Tuchin PJ, Pollard H, Bonello R, A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. Journal of Manipulative and Physiolgical Therapeutics , 2000 02, 23: 2, 91-5
OBJECTIVE: To assess the efficacy of chiropractic spinal manipulative therapy (SMT) in the treatment of migraine. DESIGN: A randomized controlled trial of 6 months' duration. The trial consisted of 3 stages: 2 months of data collection (before treatment), 2 months of treatment, and a further 2 months of data collection (after treatment). Comparison of outcomes to the initial baseline factors was made at the end of the 6 months for both an SMT group and a control group. Setting: Chiropractic Research Center of Macquarie University. PARTICIPANTS: One hundred twenty-seven volunteers between the ages of 10 and 70 years were recruited through media advertising. The diagnosis of migraine was made on the basis of the International Headache Society standard, with a minimum of at least one migraine per month. INTERVENTIONS: Two months of chiropractic SMT (diversified technique) at vertebral fixations determined by the practitioner (maximum of 16 treatments). MAIN OUTCOME MEASURES: Participants completed standard headache diaries during the entire trial noting the frequency, intensity (visual analogue score), duration, disability, associated symptoms, and use of medication for each migraine episode. RESULTS: The average response of the treatment group (n = 83) showed statistically significant improvement in migraine frequency (P < .005), duration (P < .01), disability (P < .05), and medication use (P< .001) when compared with the control group (n = 40). Four persons failed to complete the trial because of a variety of causes, including change in residence, a motor vehicle accident, and increased migraine frequency. Expressed in other terms, 22% of participants reported more than a 90% reduction of migraines as a consequence of the 2 months of SMT. Approximately 50% more participants reported significant improvement in the morbidity of each episode. CONCLUSION: The results of this study support previous results showing that some people report significant improvement in migraines after chiropractic SMT. A high percentage (>80%) of participants reported stress as a major factor for their migraines. It appears probable that chiropractic care has an effect on the physical conditions related to stress and that in these people the effects of the migraine are reduced.
Grunnet Nilsson N, Bove G, [Therapeutic manipulation of episodic tension type headache. A randomized, controlled clinical trial] Ugeskr Laeger, 2000 00, 162: 2, 174-7
In a randomized controlled clinical trial, 75 subjects fulfilling the IHS criteria for episodic tension-type headache were treated for four weeks. One group received spinal manipulation plus soft tissue therapy in the neck, the other received soft tissue therapy plus low-power laser therapy to the same region. In the three month follow-up period both groups showed significant improvement, but there were no differences between the groups. Thus, spinal manipulation had no effect on episodic tension-type headache, in contrast to the significant effect of spinal manipulation which has previously been demonstrated in cases of cervicogenic headache. These two headaches should therefore be diagnostically differentiated in the future.
Zasler ND, Posttraumatic Headache: Caveats and Controversies Topics in Clinical Chiropractic. 1999 Jun;6(2): 51-6
The following excerpt is a commentary reprinted from the Journal of Head Trauma Rehabilitation. It reviews topics germane to nomenclature and classification problems and identifies the clinical paradoxes regarding incidence relative to injury severity. Because posttraumatic headache has significant consequences for impairment and disability, and is poorly understood, and may be of significant mediocolegal consequence in whiplash cases, insight into this condition should be extremely useful for chiropractic physicians.
Launso L, Brendstrup E, Arnberg S, An exploratory study of reflexological treatment for headache. Altern Ther Health Med 1999 May;5(3):57-65.
Headache is the most frequently reported symptom among Danish adults, and studies in various European countries indicate migraine headache prevalence rates similar to those in Denmark. OBJECTIVE: An exploratory study of reflexological treatment for headache was conducted from 1993 to 1994 to examine which patients with headache underwent a course of reflexological treatment, why patients sought reflexological treatment, what previous experience patients had with medication for headache, and what outcomes patients experienced from reflexological treatment. DESIGN: Prospective and exploratory study using random sampling and the following data collection methods: headache diaries, registration schemes for practitioners, questionnaires, and qualitative interviews. SETTING: Denmark. PATIENTS: 220 patients with migraine and/or tension headache. INTERVENTION: Patients were treated for a maximum of 6 months by 78 reflexologists systematically drawn from the membership lists of 5 alternative therapist associations. MAIN OUTCOME MEASURES: A diagnosis of each patient's type of headache at the outset of treatment was made by a consulting physician according to the International Headache Society Classification (1988). RESULTS: At 3-month follow-up, 81% of patients reported that they were helped by the treatments or were cured of their headache problems. Nineteen percent of those who had formerly taken drugs to control their headaches were able to stop medication support following participation in the study. CONCLUSIONS: Reflexological treatment seems to improve patients' general well-being, energy level, ability to interpret their own body signals, and ability to understand the reasons for headache. However, these relationships may be due to other factors in the treatment environment. Additional studies are necessary to determine the proximate cause of reflexology's therapeutic benefits.
