an alternative to pharmacologic treatment of headache pain - making the case for primary spine...

An Alternative to Pharmacologic Treatment of Headache Pain___________________________________________________Making the Case for Primary Spine Practitioner Care

There are more than 129 different

classification of headaches

Break Free From the Bondage of Your

HEADACHES

But only one matters to you....

YOURS!


HEADACHES_____________________________________________________________________________________

The Headache Epidemic!___________________________________________________________________________________

50 MILLION people in the US experience headaches 28 MILLION experience migraine headaches

12 MILLION suffer with chronic daily headaches 20% OF CHILDREN report experiencing headaches 157 MILLION workdays are missed due to headaches $24.7 BILLION in costs to U.S. employers due to headaches

Yes headaches are common, but no, they are not normal.

Headaches & Medication You can break free from the bondage of your headaches!

Headaches are the #1 reason why people

take over the counter medications

Headaches & Medication You can break free from the bondage of your headaches!

For most, it seems as though no matter how many pills they take, the headaches keep returning, and in many cases the headaches increase in severity and frequency.

Pounding & ThrobbingYou can break free from the bondage of your headaches!

At times, the pounding and throbbing

seem almost unbearable

What would you Do?To Get Rid of Your Headaches

You definitely don't have to do backflips to get rid of your headaches. Our office has had the privilege of caring for hundreds of people in our community, and we would be honored to care for you.

Finding Temporary ReliefYou can break free from the bondage of your headaches!

It's no wonder most choose the quick - albeit – temporary relief found in over-the-counter

and prescription pain relievers

Headaches & Productivity You can break free from the bondage of your headaches!

Productivity in the workplace naturally drops dramatically when you're suffering with

headaches

Headaches & Productivity You can break free from the bondage of your headaches!

Feeling hopeless about your headaches? Like you'll just never get rid of them? There are natural solutions that may help you to overcome your headaches for good.

Headaches & Children You can break free from the bondage of your headaches!

A full 20% of children suffer with headaches. There are many causes for the headaches including food hypersensitivity, posture, backpacks and more.

Chronic Daily HeadachesYou can break free from the bondage of your headaches!

12 million people suffer from headaches everyday!


HEADACHES

Jeopardize yourEMPLOYMEN

T

Decrease yourPOTENTIAL

Interrupt familyLIFE

Those experiencing headaches fully understand that they can be a debilitating problem:

What price would you pay?You can break free from the bondage of your headaches!

What price would you pay to overcome your headaches for good?


HEADACHESMedication Overuse:

Many people are taking both prescription and over-the-counter pain relievers. They do it because they’re desperate. They’re in pain, and even if they’re already on a prescription, they’re easily influenced by commercials on television for medications designed to treat headaches.


HEADACHESSource vs. Symptom:“When Medicine Makes Headaches Worse”Overusing painkillers actually lowers the level of serotonin, a chemical in the brain. A decreased level of serotonin can change how a person experiences pain.

Seymour Diamond, MD [“Headache Godfather”]Founder, Diamond Headache Clinic

Chicago, ILAdjunct Professor of Cellular and Molecular Pharmacology & Clinical Professor in the Department of

Family MedicineChicago Medical School at Rosalind Franklin University of Medicine and Science

Lecturer, Department of Family Medicine (Neurology)Loyola University Chicago/Stritch School of Medicine


HEADACHESSource vs. Symptom:“When Medicine Makes Headaches Worse”

The typical patient with rebound headaches will come in and complain that they have headaches every day. The pain will escalate to a point where it’s interfering with their life, and they are suffering from depression and anxiety and simply not feeling like themselves anymore.

