Headaches and Chiropractic

If you have a headache, you’re not alone. Nine out of ten Americans suffer from headaches. Some are occasional, some frequent, some are dull and throbbing, and some cause debilitating pain and nausea.

What do you do when you suffer from a pounding headache? Do you grit your teeth and carry on? Lie down? Pop a pill and hope the pain goes away? There is a better alternative.

Research shows that spinal manipulation – the primary form of care provided by doctors of chiropractic – may be an effective treatment option for tension headaches and headaches that originate in the neck.

A report released in 2001 by researchers at the Duke University Evidence-Based Practice Center in Durham, NC, found that spinal manipulation resulted in almost immediate improvement for those headaches that originate in the neck, and had significantly fewer side effects and longer-lasting relief of tension-type headache than a commonly prescribed medication.

Also, a 1995 study in the Journal of Manipulative and Physiological Therapeutics found that spinal manipulative therapy is an effective treatment for tension headaches and that those who ceased chiropractic treatment after four weeks experienced a sustained therapeutic benefit in contrast with those patients who received a commonly prescribed medication.

Headache Triggers
Headaches have many causes, or “triggers.” These may include foods, environmental stimuli (noises, lights, stress, etc.) and/or behaviors (insomnia, excessive exercise, blood sugar changes, etc.). About 5 percent of all headaches are warning signals caused by physical problems.

Ninety-five percent of headaches are primary headaches, such as tension, migraine, or cluster headaches. These types of headaches are not caused by disease. The headache itself is the primary concern.

“The greatest majority of primary headaches are associated with muscle tension in the neck,” says Dr. George B. McClelland, a doctor of chiropractic from Christiansburg, VA. “Today, Americans engage in more sedentary activities than they used to, and more hours are spent in one fixed position or posture. This can increase joint irritation and muscle tension in the neck, upper back and scalp, causing your head to ache.”

What Can You Do?
The American Chiropractic Association suggests, and Dr. Brenda Rooney concurs with the following:

- If you spend a large amount of time in one fixed position, such as in front of a computer, on a sewing machine, typing or reading, take a break and stretch every 30 minutes to one hour. The stretches should take your head and neck through a comfortable range of motion.

- Low-impact exercise may help relieve the pain associated with primary headaches. However, if you are prone to dull, throbbing headaches, avoid heavy exercise. Engage in such activities as walking and low-impact aerobics.

- Avoid teeth clenching. The upper teeth should never touch the lowers, except when swallowing. This results in stress at the temporomandibular joints (TMJ) – the two joints that connect your jaw to your skull – leading to TMJ irritation and a form of tension headache.

- Drink at least eight 8-ounce glasses of water a day to help avoid dehydration, which can lead to headaches.

What Can a Doctor of Chiropractic Do?
Dr. McClelland says your doctor of chiropractic may do one or more of the following if you suffer from a primary headache:

- Perform spinal manipulation or chiropractic adjustments to improve spinal function and alleviate the stress on your system.

- Provide nutritional advice, recommending a change in diet and perhaps the addition of B complex vitamins.

- Offer advice on posture, ergonomics (work postures), exercises and relaxation techniques. This advice should help to relieve the recurring joint irritation and tension in the muscles of the neck and upper back.

- “Doctors of chiropractic undergo extensive training to help their patients in many ways – not just back pain,” says Dr. McClelland. “They know how tension in the spine relates to problems in other parts of the body, and they can take steps to relieve those problems.”

Patients in Medicare Demonstration Project Give Chiropractors High Marks

A Press Release from the American Chiropractic Association

According to long-awaited results from a congressionally mandated pilot project testing the feasibility of expanding chiropractic services in the Medicare program, patients have a high rate of satisfaction with the care they receive from Doctors of Chiropractic.

When asked to rate their satisfaction on a 10-point scale, 87 percent of patients in the study gave their Doctor of Chiropractic a level of 8 or higher. What’s more, 56 percent of those patients rated their chiropractor with a perfect 10.

Contributing to that satisfaction was the attention given to patients’ needs and the accessibility of chiropractic care. Patients reported that doctors of chiropractic listened to them carefully and spent sufficient time with them. Some 95 percent said they had to wait no longer than one week for appointments.

