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.

Wednesday, September 1, 2021

Chronic Daily Migraine Headaches

Migraine headaches are among the most debilitating and dreadful neurological problems that exist. They may not be fatal, but the effect on someone’s quality of life can be dramatic. Imagine having days where the sight of light cripples you. Imagine having terrible nausea, and a constant pounding in your head so bad that you wish that someone would just cut the darn thing off your neck. Imagine that pain lasting for hours or even days at a time.
You probably already know that feeling, and you’ve almost certainly been in the same room as someone going through a migraine attack. Fortunately, most people experience a migraine on rare occasion. However, there are those among us that experience these terrible headaches several times a month, and others even experience them on a DAILY basis.
This is the typical life of a chronic migraine patient in my office. Many times these patients have seen several headache specialists. They’ve seen the best neurologists that the Mayo Clinic and Cleveland Clinic have to offer, and have been through every MRI and brain scan available. They’ve tried several different medication regiments, altered their diets, and spend their lives in fear of triggers like meat, wine, and sometimes caffeine.
Many have even tried alternative therapies like acupuncture and conventional chiropractic with no change.
When they finally sit down and speak with me, they’ve been suffering for years, and almost numb to the fact that they have constant pain in the head. Some look a little pale, others need the lights off in the office, and some even come in wearing sun glasses. All of them are a little doubtful and skeptical that their condition can be cured.

Less Focus on Cure, More Focus on Cause

When most people walk into a doctor’s office with an ailment, what they are most often searching for is a cure. Though migraines are terribly common, and have been around for centuries, a cure has been elusive for the millions of patients suffering on a daily basis. Over the counter migraine medications are usually a first line of treatment, followed by prescription medications. There is also a focus on removing triggers from a person’s life like chocolate, caffeine, and certain scents/perfumes.
The truth is that headaches (especially migraines) cannot be treated as a simplistic disease that is the same in all people. Headaches are a dynamic entity with causes that are multi-factorial. Instead of looking at a migraine as a disease entity, it should be seen as a symptom of a neurophysiological process gone haywire.

The Trigeminocervical Complex: The Pain Gate Keeper of the Head/Neck

Don’t get hung up on the terminology, the name is not important for the casual reader. It is important to understand that near the top part of your spinal cord. In the area surrounded by your top 3 neck vertebra is a very important bundle of nerve cells. These specific nerve cells filter incoming signals from the outer covering of the brain known as meninges. They also filter incoming signals from the blood vessels of the brain, as well as signals that come from the neck.
You see, the brain does not have any receptors that trigger pain. It’s kind of crazy to think about, but it’s true.  However, the outer protective covering of the brain, and the blood vessels are very pain sensitive. When the receptors from these structures get set off, then a cascade of events can take place leading to the blood vessels in the brain opening up and becoming inflamed.
It’s important that we have ‘filters’ like the trigeminocervical complex around to make sure that not every pain signal gets to the brain. In that way, it acts like a gatekeeper. If it let every pain signal through, you would be in a state of pain without end.

So what went wrong with the built-in gate keeper of pain to the brain?

The normal alignment and movement of the head and neck serve as a buffer to pain signals that go into the gate keeper. When you lose the normal alignment, several things can happen.
  • Blood flow in and out of the brain is compromised
  • Inflammatory molecules stay in the brain’s blood supply longer
  • Muscles and ligaments of the neck misfire
  • Low grade inflammation persists in the joints of the neck
  • Small muscles in the neck may pull against the brain’s outer covering
When this happens, you have an environment where the trigeminocervical nucleus can get overloaded with pain signals without the buffer of signals from normal head and neck movement. All of a sudden, a seemingly harmless trigger can send someone with a tendency towards migraines can be sent in a downward spiral of a pounding headache.