R. Michael Gallagher, D.O. [“Dr. Headache”]Founder, Center for Headache Care

Melbourne, FL

“TOP DOC”National Headache Foundation, “Philadelphia” Magazine, “South Jersey” Magazine, “SJ” Magazine

Veteran [Ret. Colonel]U.S. Army, USAF Reserve, & Delaware Air Guard



It is suspected that regular utilization of headache medication will alter the function of sensory receptors and certain pain pathways in the brain.Over-the-counter pain medications (OTC’s) containing aspirin, acetaminophen (Tylenol), and ibuprofen (Motrin) can induce rebound headaches, especially if not taken as directed (i.e. > 3 days per week).



The hazardous nature of OTC use increases if the medication also contains caffeine. While beneficial in the treatment of headaches, when combined with caffeine consumption (coffee, tea, soda, or chocolate) your susceptibility to rebound headaches proliferates.



The transformation of an intermittent headache to a daily headache often results from the overuse of over-the-counter or prescription pain relievers.



Sufferers of rebound headaches can gradually get to the point where they are taking staggering doses of painkillers. We see patients who use upwards of 10 to 20 tablets per day. My all-time record holder was a patient taking 35 Excedrin a day! I simply don’t know how he tolerated them.

Timothy R. Smith, M.D., R.Ph.Medical Director, Mercy Health Research

Mercy Medical Group, St. Louis, MO

Vice President of Research, Mercy’s Center for Innovative CareMercy Medical Group, St. Louis, MO

Board of Directors, National Headache FoundationChicago, IL



Non-steroidal anti-inflammatory (NSAIDs) irritate the digestive tract, potentially causing bleeding and ulcers; they can also damage the kidneys.

Acetaminophen (Tylenol) has its own dangers and can damage the liver, especially when combined with alcohol.

Medication PathQ: “How does the medicine I take make it from my mouth to my head?”

A: The medication is absorbed through the lining of the stomach and small intestine.

Potential Side Effects of NSAIDs :1. Gastrointestinal2. Liver3. Kidney

LIVE Again!_____________________________________You can break free from the bondage of your headaches!

Are you ready to start living again? You can really break free from your headaches!

Headache

Medication

Symptom Relief

______________________________________________

Medication Overuse Headache Cycles

or overcome your headaches?

Would you like to mask

The Headache – Medication - Symptom Relief Cycle

______________________________________________Break The Vicious Cycle

Headache

Medication

Symptom Relief

Strong smells, even nice

ones, trigger migraines

in some people

The drop in blood sugar levels due to

skipping meals Is a common

cause of headaches

The preservatives in cold cuts called nitrates are a

common trigger for headaches

The hairdo headache

occurs when braids or pony tails are worn for too long

Strong Smells Skipping Meals Cold CutsHair

AccessoriesThe Journal Headache reported

stress as the most common

factor precipitating

tension headaches

Overcoming your headaches for good is directly related to your awareness of

your headache triggers, and your

discipline to avoiding them.

Aged cheese triggers

headaches - the culprit is

tyramine. The older the cheese

the more tyramine.

Work Stress Cheese

Smoke contains nicotine, which causes blood vessels in the

brain to narrow.

Like aged cheese, red wine

contains tyramine, a

common headache trigger in many people

Poor posture causes increased pressure on the neck & upper back, and can

provoke tension headaches

Caffeine’s strong vascular

influence plays an important role

as a headache trigger

mechanism

Smoking Red Wine Poor Posture Caffeine

h e a d a c h e

__________________________________________________________________________________________________________________________________________

TRIGGERS


HEADACHESFOOD ADDITIVES

____________________________________________________________

____________________________________________________________

Food DyesYellow #5; Red # 3,40; Blue 1,2

Aspartame MSG

The Food and Drug Administration (FDA) maintains a list of over 3,000 chemicals that are added to the processed food supply. Some of these additives have never been tested for safety. Food additives are a common trigger for many headache sufferers.

Studies show that most people are dehydrated. Knowing that our muscles cells are between 70-90% water makes it easy to understand the relationship between water and tension headaches.

MORE WATER!

A brisk walk can ease the throbbing of a headache. Studies show reductions in frequency and intensity of migraine following consistent aerobic exercise over several weeks.