“Doctors of Chiropractic everywhere should feel pride in these patient satisfaction results and in being part of a profession that still sees the great need for spending time with patients and truly listening to them,” said Dr. Rick McMichael, president of the American Chiropractic Association (ACA). “It’s clear that patients deeply value the time their chiropractic providers spend with them and the expert care that Doctors of Chiropractic offer.” ACA is the largest chiropractic organization in the United States, representing more than 15,000 Doctors of Chiropractic and students.

The pilot, known as a “demonstration project” in Congress, was conducted from April 2005 to March 2007 throughout the states of Maine and New Mexico, and also in Scott County, Iowa, 26 counties comprising the Chicago metropolitan area, and 17 counties in central Virginia.

Current chiropractic coverage under Medicare is limited to spinal manipulation. Under the demonstration project, however, chiropractic care was expanded to include diagnostic and other services, such as X-rays, examinations, physical therapy and rehabilitation services.

The final report to Congress also includes information on the costs of expanding chiropractic services in the demonstration sites. The report indicates that in all but one of the demonstration sites, patients’ health care costs were not significantly changed by expanding coverage of chiropractic services. In contrast, a cost increase was found in the Chicago metropolitan area. Further research into the reasons why the results in Chicago differ from the rest of the demonstration project sites is needed to better understand these findings.

“We already know that Medicare costs in general tend to be higher in Chicago than other similar areas of the country. We must find the underlying cause of the cost difference found in the chiropractic demonstration project and determine whether it had anything at all to do with the expansion of chiropractic services,” Dr. McMichael noted.

To further analyze the results of the demonstration project, ACA is creating a taskforce of Medicare experts and researchers who will review the report and develop a response for the Centers of Medicare and Medicaid Services.

To view the report online, visit www.acatoday.org/pdf/demo_report.pdf.

Back Pain Facts and Statistics

Although chiropractors care for more than just back pain, many patients visit chiropractors looking for relief from this pervasive condition. In fact, 31 million Americans experience low-back pain at any given time.1

A few interesting facts about back pain:
· One-half of all working Americans admit to having back pain symptoms each year.2
· Back pain is one of the most common reasons for missed work. In fact, back pain is the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections.
· Most cases of back pain are mechanical or non-organic—meaning they are not caused by
serious conditions, such as inflammatory arthritis, infection, fracture or cancer.
· Americans spend at least $50 billion each year on back pain—and that’s just for the more
easily identified costs.3
· Experts estimate that as many as 80% of the population will experience a back problem at
some time in our lives.4

What Causes Back Pain?
The back is a complicated structure of bones, joints, ligaments and muscles. You can sprain ligaments, strain muscles, rupture disks, and irritate joints, all of which can lead to back pain. While sports injuries, or accidents can cause back pain, sometimes the simplest of movements—for example, picking up a pencil from the floor— can have painful results. In addition, arthritis, poor posture, obesity, and psychological stress can cause or complicate back pain. Back pain can also directly result from disease of the internal organs, such as kidney stones, kidney infections, blood clots, or bone loss.

Manipulation as a Treatment for Back Problems
Used primarily by Doctors of Chiropractic (DCs) for the last century, manipulation has been largely ignored by most others in the health care community until recently. Now, with today's growing emphasis on treatment and cost effectiveness, manipulation is receiving more widespread attention.

Chiropractic spinal manipulation is a safe and effective spine pain treatment. It reduces pain, decreases medication, rapidly advances physical therapy, and requires very few passive forms of treatment, such as bed rest.5

In fact, after an extensive study of all currently available care for low back problems, the Agency for Health Care Policy and Research—a federal government research organization—recommended that low back pain sufferers choose the most conservative care first. It recommended spinal manipulation as the only safe and effective, drugless form of initial professional treatment for acute low back problems in adults.6

The American Chiropractic Association (ACA) urges you to make an informed choice about your back care. To learn more about how chiropractic manipulation may help you, contact a Doctor of Chiropractic in your area. Dr. Brenda Rooney, a member of the American Chiropractic Association, as well as a member of the Association of New Jersey Chiropractors (ANJC) recommends the following tips for back pain prevention in accordance with the ACA.