Browne WB, Goodman JE, Migraine Headaches: An Alternative Approach for the Migraine Sufferer Journal of the American Chiropractic Association 1999 Mar;6(3): 24-6,28-9
Although the number of clinical trials dealing specifically with the treatment of migraine headaches (MH) by manipulative therapy is limited, there is sufficient evidence that manipulative therapy is effective in reducing the frequency and the severity of both acute and chronic migraine headaches. Anecdotal success implies the need for further study into the exact nature of the effects of dysfunction of the spinal segments and the correction of those dysfunctions by chiropractic methods. The etiologies of MH are known among health care providers to be very elusive. There are numerous proposed etiologies and many new ones are currently under investigation. Treatment protocols for this condition and proposed mechanisms of how they affect migraine are just as numerous, and the epidemiology is a topic of much discussion. Rising labour and production costs due to lost workdays and increased cost of health care due to MH are also of great concern. The rising public trend to seek alternative care has stimulated investigation into a variety of treatment plans. The medical community is discovering the benefits of physical medicine in correcting the faults in structure and function as they relate to MH and the various subgroups classified as MH. A common type of alternative or complementary care associated with the treatment of MH is the field of manipulative techniques.
Anderson AV, Boline P, Bronfort G, Evans R, Goldsmith C, Nelson CF, The Efficacy of Spinal Manipulation, Amitriptyline and the Combination of Both Therapies for the Prophylaxis of Migraine Headache Journal of Manipulative and Physiolgical Therapeutics. 1998 Oct; 21(8): 511-9
Background: Migraine headache affects approximately 11 million adults in the United States. Spinal manipulation is a common alternative therapy for headaches, but its efficacy compared with standard medical therapies is unknown. Objective: To measure the relative efficacy of amitriptyline, spinal manipulation and the combination of both therapies for the prophylaxis of migraine headache. Design: A prospective, randomized, parallel-group comparison. After a 4-wk baseline period, patients were randomly assigned to 8 wk of treatment, after which there was a 4-wk follow-up period. Setting: Chiropractic college outpatient clinic. Participants: A total of 218 patients with the diagnosis of migraine headache. Interventions: An 8-wk course of therapy with spinal manipulation, amitriptyline or a combination of the two treatments. Main Outcome Measures: A headache index score derived from a daily headache pain diary during the last 4 wk of treatment and during the 4-wk follow-up period. Results: Clinically important improvement was observed in both primary and secondary outcomes in all three study groups over time. The reduction in headache index scores during treatment compared with baseline was 49% for amitriptyline, 40% for spinal manipulation and 41% for the combined group; p = .66. During the posttreatment follow-up period the reduction from baseline was 24% for amitriptyline, 42% for spinal manipulation and 25% for the combined group; p = .05. Conclusion: There was no advantage to combining amitriptyline and spinal manipulation for the treatment of migraine headache. Spinal manipulation seemed to be as effective as a well-established and efficacious treatment (amitriptyline), and on the basis of a benign side effects profile, it should be considered a treatment option for patients with frequent migraine headaches.
Nelson C, Principles of Effective Headache Management Topics in Clinical Chiropractic 1998 Mar; 5(1): 55-61
Purpose: An increasing amount of scientific literature is developing around conservative interventions, including manipulation, for the care of patients with headaches. This literature allows several supportable conclusions to be reached regarding current best practices in the evaluation and treatment of headaches. Methodology: Qualitative review of the literature with synthesis by the author for clinical implementation. Summary: Variation exists in headache management techniques, reflecting a continuing lack of understanding. Several relevant management principles are supportable, however, including: (1) The cervical spine is involved in the etiology of most chronic headaches and (2) manipulation is an effective prophylactic therapy for cervicogenic, migraine, and tension-type headaches. Manipulation is best applied in a "therapeutic trial" fashion.
Frogley HR, Wallace HI, Manipulation for Headache Patients: A Brief Introduction of a Novel Technique Chiropractic Technique 1998 Feb; 10(1): 11-8
Background: Alterations in the cervical articulations are believed to be associated with headaches. The upper cervical vertebrae become fixed in normal motion by elevated cervical spinal processes resulting from kyphotic posture. From experience, the principal author (HRF) observed that patients with headaches note diminished frequency and intensity of those headaches when the second cervical vertebra was adjusted from a cephalic to caudal line of drive. Objective: To point out the kinematic changes in the cervical spine and the headache relief after chiropractic adjustments. Five patients of chronic headache were relieved of headaches after spinal correction. Pain intensity and frequency of headache were measured with Visual Analog Scale (VAS) and a journal recording the daily total hours of headache suffering. Design: A case series of five subjects with a history of chronic headaches was selected for this study. Patients must have had a recurrent history of headaches for at least 6 months to have been considered chronic. A complete physical and history was taken for each subject, including a cervical X-ray series with video fluoroscopic (VF) sagittal viewing. Both the VAS and hourly journal of daily headaches were recorded weekly for this study. Results: Each subject received between 13 and 30 chiropractic adjustments over a period of 12-14 wk. There were apparent significant changes in intersegmental ROM as determined by flexion and extension measurements and reduction in both the severity by VAS and duration by the journal of daily headache hours. Conclusion: The manipulation described in this paper may be useful for reducing pain intensity and frequency in patients with chronic headache caused by cervical fixation.