EXERCISE

Current scientific evidence suggests that cigarette smoke may contribute substantially to headache disorders. Surveys have shown that 33% of migraine sufferers use tobacco.

QUIT SMOKING

Emotional & Psychological health are very important aspects to overcoming Headaches.Stress reduction tips:1. Meditation2. Spiritual Practice3. Relaxation training4. Biofeedback5. Cog-B training

MANAGE STRESS

Sleep plays a vital role in managing your headaches.

Improve your sleep:1. Stick to a sleep schedule2. Take a warm bath3. Decrease or better yet – eliminate caffeine

PROPER SLEEP

Eliminate the following from your diet:- Food triggers- ALL Grains esp. those w/gluten- ALL Refined sugar- Hydrogenated oil- Limit soy/diary

www.deflame.com

EAT PROPERLY

Vitamins & minerals play a pivotal role in reducing your headaches.

They include:MagnesiumRiboflavin (B2)Vitamin DCoQ10Alpha Lipoic AcidMelatonin

VITAMINS/MINERALS

To reduce the potential of postural related headaches, be mindful of your workplace setup , holding the phone between your head & ear, and slouching at your desk.

IMPROVED POSTURE

http://www.deflame.com/

http://www.deflame.com/

Posture & Headaches

“For every inch of Forward Head Posture, it can increase theweight of the head on the spine by an additional 10 pounds.” 1

“Over time poor posture results in pain, muscle aches, tension and headache and can lead to long term complication such as osteoarthritis. Forward head carriage may promote accelerated aging of intervertebral joints resulting in degenerative joint disease.” 2

1 Kapandji, I.A. The Physiology of the Joints - The Vertebral Column, Pelvic Girdle and Head Vol 3.6th Ed. London: Churchill Livingstone, 2008. Print

2 31st Annual International Conference of the IEEE Engineering in Medicine and Biology Society.Minneapolis, MN; USA, Sept. 2009.

________________________________________Making the Case for Primary Spine Practitioner Care

Posture & Headaches

“The extra pressure imposed on the neck from poor posture flattens the normal cervical curve resulting in abnormal strain on muscles, ligaments, fascia and bones.”

Ultimately, chronic low back pain, neck-related headaches,

and stress-related illnesses occur.

American Journal of Pain Management, January 2008, 4:36-39


Posture & Headaches

The result of creep is the rearrangement of collagen fibers and its associated proteins as well as the water being squeezed from the tissue which causes it to lengthen. If the applied force isn’t excessive, upon release of the force the tissue will begin to recover.

2

1 Bogduk, N. Clinical Anatomy of the Lumbar Spine and Sacrum. 2McKenzie R, May S. The Cervical & Thoracic Spine – Mechanical Diagnosis & Therapy 3rd Ed. New York: Churchill Livingstone, 1997. Print 2nd Ed. Raumati Beach: Spinal Publications, 2006. Print.

“Constant force applied to collagen structures (i.e. annular fibers of vertebral disc, ligaments, muscle fascia, joint capsules) for prolonged periods of time results in creep.” 1


Posture & Headaches

SET: difference between initial and final length of tissue after creep. If interval between episodes of creep loading is adequate the tissue can fully recover its original shape.McKenzie R, May S. The Cervical & Thoracic Spine – Mechanical Diagnosis & Therapy

2nd Ed. Raumati Beach: Spinal Publications, 2006. Print

.


Posture & Headaches

If creep loading frequency increases, thereby not allowing sufficient time for collagen fibers to recover, set may persist indefinitely.Therefore the collagenous tissues (i.e. vertebral disc, ligament, joint capsule, etc.) will remain lengthened with decreased ability to carry out their mechanical function making them vulnerable to injury.McKenzie R, May S. The Cervical & Thoracic Spine – Mechanical Diagnosis & Therapy

2nd Ed. Raumati Beach: Spinal Publications, 2006. Print.