Tips to Prevent Back Pain:
· Maintain a healthy diet and weight.
· Remain active—under the supervision of your doctor of chiropractic.
· Avoid prolonged inactivity or bed rest.
· Warm up or stretch before exercising or other physical activities, such as gardening.
· Maintain proper posture.
· Wear comfortable, low-heeled shoes.
· Sleep on a mattress of medium firmness to minimize any curve in your spine.
· Lift with your knees, keep the object close to your body, and do not twist when lifting.
· Quit smoking. Smoking impairs blood flow, resulting in oxygen and nutrient deprivation to
spinal tissues.
· Work with your doctor of chiropractic to ensure that your computer workstation is
ergonomically correct.

References:
1. Jensen M, Brant-Zawadzki M, Obuchowski N, et al. Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain. N Engl J Med 1994; 331: 69-116.
2. Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98.
3. This total represents only the more readily identifiable costs for medical care, workers compensation payments and time lost from work. It does not include costs associated with lost personal income due to acquired physical limitation resulting from a back problem and lost employer productivity due to employee medical absence. In Project Briefs: Back Pain Patient Outcomes Assessment Team (BOAT). In MEDTEP Update, Vol. 1 Issue 1, Agency for Health Care Policy and Research, Rockville, MD, Summer 1994.
4. In Vallfors B, previously cited.
5. Time to recognize value of chiropractic care? Science and patient satisfaction surveys cite usefulness of spinal manipulation. Orthopedics Today 2003 Feb; 23(2):14-15.
6. Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline No.14. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services, December, 1994.

Chiropractic: A Safe Treatment Option

Chiropractic is widely recognized as one of the safest drug-free, non-invasive therapies available for the treatment of back pain, neck pain, joint pain of the arms or legs, headaches, and other neuromusculoskeletal complaints says the American Chiropractic Association. Although chiropractic has an excellent safety record, no health treatment is completely free of potential adverse effects.

The risks associated with chiropractic, however, are very small. Many patients feel immediate relief following chiropractic treatment, but some may sometimes experience mild soreness or aching, just as they do after some forms of exercise. Current literature shows that minor discomfort or soreness following spinal manipulation typically fades within 24 hours.1

In addition to being a safe form of treatment, spinal manipulation is incredibly effective, getting patients back on their feet faster than traditional medical care. A March 2004 study in the Journal of Manipulative and Physiological Therapeutics found that chiropractic care is more effective than medical care at treating chronic low-back pain in those patients who have been experiencing the symptoms for one year or less. In addition, a study published in the July 15, 2003, edition of the journal Spine found that manual manipulation provides better short-term relief of chronic spinal pain than a variety of medications.

Neck Adjustments
Neck pain and some types of headaches are sometimes treated through neck adjustment. Neck adjustment, often called cervical manipulation, works to improve joint mobility in the neck, restoring range of motion and reducing muscle spasm, which helps relieve pressure and tension. Neck adjustment is a precise procedure that is generally applied by hand to the joints of the neck. Patients typically notice a reduction in pain, soreness, stiffness, and an improved ability to move the neck.

Neck manipulation is a remarkably safe procedure. Although some reports have associated upper high-velocity neck manipulation with a certain kind of stroke, or vertebral artery dissection, there is not yet a clear understanding of the connection. While we don’t know the actual incidence of stroke associated with high-velocity upper neck manipulation, the occurrence appears to be rare—1 in 5.85 million manipulations2— based on the clinical reports and scientific studies to date.

To put this risk into perspective, if you drive more than a mile to get to your chiropractic appointment, you are at greater risk of serious injury from a car accident than from your chiropractic visit.

It has also been suggested that sudden, severe upper-neck pain and/or headache, which may indicate a pre-stroke condition, could cause someone to visit a doctor of chiropractic. In addition, some common activities, such as stargazing, rapidly turning the head while driving, and having a shampoo in a hair salon may cause an aneurysm—a widening of an artery resulting from the weakening of the artery walls—of the neck arteries, resulting in stroke. Such events remain very difficult to predict.

