Relief for Chronic Headaches & MigrainesSean Valenti, DC, Chiropractic

www.SpringfieldClinic.comwww.SpringfieldClinic.com

Headache Statistics

• According to the National Headache Foundation, over 45 million Americans suffer from chronic, recurring headaches and of these, 28 million suffer from migraines. About 20% of children and adolescents also have significant headaches.

• In the United States in the year of 2001 alone, there were 9,876,000 visits to doctors by patients seeking some sort of relief for their headache pains

Types of Headaches

• 4 Primary Headaches• Migraines

• Cluster

• Tension

• Trigeminal• International Headache Society

Most Common Treatments

•Acetaminophen (Tylenol) – liver & kidney disease •Aspirin – internal bleeding, stomach ulcers, kidney dysfunction •Ibuprofen (Motrin, Advil, etc.)– heart disease, stroke

What Are Possible Causes

and

How can we treat them with less negative side effects

Causes and Affective Treatments

• Dietary Issues

• Neuromuscular

Dietary Issues

• Magnesium Deficiency

• Dehydration

• Artificial Sweeteners

• Food Allergies

Magnesium• Magnesium ( /mæɡˈniːziəm/ mag-NEE-zee-əm) is a

chemical element with the symbol Mg• Magnesium is the 11th most abundant element by

mass in the human body; its ions are essential to all living cells.

• Magnesium compounds are used medicinally as common laxatives, antacids (e.g., milk of magnesia), and in a number of situations where stabilization of abnormal nerve excitation and blood vessel spasm is required.

Red Blood Cell Magnesium Levels in Migraine Patients

• “In comparison with normal subjects, migraine patients with and without aura had significantly lower red blood cell magnesium levels”.

• Low red blood cell magnesium levels could be a peripheral expression of the reduced brain magnesium concentration observed in migraine patients

• Cephalalgia April 1993 vol. 13 no. 2 94-98

Serum and Salivary Magnesium Levels in Migraine and Tension-Type Headache. Results in a Group of Adult Patients

• We measured, by atomic absorption spectrophotometry, serum and salivary magnesium levels in drug-free migraine patients with and without aura and in tension-type headache patients

• Migraine sufferers with and without aura and tension-type headache had significantly lower levels of serum and salivary magnesium concentrations in the interical periods than a group of healthy young individuals

• Cephalalgia February 1992 vol. 12

Serum and Salivary Magnesium Levels in Migraine and Tension-Type Headache. Results in a Group of Adult Patients

• Serum magnesium levels tended to be further reduced

during attacks in all patient groups studied.

• Serum magnesium levels and to a lesser extent salivary magnesium levels might express indirectly the lowering of brain extracellular magnesium

concentration which occurs in migraine patients.• Cephalalgia February 1992 vol. 12

STUDY : Relationship between serum magnesium level and migraine attacks

• Study determining serum magnesium levels in individuals and migraines attacks– 26 males, 114 females enrolled – Compared to 140 healthy people– Results: Patient with headaches had approximately

20% lower serum magnesium levels.– There was a significant linear relationship between

the amount of serum magnesium and the frequency of headaches.Neurosciences Research Center, Department of Neurology, Tabriz University of Medical Sciences, Tabriz, Iran.

Chronic Dehydration and Headaches

• Water is a critical element of the body. 75% of the bodies weight is made up of H2O.

• We lose water when we breath, sweat, and eliminate waste.

• We need approx 65oz. for a 150lbs person.

• Approx . 2-3oz. Per pound

Food Allergy/ Intolerance

• A food allergy is an adverse immune response to a food protein. They are distinct from other adverse responses to food, such as food intolerance.

Food Allergy/ Intolerance

• IgG. IgG antibodies are found in all body fluids. They are the smallest but most common antibody (75% to 80%) of all the antibodies in the body. IgG antibodies are very important in fighting bacterial and viral infections. IgG antibodies are the only type of antibody that can cross the placenta in a pregnant woman to help protect her baby (fetus).

• IgE. IgE antibodies are found in the lungs, skin, and mucous membranes. They cause the body to react against foreign substances such as pollen, fungus spores, and animal dander. They may occur in allergic reactions to milk, some medicines, and some poisons. IgE antibody levels are often high in people with allergies.