Posture & Headaches

Fatigue Failure: Structural malfunction of tissue, due to sustained or repetitive mechanical stress, after a solitary application of force by a load that is substantially less than what is needed to cause damage.“The clinical importance of fatigue failure is that damage to tissues may occur without a history of major or obvious trauma.”1

1 Bogduk, N. Clinical Anatomy of the Lumbar Spine and Sacrum. McKenzie R, May S. The Cervical & Thoracic Spine – Mechanical Diagnosis & Therapy 3rd Ed. New York: Churchill Livingstone, 1997. Print 2nd Ed. Raumati Beach: Spinal Publications, 2006. Print.


Myofascial Trigger Point (TrPs)

- A hyperirritable spot in skeletal muscle that is associated with a hypersensitive nodule that can be felt upon examination in an associated taut band within the muscle.1

- Area of congestion within a muscle due to sustained shortening of muscle fibers.2

1 Travell and Simons’. Myofascial Pain and Dysfunction - The Trigger Point Manual Vol 1. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 1999. Print2 Liebenson, Craig’. Rehabilitation of the Spine – A Practitioner’s Manual. 2nd ed. Baltimore: Lippincott Williams & Wilkins, 2007. Print

Myofascial Trigger Point (TrPs)- The spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, decrease the neuro-muscular system’s ability to produce or control motion, and induce involuntary central nervous system phenomena.1

- Trps are common pain generators that are a result of dysfunction.2

1 Travell and Simons’. Myofascial Pain and Dysfunction - The Trigger Point Manual Vol 1. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 1999. Print2 Liebenson, Craig’. Rehabilitation of the Spine – A Practitioner’s Manual. 2nd ed. Baltimore: Lippincott Williams & Wilkins, 2007. Print

Myofascial Trigger PointsMaking the Case for Primary Spine Practitioner Care

________________________________________

Active TrPs within the suboccipital, upper trapezius, sternocleidomastoid, temporalis, superior oblique and lateral rectus muscles have been associated with chronic and episodic tension-type headache forms.

Alonso-Blanco C, de-la-Llave-Rincón AI, Fernández-de-las-Peñas C. Muscle trigger point therapy in tension-type headache. Expert Review of Neurotherapeutics. March 2012, Vol. 12, No. 3, Pages 315-322

Fernandez-de-Las-Peñas C1, Cuadrado ML, Gerwin RD, Pareja JA. Referred pain elicited by manual exploration of the lateral rectus muscle in chronic tension-type headache. Pain Med. 2009 Jan;10(1):43-8.

Myofascial Trigger Points

“Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous chronic tension-type headache (CTTH) in children, supporting a relevant role of active TrPs in CTTH in children.”

Fernández-de-las-Peñas C, et al. Referred pain from myofascial trigger points in head and neck-shoulder muscles reproduces head pain features in children

with chronic tension type headache. J Headache Pain (2011) 12:35–43


Myofascial Trigger Points

“Headache can at least partly be explained by referred pain from trigger points (TrPs) in the posterior cervical, head, and shoulder muscles.”Fernández-de-las-Peñas C, Cuadrado ML, Arendt-Nielsen L, Simons DG, Pareja JA. Myofascial trigger

points and sensitization: An updated pain model for tension-type headache. Cephalagia. 2007;27:383-93

“Headache subjects with active TrPs reported a greater headache intensity and longer headache duration. Headache subjects with active TrPs also tended to have a greater forward head posture.”

Fernández-de-Las-Peñas C1, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache. Headache. 2006 Sep;46(8):1264-72.