Tuchin PJ, A Case Series of Migraine Changes Following a Manipulative Therapy Trial Australasian Chiropractic and Osteopathy 1997 Nov; 6(3): 85-91
Objective: To present the characteristics of four cases of migraine, who were included as participants in a prospective trial on chiropractic spinal manipulative therapy for migraine. Methods: Participants in a migraine research trial were reviewed for the symptoms or clinical features and their response to manual therapy. Results: The four selected cases of migraine responded dramatically to SMT, with numerous self reported symptoms being either eliminated or substantially reduced. Average frequency of episodes was reduced on average by 90%, duration of each episode by 38%, and use of medication was reduced by 94%. In addition, several associated symptoms were substantially reduced, including nausea, vomiting, photophobia and phonophobia. Discussion: The various cases are presented to assist practitioners making a more informed prognosis.
Tuchin PJ, The Effect of Spinal Manipulative Therapy (SMT) on the Cervical Spine for Migraine With Aura. A Randomised Control Trial Australasian Chiropractic and Osteopathy 1997 Nov; 6(3): 96-7
Conclusion: The results of this study suggest that Chiropractic SMT is an effective treatment for migraine with aura. However, due to the cyclical nature of migraine with aura, and the finding that episodes usually reduce following any intervention, further larger study is required.
Tuchin PJ; The Efficacy of Chiropractic Spinal Manipulative Therapy (SMT) in the Treatment of Migraine. A Pilot Study Australasian Chiropractic and Osteopathy. 1997 Jul; 6(2): 41-7
Objective: To test the efficacy of Chiropractic spinal manipulative therapy (SMT) in the treatment of migraine, using an uncontrolled clinical trial. Design: A clinical trial of six months duration. The trial consisted of 3 stages: two months of pre-treatment, two months of treatment, and two months post treatment. Comparison was made to initial baseline episodes of migraine preceding commencement of SMT. Setting: Chiropractic Research Centre of Macquarie University. Participants: Thirty two volunteers, between the ages of 23 to 60 were recruited through media advertising. The diagnosis of migraine based on a detailed questionnaire, regarding self reported symptoms or signs, with minimum of one migraine with aura per month. Interventions: Two months of SMT provided by an experienced chiropractor at a university clinic. Main Outcome Measures: Participants completed diaries during the entire trial noting the frequency, intensity, duration, disability, associated symptoms and use of medication for each migraine episode. In addition, clinic records were compared to their diary entries of migraine episodes. Conclusion: The results of this study suggest that Chiropractic SMT is an effective treatment for migraine with aura. However, due to the cynical nature of migraine with aura, and the finding that episodes usually reduce following any intervention, further research is required. A prospective randomised controlled trial utilising detuned EPT (interferential), a sham manipulation group and an SMT group is nearing conclusion. It is anticipated this trial will provide further information of the efficacy of Chiropractic SMT in the treatment of migraine with aura.
Elkington W, Haas M, Nelson C, Sawyer C, Clinical Research Within the Chiropractic Profession: Status, Needs and Recommendations Journal of Manipulative and Physiolgical Therapeutics 1997 Mar; 20(3): 169-78
In the current climate of accountability, health care financing reform and the demand on all health professions for evidence, there is an urgent need to expand clinical research activity within the profession. Those randomized clinical trials that have been reported in the literature have focused primarily on low back and headache pain. Only recently have studies been initiated to investigate the effectiveness of chiropractic interventions for conditions other than back pain. The ability of chiropractic colleges to develop research infrastructures and productive clinical research programs depends on removing or minimizing a number of impediments. A shortage of chiropractic clinicians who have the experience and training to conduct clinical research is compounded by a dependency on tuition revenue, limited external funding and a lack of institutional emphasis on research. The profession generally, and chiropractic colleges specifically, must address the impediments that limit the growth of research capacity. We present several recommendations and the action steps required to achieve specific outcomes.
