, you can get the impression that a collision at just 5-7 mph causes rapid movement of the head and neck.

Despite the fact that your body is encased by a 2 ton metal box, it’s easy to see that even though the vehicle stops moving, there is still a transfer of energy into the body. When you’re wearing your seat belt, it causes a rapid deceleration of your body, but your head will continue to move forward and backward very rapidly.

In fact, a large enough force to the neck can actually produce a concussion even if there’s not direct contact to the head! These accidents would need somewhere around 90 G’s of force to the head.

While that would cease to be a small accident, the smaller 10 mph accidents can produce 3-5 G’s of force which is enough to damage the tissues of the neck. The way your head accelerates and decelerates can put 3-6 G’s of force into the cervical spine. This force gets transferred into the ligaments, muscles, discs, and joints of the neck more than any other piece of anatomy.

While the body can tolerate large amounts of force in brief periods, a large amount of force applied to a small region of anatomy as seen in a car accident can damage the tissues of the neck.

Ligament Injury

Ligaments are like the rubber bands of the spine. They can be stretched, but once they stretch too far, they can’t go back to normal again. As ligaments are damaged, scar tissue is used as a patch, but it’s not as functional as the stuff you were built with.

Just like when you sprained your ankle as a kid and that ankle never worked the same, damage to ligaments of your neck can happen the same way. Fortunately, true sprains of the neck take a lot of force and don’t happen with most accidents.

Muscle Strains

When muscle works beyond its capacity, or gets stretched beyond its end range, it forms small tears within the muscle belly. That’s why there’s no consensus as to whether you’re better off knowing about a coming accident and bracing, or if you’re better off being surprised.

Either way, damage to the muscle tissue can happen depending on the nature of the collision.

Muscle strains can be painful, but they can and do heal with time. Strain to muscle tissue is one of the most common sources of pain from whiplash injuries and resolve well with chiropractic and exercise.

Disc Damage

Accidents are one of the most common ways that people under 30 can suffer herniated discs in the spine. When the force of an accident overcomes the resistance of the disc material, small tears in the disc can result in the inner fluid spilling into the spinal canal.

Sometimes this results in a pinched nerve, but most of the time it does not. A disc problem doesn’t have to be a big problem. Many people have disc damage and have no idea because it’s not symptomatic.

Structural Shifting

The muscles, ligaments, discs, and nerves of the neck help dictate the Structural Positioning of the spine. The force of an accident can deform one or all of these tissues leading to abnormal positioning of the head and neck.

This leads to abnormal neurological input to the brain and what manifests as poor posture (slouching, head tilt, antalgic lean). While poor posture is not the problem that needs to be treated, it’s an objective sign of a nervous system is operating at less than its full capacity.

Remember That It’s Not About Pain

Remember at the beginning of the article we talked about how pain can be deceptive. The reason I wanted to point that out is because you can experience damage to all of the above structures and not feel an immediate onset of pain. Pain is just tricky like that.

Whether you feel immediate pain or not, your neck should always be evaluated even after minor accidents because it gives the earliest and best opportunity to correct a silent problem.

Friday, October 1, 2021

Whiplash: 12 Things you should know

1. Significant injuries occur at low-speeds.
2. Women suffer greater injuries than men because they have less strength in their neck muscles.
3. Early mobilization is critical. Use of a cervical collar actually gives worse results than no treatment at all. Immobilization following injury causes muscle wasting and loss of strength that significantly delays recovery. Corticosteroids damage articular cartilage & decrease collagen strength & repair. Early mobilization improves healing & repair of bone, cartilage, ligaments, & tendons. It also improves joint proprioception, which helps to prevent early joint degeneration. 
4. Most whiplash injuries are occult and cannot be identified on conventional imaging such as x-ray, MRI, or CT scans.
5. The peak inflammation associated with whiplash is located around the C2 vertebra and is the most common origination of headache symptoms. The C2/C3 facet joint in particular is the cause of cervicogenic headache 53% of the time.
6. The severity of vehicle damage is not predictive of injury or outcome. Stiffer vehicles actually increase the probability of long-term consequences because the forces get focused on the head & neck. A more accurate predictor of outcome is if the injured person experiences acute neck pain within the same day of injury. These people are 3x more likely to report chronic neck pain 7 years later. Also of note, younger people generally have a better prognosis & require less treatment.
7. Upper Cervical spine is most injured when head & neck are in flexed & rotated position at time of impact (e.g. looking at cell phone or child in back seat).
8. Whiplash patients are 5x more likely to suffer from chronic neck pain compared to control population.
9. Whiplash patients are at a significantly increased risk for premature disc degeneration. Most common site of disc injury is C5/C6.
10. Cervical range of motion is the most important indicator of physical impairment. It has proven to be 90% accurate in diagnosing people with whiplash symptoms. Flexion and extension are usually the most impaired movements.
11. Over 90% of whiplash patients under chiropractic care showed notable improvement over a 6 month period of care. Chiropractic treatment has been shown to be 5x more effective than Celebrex or Vioxx within 9 weeks of treatment. Chiropractic care has also been shown to have a 2x greater success rate than standard medical care, and a significantly higher success rate than Physical Therapy. Some measured markers include less work absences and less reliance on pain medications. Passive joint motion is superior to active exercise therapy.
12. In order to get the best therapeutic outcome, treatment must be initiated within the first 3 months following whiplash injury. Recommended guidelines for acute or sub-acute recovery with treatment ranges from 2 months to 2 years, with a mean of 7 months. An appropriate initial treatment frequency is 2-3 x per week for the initial 10 weeks of care.