Spinal Manipulative Therapy___________________________________Making the Case for Primary Spine Practitioner Care

In 1995, a team of medical doctors at Syracuse University established neck problems as the cause of many headaches "with scientific, anatomical proof." Subsequently, in an article entitled "A Pain in the Neck" and subtitled “Chiropractors were right” published in the Toronto Star, Canadian anesthesiologist, Peter Rothbart, MD – former president of the North American Cervicogenic Headache Society, made the following comments:

"We couldn't believe it at first. We've been able to put together a scientific explanation for how neck structure causes headaches -- not all headaches, but a significant number of them.“

"It's true that chiropractors have been saying this for years. Unfortunately, many (medical) doctors tend to have a jaundiced view of chiropractors, but they were right about headaches.“

"Chiropractic's Role in Treating Headaches." Chiropractic's Role in Treating Headaches.Editorial Staff. Dynamic Chiropractic, 10 Feb. 1997. Vol. 15, Issue 04

Web. 02 Mar. 2014.

Spinal Manipulative Therapy

abnormalities were found to be common in those patients suffering from migraine and tension-type headaches.

Jull G, et al. Inter-examiner reliability to detect painful upper cervical joint dysfunction.Aust J Physiother. 1997;43(2):125-129.

Marcus DA, et al. Musculoskeletal abnormalities in chronic headache: a controlled comparison of headache diagnostic groups. Headache. 1999 Jan;39(1):21-7.

Jull G, et al. Cervical musculoskeletal impairment in frequent intermittent headache. Part 1: Subjects with single headaches. Cephalalgia. 2007 Jul;27(7):793-802.

Postural, myofascial,

and mechanical (upper cervical joint dysfunction)

Making the Case for Primary Spine Practitioner Care

___________________________________

Spinal Manipulative Therapy

Investigators conducted a randomized control trial of one hundred fifty (150) participants where spinal manipulation was compared to the drug amitriptyline for the treatment of chronic tension-type headaches.

Data collected four (4) weeks after the study concluded found that people who had received spinal manipulation exhibited greater reduction in headache intensity and frequency as well as a decreased usage of OTCs than those who had received amitriptyline treatment during the study.

The difference in the amount of improvement between the groups was statistically significant.

Boline PD, Kassak K, Bronfort G, et al. Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. J Manipulative Physiol Ther. 1995;18:148-154.

Making the Case for Primary Spine Practitioner Care

___________________________________

Spinal Manipulative TherapyMaking the Case for Primary Spine Practitioner Care

A randomized, parallel-group comparison of 218 people suffering from migraine headaches was conducted to measure the relative prophylactic efficacy of amitriptyline, spinal manipulation, and the combination of both therapies. Subjects were randomly divided into 3 groups, all of which experienced comparable benefits during the eight (8) week treatment period. However, during the four (4) week post-treatment follow-up period, the spinal manipulation group was found to have experienced a 17.5% greater reduction in symptoms compared to the other two groups.

Nelson CF, Bronfort G, Evans R, et al. The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. J Manipulative Physiol Ther. 1998;21:511-519.

___________________________________


200 participants who were diagnostically determined to be suffering from cervicogenic headache took part in a randomized control trial that compared the treatment efficacy of manipulative therapy and exercise therapy for neck-related headache. The researchers found that while neither therapy alone was clinically significant, 10% more patients found relief from their headaches when the therapies were combined, and this result was also prevalent during the 3, 6, and 12 month follow-up assessments.

Jull G, et al. A Randomized Controlled Trial of Exercise and Manipulative Therapy for Cervicogenic Headache. Spine: 1 September 2002 - Volume 27 - Issue 17 - pp 1835-1843


Safety: Established in 2000 and given official status by the Steering Committee of the Bone and Joint Decade, an initiative of the United Nations and World Health Organization, The Task Force on Neck Pain and Its Associated Disorders came to the following conclusion regarding their study of vertebrobasilar stroke:

“There was an association between chiropractic services and subsequent vertebrobasilar artery stroke in persons under 45 years of age, but a similar association was also observed among patients receiving general practitioner services.

This is likely explained by patients with vertebrobasilar artery dissection-related neck pain or headache seeking care before having their stroke.”