Knutson GA, Case Studies of Upper Cervical Adjusting Errors: The Possibility of Chiropractic Iatrogenesis Chiropractic Research Journal 1996 ;3(3): 20-4
This paper presents a series of case studies chronicling iatrogenic musculo-skeletal symptoms resulting from errors in upper cervical chiropractic adjustment. In four cases, a variety of circumstances brought about the use of incorrect adjusting vectors on routine visits. The adjusting errors were related within a short time to the production of symptoms including headache, dizziness, and pain in the neck, low back, leg and foot. When the adjusting errors were discovered, and the proper adjustments given, the symptoms were abolished. One additional case is related in which cervical manipulation produced symptoms that were reversed with the use of vectored upper cervical adjustment. Recording and reporting what happens after errant adjusting could potentially aid research in determining the effects of the vertebral subluxation. The role of belief and intent in the patient/doctor interaction and the potential for iatrogenesis in upper cervical adjusting is also discussed.
Assendelft WJ, Bouter LM, Bronfort G, Efficacy of Spinal Manipulative Therapy for Conditions Other Than Neck and Back Pain: A Systematic Review and Best Evidence Synthesis Proceedings of the Int'l Conference of Spinal Manipulation 1996 Oct: 105-6
Background and Objective: To critically appraise and systematically review clinical journal articles reporting on the efficacy of manual spinal manipulative therapy (SMT) in the treatment of conditions other than neck or back pain. In addition to the review and appraisal of randomized clinical trials (RCTs), this study includes brief structured summaries of all prospective and retrospective clinical series with n>10, retrospective comparative studies, and non-randomized prospective comparative studies. Conclusion: The some evidence of efficacy of SMT in the management of tension-type cervicogenic headache. There is limited evidence to suggest that SMT may be efficacious for migraine headaches, but not enough to make recommendations for its use. SMT seems to be non-efficacious in the treatment of hypertension and chronic moderately severe asthma in adults, although, at this point in time there is insufficient basis to advise its use for these conditions. There is insufficient evidence to advise for or against the use of SMT in the treatment of vertigo, nocturnal childhood enuresis, dysmenorhea, chronic obstructive pulmonary disease, duodenal ulcer, and infantile colic.
Brookes M, Swaffer T, Tuchin PJ, A Case Study of Chronic Headaches Australasian Chiropractic and Osteopathy 1996 Jul; 5(2): 47-52
The following paper is a case study of a patient with a history of chronic headaches (originally diagnosed as migraine without aura) who was being treated at the Macquarie University Chiropractic Outpatient Clinic for cervical spine dysfunction. The treatments successfully reduced the upper neck and thoracic pain that the patient was experiencing and for which they had initially presented at the clinic. During the treatments, the patient also showed a significant subjective reduction in prevalence and intensity of headaches over a four month period. Analysis of the outcome is complicated by the fact that it is not clear whether the patient's headaches were initially misdiagnosed as common migraine when in fact, they were cervicogenic. There may be some overlap between the two conditions, and a possible causative relationship between cervical spine dysfunction and common migraine. Furthermore, this case study discusses the validity of chiropractic treatment of organic disorders such as chronic headache or migraine.
Christensen H, Hartvigsen J, Nilsson N, Lasting Changes in Passive Range of Motion after Spinal Manipulation: A Randomized, Blind, Controlled Trial Journal of Manipulative and Physiolgical Therapeutics 1996 Apr; 19(3):165-168
Purpose: To study whether a 3-wk series of spinal manipulation has any lasting effect on passive cervical range of motion. Design: Randomized, controlled trial with a blind observer. Setting: Ambulatory outpatient facility in an independent National Health Service funded chiropractic research institution. Participants: Thirty-nine headache sufferers who, on entering the study, displayed objectively decreased passive cervical range of motion. These subjects were recruited from 400 headache sufferers who responded to newspaper advertisements. Intervention: Half of the group received high-velocity, low-amplitude cervical manipulaiton twice a week for 3 wk. The other half received low-level laser in the upper cervical region and deep friction massage in the lower cervical/upper thoracic region, also twice a week for 3 wk. Main outcome measures: Goniometrically assessed passive range of motion of the cervical spine. Conclusions: It seems that any changes in passive range of motion after spinal manipulation are of a temporary nature.
Stude D, Sweere J, A Holistic Approach to Severe Headache Symptoms in a Patient Unresponsive to Regional Manual Therapy Journal of Manipulative and Physiolgical Therapeutics. 1996 Apr;19(3): 202-207
Objective: To discuss the case of a patient suffering from a severe headache complaints who was previously unresponsive to regional cervical spine care. Clinical Features: A prodrome was described. In addition to headache itself, associated symptoms included light sensitivity, blurred vision and nausea. A visit to a hospital emergency room was often necessary to reduce pain intensity. Intervention and Outcomes: Manual chiropractic spinal adjustments were provided as the only treatment intervention. After a course of treatment, the patient reported no visits to the emergency room, even after a 1-yr follow-up, and the average visual analogue pain scores decreased. Conclusion: This patient seemed to respond favorably to conservative care that included regions of the spine not traditionally associated with headache pain. This suggests that some individuals may require a more comprehensive evaluation if regional care fails to promote a positive response within a few weeks. Controlled, randomized trials will assist in comparing effectiveness of various treatment interventions.