It is important for patients to understand the risks associated with some of the most common treatments for neck and back pain—prescription nonsteroidal anti-inflammatory drugs (NSAIDS)—as these options may carry risks significantly greater than those of manipulation. According to a study from the American Journal of Gastroenterology, approximately one-third of all hospitalizations and deaths related to gastrointestinal bleeding can be attributed to the use of aspirin or NSAID painkillers like ibuprofen.3
Furthermore, surgery for conditions for which manipulation may also be used carries risks many times greater than those of chiropractic treatment. Even prolonged bed rest carries some risks, including muscle atrophy, cardiopulmonary deconditioning, bone mineral loss and thromboembolism.4

Dr. Brenda Rooney obtains very specific information about symptoms from her patients with upper-neck pain or headache. “This will help me provide the safest and most effective treatment,” says Dr. Rooney. "If the issue of stroke concerns you, do not hesitate to discuss it with me. Depending on your clinical condition, instead of manipulation, I may recommend joint mobilization, therapeutic exercise, or soft-tissue techniques.”

Research Ongoing
Today, chiropractic researchers are involved in studying the benefits and risks of spinal adjustment in the treatment of neck and back pain through clinical trials, literature reviews and publishing papers reviewing the risks and complications of neck adjustment.

All available evidence demonstrates that chiropractic treatment holds an extremely small risk. The American Chiropractic Association points out that the chiropractic profession takes this issue very seriously and engages in training and postgraduate education courses to recognize the risk factors in patients, and to continue rendering treatment in the most effective and responsible manner.

Dr. Rooney is a member of the American Chiropractic Association. For more information about chiropractic and the issues mentioned above, contact Optimal Family Chiropractic, LLC at (973) 584-4888 or visit www.optimalfamilychiropracticllc.com.

References
1. Spine 1997 Feb 15; 435-440.
2. Can Med Assoc J 2001; 165(7):905-906.
3. Am J Gastroenterol 2005;100:1685–1693.
4. Contemporary Chiropractic. New York: Churchill Livingstone, 1997, p. 230-238

Chiropractic Effective Treatment for Headaches

This October, during National Chiropractic Month, the American Chiropractic Association (ACA) is encouraging families to consider chiropractic care as a treatment for several types of headaches.

While many people associate chiropractic care as a treatment for bad backs, there is growing documentation that chiropractic is also effective in the treatment of cervicogenic headaches, migraines and cluster headaches.

“Research shows that spinal manipulation is an effective treatment option for headaches,” says Dr. Brenda Rooney of Optimal Family Chiropractic in Mount Olive and a member of the American Chiropractic Association. “Not only does drug-free, conservative chiropractic care provide almost immediate relief from pain, but it has significantly fewer side effects and longer-lasting relief than many commonly prescribed medications.”

Additionally, doctors of chiropractic are trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary and lifestyle counseling—all of which are important components in the management of chronic headache pain.

If you frequently suffer from headaches, Dr. Rooney and ACA recommend the following tips.

• If you spend a large amount of time in one fixed position, such as in front of a computer, take a break and stretch every 30 minutes to one hour.
• Low-impact exercise may help relieve the pain associated with primary headaches.
• Drink at least eight 8-ounce glasses of water a day to help avoid dehydration, which can lead to headaches.
• Avoid slouching.
• Try a low-fat, high-complex carbohydrate diet. A recent study demonstrated that such a diet can dramatically lower the frequency, intensity, and duration of migraine headaches.
• Reduce stress at home and work by planning ahead and engaging in relaxation and breathing exercises.
• Get plenty of sleep and maintain a regular sleep schedule.

This October, during National Chiropractic Month, talk with a doctor of chiropractic about how you can obtain headache relief through spinal manipulation and chiropractic care. “When it comes to managing headache pain, there’s no magic solution that works for everyone, but chiropractic care is certainly an effective treatment option every patient should keep in mind.” said Dr. Rooney.

Dr. Rooney is working in collaboration with the American Chiropractic Association to observe National Chiropractic Month. For more information on chiropractic or any of the tips mentioned above, contact Optimal Family Chiropractic at (973) 584-4888.