Haldeman S, et al. The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders - Executive Summary. Eur Spine J (2008) 17 (Suppl 1): S5-S7


Safety: NYU Langone Medical Center published the following conclusions on their website regarding chiropractic care: “Although attempts have been made to determine in advance who will experience strokes following chiropractic, they have not been successful.1

Thus, stroke must be considered an unpredictable, though rare, side effect of chiropractic manipulation of the neck.”

1 Haldeman S, Kohlbeck FJ, McGregor M. Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy. Spine. 2002;27:49-55.

"Chiropractic." NYU Langone Medical Center. Ed. Richard Glickman-Simon, MD and Jeffrey S. Geller, MD. EBSCO Publishing, Aug. 2013. Web. 02 Mar. 2014

EBSCO Complementary and Alternative Medicine (CAM) Review Boardhttp://www.med.nyu.edu/content?ChunkIID=35926

http://www.med.nyu.edu/content?ChunkIID=35926



NYU Langone Medical Center published the following conclusions on their website regarding chiropractic care: “To put this in perspective, however, the rate of complications from chiropractic is extremely low. According to one estimate, only one complication per million individual sessions occurs.”2 “Among people receiving a course of treatment involving manipulation of the neck, the rate of stroke is perhaps one per 100,000 people; the rate of death is one per 400,000.” 3

2 Coulter ID. The Appropriateness of Manipulation and Mobilization of the Cervical Spine. Santa Monica, CA: Rand Corporation; 1996

3 Dabbs V, Lauretti WJ. A risk assessment of cervical manipulation vs. NSAIDs for the treatment of neck pain. J Manipulative Physiol Ther. 1995;18:530-536.


Safety:


Safety: NYU Langone Medical Center published the following conclusions on their website regarding chiropractic care: “By comparison, serious medical complications involving common drugs in the ibuprofen family (non-steroidal anti-inflammatory drugs, or NSAIDs) are far more common. Among people using them for arthritis, NSAIDs result in hospitalizations at a rate of about four in 1,000 people, and death at a rate of four in 10,000.”1

1 Dabbs V, Lauretti WJ. A risk assessment of cervical manipulation vs. NSAIDs for the treatment of neck pain. J Manipulative Physiol Ther. 1995;18:530-536.



Safety: NYU Langone Medical Center published the following conclusions on their website regarding chiropractic care:

“To put it another way, the rate of complications with these common over-the-counter drugs is perhaps 100 to 400 times greater than with chiropractic.”


EBSCO Complementary and Alternative Medicine (CAM) Review Boardhttp://www.med.nyu.edu/content?ChunkIID=35926


6139 Route 96 – Suite 1Farmington, NY 14425

(585) 953-0200

3111 Winton Rd. SouthRochester, NY 14623

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Excellence in hands-on care for musculoskeletal pain.

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Bibliography

"Chiropractic." NYU Langone Medical Center. Ed. Richard Glickman-Simon, MD and

Jeffrey S. Geller, MD. EBSCO Publishing, Aug. 2013. Web. 02 Mar. 2014

Dalton, Erik, PhD. "Forward Head Posture." Forward Head Posture. Freedom From Pain Institute, 2011. Web. 28 Feb. 2014.

“Headache Workshop." Waiting Room DVD. Dr. Frank Corbo. www.chiroworkshop.com. DVD.

McKenzie R, May S. The Cervical & Thoracic Spine – Mechanical Diagnosis & Therapy 2nd Ed. Raumati Beach: Spinal Publications, 2006. Print.

Murphy, Donald. “Principles of Primary Spine Care and the Cervical Spine.” Community Spine Pathway Training Part III. Excellus BC/BS,

Rochester. 26&27 Oct 2013. Lecture.

Samsung. “Over the Horizon." Samsung. 2014. MPEG.

an alternative to pharmacologic treatment of headache pain - making the case for primary spine...

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chronic daily headaches

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