Vernon H, The Effectiveness of Chiropractic Manipulation in the Treatment of Headache: An Exploration in the Literature Journal of Manipulative and Physiolgical Therapeutic 1995 ;18(9): 611-7
Objective: To review the literature on outcome studies of chiropractic/manipulation for tension-type migraine headaches. Design: Qualitative literature review. Conclusions: A modest body of clinical studies exists dealing with the effect of manipulation and headache. The overall results are encouraging, even if not quite supportive in the case of tension-type headache. Further studies in this area are definitely warranted, particularly well-controlled studies in migraine. Purpose: To study whether a 3-wk series of spinal manipulation has any lasting effect on passive cervical range of motion. Design: Randomized, controlled trial with a blind observer. Setting: Ambulatory outpatient facility in an independent National Health Service funded chiropractic research institution. Participants: Thirty-nine headache sufferers who, on entering the study, displayed objectively decreased passive cervical range of motion. These subjects were recruited from 400 headache sufferers who responded to newspaper advertisements. Intervention: Half of the group received high-velocity, low-amplitude cervical manipulation twice a week for 3 wk. The other half received low-level laser in the upper cervical region and deep friction massage in the lower cervical/upper thoracic region, also twice a week for 3 wk. Main outcome measures: Goniometrically assessed passive range of motion of the cervical spine. Conclusions: It seems that any changes in passive range of motion after spinal manipulation are of a temporary nature.
Jamison J, Chiropractic Referral: The Views of a Group of Conventional Medical Practitioners with an Interest in Unconventional Therapies Journal of Manipulative and Physiolgical Therapeutics 1995 Oct; 18(8): 512-8
Objective: To identify, from a list of conditions prepared by leaders the Australian chiropractic profession, disorders that medical practitioners regard as suitable for referral for chiropractic care. Design: A descriptive study in which eight hundred and twenty (820) medical practitioners with an interest in "unconventional" interventions were invited to respond to a mailed questionnaire. Participants: Medical practitioners with a demonstrable interest in at least one form of nonconventional therapy were surveyed. Seven hundred and ninety-six medical practitioners who subscribe to a professional organization committed to "alternative" nutritional approaches in health care were sent mail. Twenty-four practitioners known to be sympathetic to chiropractic were also included. The response rate was 28%. Results: Medical respondents who refer to chiropractors more frequently consider a larger number of conditions suitable for chiropractic care than those who never refer. Referral of patients with visceral disorders enjoys relatively little support, especially among practitioners who never actually use chiropractic referral as an intervention option. Analysis of perceptions regarding chiropractic referral of patients with headaches suggests that the perceived etiology of the symptom is a consideration in making referral decisions. Conclusion: Chiropractic referral for musculoskeletal care enjoys substantial support, whereas referral for chiropractic intervention in visceral conditions continues to be largely opposed by those members of the medical profession participating in this study.
Vernon H, Spinal Manipulation and Headaches: An Update Topics in Clinical Chiropractic 1995 Sep; 2(3): 34-47
The role of cervical spine and of spinal manipulation in headache unresolved. This article will review the existing literature in three important areas which relate to these controversies, namely: (1) studies of spinal manipulation for headache; (2) mechanisms of cervicogenic head pain; and (3) components of cervicogenic dysfunction. The main thesis of this article is that the cervical spine plays an important role in benign headache and that evidence exists supporting chiropractic spinal manipulation as a beneficial therapy.
Vernon H, The Effectiveness of Chiropractic Manipulation in the Treatment of Headache: An Exploration in the Literature Conference Proceedings of the Chiropractic Centennial 1995 Jul: 153-67
Practitioners of spinal manipulation have long been proponents of its effectiveness in the treatment of headaches. Reports to this effect exist in all literature of each of the main branches of manual therapy--chiropractic, osteopathy, manual medicine and physiotherapy. These reports range from anecdotal presentations, theoretical treatises, pathophysiologic and clinical studies to case series, cohort and randomized controlled studies [1,2]. There is a remarkable longevity and consistency to this literature, contributing to a coherent body of opinion and data which supports the role of the cervical spine in the etiology of a significant proportion of what we might call "benign headache". As well, there is growing evidence for the efficacious role for manual therapeutics in the treatment of these kinds of headaches. Nevertheless, this coherent "manual therapy" paradigm is largely disregarded in orthodox circles, despite the introduction, in 1988, of a "cervicogenic headache" category in the Classification of Headaches of the International Headache Society [3]. This neglect of the "manual therapy model" also continues despite the large body of data which clearly delineates the role of the interconnection of neural pathways in what Bogduk has called the "trigemino-cervical nucleus" in the genesis of head and possibly face pain [4]. It is now indisputable that the afferent connections from the upper cervical joints have an enormous capacity to create referred head and facial pain [5,6,7], as well as muscle dysfunction in the cranio-vertebral region [8]. Manual therapy researchers have consistently reported on signs of cervicogenic dysfunction, including local and referred pain as well as myofascial dysfunction, in the upper cervical region of many sufferers of what has now come to be called "tension-type" and "migraine without aura" headache types [9,10]. This presentation will focus on the evidence which does exist in the literature mentioned above as to the "effectiveness" of spinal manipulation in the treatment of these types of headaches. The reader is referred to other sources on the issues of the cervicogenic basis of headache and the nature of the kinds of dysfunction which chiropractors and others target in their treatment approaches.