Correction not Cure

Our focus is on correcting the Structural positioning rather than curing migraine headaches. The truth is that Structural Correction has benefits that go beyond treating or curing a specific illness or disease. Correction of Spinal Displacement does one thing, and only one thing:
It mobilizes the self-healing, self-restoring potential within your own body.
If we believe that our bodies were meant to be healthy, pain-free, and vibrant, then we must only find what is inhibiting the body’s self-healing potential.

Sunday, August 1, 2021

Neck Protecting Tips for Sleeping Positions...

“Doc, I know that you can help me get better, but what can I do on my own to keep this problem from coming back again?”
Almost everyone who comes to my office want to know what they can do to protect their neck from shifting into a bad position again, and one of the most important things someone can do to protect their neck is to create an optimal position for sleep.
Why is sleep important? Aside from the obvious benefits it has on mood, energy, healing, and overall longevity, the way we sleep also impacts the structural integrity of the spine. Just think about it, most of us spend almost 1/3 of our lives sleeping, and that time is often spent in one of a few postures.
In fact, I’ve seen numerous patients tell me that their problem began upon waking, or that they think that their problem began because they slept funny. The fact is that a prolonged period in a structurally poor position can affect the neck and affect the neurovascular tissues that travel through the neck. This can lead to Secondary Conditions like torticollis, neck pain, headaches, and back problems.
So how do we protect our neck and the nerves that pass through it? These  tips should get you off on the right foot.
Positioning Matters
There are 3 primary positions, and sub variations around that.
Stomach Sleeping – Avoid it:
If you haven’t been told already, stomach sleeping without a specialized pillow can put your neck in too much twist in your neck.
Just try this. Turn your head to your right. Now keep it there for an hour.
I bet that sounds pretty terrible. Now think about how that must feel to have your neck sitting like that for 6-8 hours by the time you wake up.
Stomach sleeping also puts the spine in a hyper-extended position which can also lead to back pain on rising.
Side Sleeping
Side sleeping is a position where almost anyone can get their spine into a neutral position. It allows the
lumbar, thoracic, and cervical spine to line up in one plane when the correct pillows are used.
 A pillow between bent knees helps keep the pelvis neutral, while a head pillow should be high enough to support the neck, but not be so high that it pushes the neck upwards like you see on the right. 
Side sleeping can cause shoulder pain on the side of the low shoulder. This can be corrected by laying on the shoulder blade rather than the arm itself.

Back Sleeping
Sleeping on your back is probably the easiest way to protect your neck. However, it is associated with higher incidences of snoring and sleep apnea. Back sleeping can also be excruciating for someone suffering from acute low back pain. If this is the case for you, then a side sleeper may be your best resort.

What Pillow Do I use?

EVERYONE wants to know about pillows. It’s almost like they’re looking to justify buying $100 pillow as long as it’s approved by their doctor.
What’s the best brand? Does it need to have contours? What should it be made of? Water? Foam? Feathers?
While I do make specific recommendations for my patients in the office, the truth is that the brand and material matter far less than what the pillow is looking to accomplish.
Pillows should comfortably support the structure of your spine. If your head feels jammed or you feel too extended, then you are not getting the necessary support.
Any conversation about investing in a pillow should involve measurements of your head and neck so that your pillow fits your specific anatomy (it keeps your spine inline when lying down). The material should be hypoallergenic and supportive for long term use. That will usually leave feather based pillows out of the conversation, which they are shown to increase discomfort in pain patients.
Side sleepers – Side sleeping puts your shoulder distance between the head and the bed. Alarger pillow with firmer material is best to support the head and reduce cervical strain.
Back sleepers – Sleeping on your back puts a small distance between the head and the bed. A thinner pillow is usually helpful here. However, if you have severe Anterior Head Syndrome, than a flat pillow may be very uncomfortable and force too much hyperextension. Measurement is key to address your pillow concerns here, but correcting the anterior head syndrome will require a chiropractic approach.
While this may not solve all of your sleep dilemmas. It’s a fast and easy way to start getting better sleep today.