Haldeman S, Kohlbeck F, McGregor M, Cerebrovascular Complications Following Cervical Spine Manipulation Therapy: A Review of 53 Cases Conference Proceedings of the Chiropractic Centennial 1995 Jul: 282-3
Conclusions: This study supplies an analysis 53 cases of post-CMST CVA complications that have been previously unreported in the chiropractic/medical literature. These cases represent approximately a 45% increase in the number of such cases reported in the English language literature over the past 100 years. The data from this case series confirm conclusions from prior analyses of case reports, but with considerably more confidence than that published based solely on post event medical evaluation. No clear cut risk factors can be elicited from the data. Previously proposed risk factors such as migraine headaches, hypertension, diabetes, history of cardivascular disease, oral contraceptives recent head or neck trauma, or abnormalities on x-rays do not appear to be significantly greater in patients who have cerebrovascular complications of manipulation than that noted in the general population.
Killinger L, A Chiropractic Case Series of Seven Chronic Headache Patients Palmer Journal of Research 1995 Jun; 2(2): 48-53
For nearly a century, chiropractors have considered spinal contributing factors in many health concerns including headaches. Recent research has shown that the cervical spine should not be overlooked in evaluating headache patients. This study represents the care of seven subjects who were monitored and treated in a chiropractic research clinic. The subjects in this report all suffered from chronic headaches, and received chiropractic adjustments using the Palmer Upper Cervical Specific Technique. The patient histories, care, and results are outlined below.
Croft A, Swenson R, Tarola G, Vernon H, Grand Rounds: Symptoms Following a Motor Vehicle Accident Journal of the Neuromusculoskeletal System. 1995 Win; 3(4): 203-10
Each issue will contain a case of interest of those providing care to patients with disorders of the neuromusculoskeletal system. There will be a commentary by a panel of distinguished authors who will discuss the care from his or her perspective. Case discussion will focus on the evaluation, management, and prognostic indicators.
Samms J,; Chiropractic Care of Headache Alternative and Complementary Therapies 1994 Oct; 1(1): 26-31
Humans have endured and suffered headaches for all of history as we it. While we can now presumably exclude the ancient source of demons and supernatural forces and its probable solution of drilling the head to release demonic spirits (trephination of historic skulls), we have yet to conquer the ubiquitous headache. Chiropractic has championed a natural, drugless approach to the treatment of headache since the introduction of the discipline in 1895. Many headache sufferers have found significant improvement or complete relief of headache pain through chiropractic care. Their success rate has motivated tens of millions of Americans to choose chiropractic as part of their care regime. And these legions are still growing.
Ellis W, Molyneux T, Whittingham W, The Effects of Manipulation (Toggle Recoil Technique) for Headaches with Upper Cervical Joint Dysfunction: A Pilot Study Journal of Chiropractic 1994 Jul; 17(6): 369-75
Objective: The objective of this pilot study was to investigate the of spinal manipulation for the relief of chronic headache of cervical origin, utilizing a specific technique, toggle recoil, to treat the two upper cervical vertebrae. This study will help delineate the design for a future, larger study. Design: Twenty-six patients were accepted for a continuous time series analysis (6 wk) design. Setting: Chiropractic outpatient research clinic. Patients: The patients-16 females (average age 42.1 yr, SD 11.03) and 10 males (average age 52.1 yr, SD 10.69) all had chronic headaches ( > 3 mo) with upper cervical joint dysfunction. Intervention: All the patients received four upper cervical toggle recoil adjustments over a 2 wk period. Main Outcome Measures: Standardized headache history, daily questionnaires for the duration of the trial, measuring; frequency; and severity of the headache, plain film with dynamic spinal radiographs and motion palpation. Results: The results indicate statistically significant outcomes (p < .001) that indicates changes in headache frequency, duration and severity in all but two of the patients. The overall duration of headaches decreased from 110 hr pre treatment to 25 hr posttreatment, a decrease of 77%. The overall score for severity dropped from 55 to 22 - a 60% improvement in perceived pain. The frequency of headaches over a 2-wk period dropped from 18 to 7, an improvement of 62%. Conclusions: Since the results of this pilot study were not adequately controlled they cannot be seen as proof supporting the clinical efficacy of manipulation for chronic headaches. However, as a group for duration, severity and frequency all measures were significant. These findings would suggest that further study of upper cervical manipulation for the treatment of chronic headaches with upper cervical joint dysfunction in a randomized, controlled clinical trial is needed.
Gemmell H, Jacobson B, Sutton L, Toftness Spinal Correction in the Treatment of Migraine: A Case Study Journal of Chiropractic Research 1994 May; 6(2): 57-60
Headache is a common symptom with migraine affecting 15% of those 40 of age and under. The case of a 38-year-old female with basilar migraine treated with the Toftness system of spinal correction is presented. The patient responded well to treatment and remained free of migraine at the 12-month follow-up. Due to the nature of case reports, conclusions concerning the effectiveness of the Toftness method in treating migraine cannot be made.
______________The Conservative Management of Headaches Proceedings of the Int'l Conference of Spinal Manipulation. 1994 Jun: 167-8
Boline P, Nelson C, An Outcomes Based Approach to the Management of Headache Proceedings of the Int'l Conference of Spinal Manipulation 1993 : 123
Headache is recognized as a significant public health problem with millions of people suffering disabling headaches. Relatively little attention has been paid to developing a systematized approach to the management of this problem. This presentation examines an effort to order and systematize the treatment of headache. The effort centers around two initiatives: the creation of a diagnostic and therapeutic algorithm for headache management and the concurrent conduct of clinical trials examining the effectiveness of various headache treatments. Clinicians at Northwestern College of Chiropractic have developed a diagnostic and treatment algorithm for headaches which has been implemented in the outpatient clinic. The protocol defined by this algorithm emphasizes a multidisciplinary approach to headache management as well as providing a standardized set of assessment and outcomes measures. The development of this algorithm is discussed as well as the assessment and outcome measures that are used. A randomized clinical trial was recently completed at the Center for Clinical Studies which compared amitriptyline and chiropractic care for the treatment of chronic recurrent tension headaches. The outcome measures in this study included paint ratings, use of over the counter medications, headache frequency, and the SF-36D. 150 subjects were recruited into the study. Each subject was enrolled in a twelve-week program; two-week baseline period, six-week treatment period, and a four-week follow-up period. The results of this study will be discussed. Following the completion of this study, a second randomized controlled trial comparing the effectiveness of chiropractic and medical therapy for the treatment of migraine headache was begun. The design of this study will be discussed as well as some of the preliminary data.
Gorman R, Automated Static Perimetry in Chiropractic Journal of Manipulative and Physiolgical Therapeutics. 1993 Sep; 16(7): 482-7
Objective: To demonstrate the value of quantitative static in research and practice of spinal manipulation therapy, by reference to the recovery of uniocular loss of vision. Clinical Features: A 44-yr-old housewife presented with nonspecific bilateral visual field loss. This visual disability disappeared immediate to pan-spinal manipulation under anesthetic. Later, on review, the presence of a uniocular visual defect was detected by quantitative static perimetry. Further examination revealed no pathology in the eye or brain to explain its occurrence, suggesting that it was due to microischemia of the optic nerve. Intervention and Outcome: The uniocular scotoma recovered immediate to further spinal manipulation under anesthetic, only to recur on two further occasions, each time to disappear immediate to spinal treatment. Conclusions: This case history demonstrates that spinal manipulation may dissipate microvascular spasm in the brain: even in branches of the carotid arterial system, which is not directly related to the spine. The author feels that the underlying pathology was interictal migraine, which is now known to produce prolonged hypertonic changes in the cerebral microcirculation; and he suggests that spinal manipulation is a treatment to be considered for interictal migraine.
Rupert R, Case Reports: A Review of all Chiropractic Peer-Reviewed Research Journals Journal of Chiropractic Case Reports 1993 Jan; 1(1): 1
Objective: To provide a global review of all case reports published chiropractic peer-reviewed journals. To establish a profile of chiropractic research as reflected by single subject studies, identify trends, strengths, weaknesses and future research needs. Data Sources: A search of the CHIROLARS online chiropractic database was performed. In view of the fact that this database contains all issues from all peer-reviewed chiropractic journals, no other index source was necessary. All case reports are identified in CHIROLARS by the check tag "case report" making it necessary only to combine this term with a specific journal title to retrieve all case reports for that chiropractic peer-reviewed journal. All 14 peer-reviewed chiropractic research journals were included in this review. Study Selection: All studies that were identified as case reports per the definition established by the National Library of Medicine were included in this study. Data Synthesis: A total of 318 case reports have been published in chiropractic peer-reviewed journals. Each of these reports were critically reviewed, classified and categorized along several dimensions, e.g. age of patient, type of conditions treated, types of therapeutic intervention employed. The journals themselves were assessed relative to multiple parameters, e.g. number of case reports by journal, number of case reports by year. Conclusions: This study demonstrates a trend toward an increase in the number of published case reports. However it is clear that, for the second largest health physician group, the total number of case reports is small. Many conditions that have been purported to respond to chiropractic care (e.g. migraine, hypertension, colic, vertigo) are poorly represented or documented in case reports. Finally, many therapeutic interventions used by chiropractors are also not well represented in the published case reports to date. This review identified areas that need to be addressed by future single subject and other forms of chiropractic research.
Jamison J, McEwen A, Thomas S, Chiropractic Adjustment in the Management of Visceral Conditions: A Critical Appraisal Journal of Manipulative and Physiolgical Therapeutics. 1992 Mar; 15(3): 171-80
Objective: To establish whether Australian chiropractors regard spinal adjustment as an intervention option for patients presenting with visceral conditions and to ascertain the preferred level of adjustment for patients presenting with migraine, asthma, hypertension, or dysmenorhea. Design and Setting: A survey of all chiropractors registered in Australia. Outcome Measure: Practitioners' opinions regarding the usefulness of spinal adjustment in the management of patients with visceral conditions were canvassed. Based upon their personal clinical experience, practitioners were requested to comment on the appropriate level of adjustment in the management of various visceral conditions. Main Results: Twenty-two percent of the 1311 chiropractors registered in Australia responded to the survey. More than half of the respondents favored a role for spinal adjustment in the management of patients with visceral conditions. The perceived usefulness of spinal adjustment varied according to the condition being managed, as did the preferred level of adjustment. Conclusions: Chiropractors continue to use spinal adjustment in the management of visceral conditions despite this intervention being regarded as an obstacle to the recommendation of public funding for chiropractic services in Australia. Further investigation into the validity of the chiropractic management of visceral conditions is recommended.
Boline P, Nelson C, A Consensus on the Assessment and Treatment of Headache Chiropractic Technique 1991 Nov;3(4): 151-68
Consensus methods are being used with increasing frequency in order to develop protocols which help to solve health problems. This paper describes a consensus process which involved 13 allied health care professionals and establishes a level of agreement on the management of headache patients in a multidisciplinary setting. The developed protocols are for both assessment and treatment of headache patients and are displayed in an algorithmic format with accompanying annotations. Outcome measures were included in the development of the algorithm for the purpose of evaluating patient outcome. After 1 year of implementation the algorithm will be reevaluated and improvements made where necessary. The implications and limitations of this work are discussed.
Rouzer P, Structured Interdisciplinary Treatment of Chronic Headache Transactions of the Consortium for Chiropractic Research 1988 Jun
Structural interdisciplinary treatment of chronic headache offers the effective form of relief. One such model, The Northern California Headache Clinic, integrates pharmacology, chiropractic manipulation with biofeedback and stress management.
Vernon H, Chiropractic manipulative therapy in the treatment of headaches: a retrospective and prospective study Journal of Manipulative and Physiolgical Therapeutics. 1982 Sep:;5(3): 109-12
The treatment of benign, chronic, headache by chiropractic therapy is investigated in this study. Thirty-three subjects were assessed, 15 retrospectively and 18 prospectively. The treatment outcomes used in the study included frequency, duration, severity and treatment satisfaction. These outcomes were assessed by questionnaire. The results indicated statistically significant outcomes in at least nine treatments. The possible mechanisms of action of manipulative therapy are discussed.
Wight J, Some aspects of the chiropractic treatment for migraine Bulletin European Chiropractor's Union 1980; 28(2): 15-24
The diagnosis of migraine headache is considered and some diagnostic pitfalls are discussed. The treatment of adults and children by chiropractic adjustive techniques is outlined in conjunction with a practical management regime for the patient at home or in the office. Suggestions are given to assist those patients who do not respond to chiropractic treatment.
Barry H, Headaches and cervical manipulation Medical Journal of Australia 1979 ; 66(7): 367-8
Parker G, Pryor D, Tupling H, A controlled trial of cervical manipulation for migraine Medical Journal of Australia 1978 Dec;8(6): 589-593
The efficacy of cervical manipulation for migraine was evaluated. In six-month trial, 85 volunteers suffering from migraine were randomly allocated to three treatment groups. One group received cervical manipulation performed by a medical practitioner or by a physiotherapist, another received cervical manipulation performed by a chiropractor, while the control group received mobilization performed by a medical practitioner or by a physiotherapist. For the whole sample, migraine symptoms were significantly reduced. No difference in outcome was found between those who received cervical manipulation, performed by chiropractor or orthodox therapist, and those who received the control treatment. Chiropractic treatment was no more effective than the other two treatments in reducing frequency, duration or induced disability of migraine attacks, but chiropractic patients did report a greater reduction in pain associated with their attacks.
Watkins R, The migraine key Digest of Chiropractic Economics 1970; 12(4): 9-10