Diet restriction in migraine, based on IgG against foods: A clinical double-blind, randomized, cross-over trial

• Introduction: It is well-known that specific foods trigger migraine attacks in some patients. We aimed to investigate the effect of diet restriction, based on IgG antibodies against food antigens on the course of migraine attacks

• Methods: Following a 6-week baseline, IgG antibodies against 266 food antigens were detected by ELISA. Then, the patients were randomized to a 6-week diet either excluding or including specific foods with raised IgG antibodies, individually.

• Cephalalgia July 2010 vol. 30 no. 7 829-837

Diet restriction in migraine, based on IgG against foods: A clinical double-blind, randomized, cross-over trial

• Results: The average count of reactions with abnormally high titre was 24 ± 11 against 266 foods. Compared to baseline, there was a statistically significant reduction in the number of headache days (from 10.5 ± 4.4 to 7.5 ± 3.7; P < 0.001) and number of migraine attacks (from 9.0 ± 4.4 to 6.2 ± 3.8; P < 0.001) in the elimination diet period.

• Conclusion: This is the first randomized, cross-over study in migraine patients, showing that diet restriction based on IgG antibodies is an effective strategy in reducing the frequency of migraine attacks.

• Cephalalgia July 2010 vol. 30 no. 7 829-837

STUDY: Migraine headaches caused by Food Allergies?

• Found – allergic food elimination greatly reduced intensity, frequency and duration of migraine headaches in patients

• Gluten – was a frequent culprit.

Cephalalgia- 2010 Jul;30(7):829-37. Epub 2010 Mar 10.Pub Med. Gov:  http://www.ncbi.nlm.nih.gov/pubmed/20647174

Artificial Sweeteners

ELIMINATE!

Artificial Sweeteners

• Aspartame

• Sucralose

• Acesulfame potassium

• Saccharin

• Stevia*

Neuromuscular

• Nerves

• Muscles

Cervicogenic Headache – What is it?

• a chronic, hemicranial pain syndrome in which the primary source of the pain is in the cervical spine but the pain is perceived in the head 

STUDY : Spinal Manipulation vs. Amitriptyline

• A Randomized Clinical Trial for treatment of Chronic Tension-type Headaches– 6 weeks of drug therapy compared to

chiropractic adjustments

Boline PD, Kasaak K, Bronfort G, Nelson C, Anderson AV,   J Manipulative Physiol Ther. 1995 (Mar-Apr); 18 (3): 148-154 

STUDY : Spinal manipulation vs. Amitriptyline

• Results:– Drug Therapy

• Slightly more effective however 82% of patients had side effects including:

– Drowsiness, weight gain, dry mouth– Cardiac problems & Glaucoma were also associated

with use

• After 4 weeks – patients reported having headaches again

Boline PD, Kasaak K, Bronfort G, Nelson C, Anderson AV,   J Manipulative Physiol Ther. 1995 (Mar-Apr); 18 (3): 148-154 

STUDY:Spinal manipulation vs. Amitriptyline

• Results:– Spinal manipulation

• Side effects– Slight neck stiffness in the first 2 weeks (5 % of

patients)

• After 4 weeks – patients still expressed headache relief, as well as higher energy & vitality

Boline PD, Kasaak K, Bronfort G, Nelson C, Anderson AV,   J Manipulative Physiol Ther. 1995 (Mar-Apr); 18 (3): 148-154 

STUDY : Migraine Changes Following Manipulative Therapy Trial

• 4 cases – responded dramatically to spinal care

• Episodes were reduced by 90%

• Length of headache reduced by 38%

• Medicine use dropped 94%

• Symptoms were reduced including nausea, vomiting, photophobia and phonophobia.

Tuchin PJ.   Australasian Chiropractic & Osteopathy 1997 (Nov); 6 (3): 85-91

STUDY : Chronic Episodic Tension type Headaches in Males

• Study conducted at Palmer College of Chiropractic – West Outpatient Clinic– 11 men between ages 18-40 who suffer from

headaches– Adjustments used along with:

• Myofascial trigger point therapy• Moist hot packs

– Patients reported reduction in the frequency and duration of headaches

Mootz, RD, Dhami MSI, Hess JA, et al.   Journal of the Canadian Chiropractic Association, September 1994; 38(3): 152-159.

STUDY : Spinal Curvatures – Visceral Disturbance in Relation to Thereto

• Per Ussher – spinal abnormalities could be causing visceral disorders and that X-rays could be a help in diagnosing the spine/internal organ relationship.

• Ussher urged “A careful neurological examination of the spine” as part of differential diagnosis.

Ussher NT. California and Western Medical Journal, 1933, 38:423. 

STUDY : Manipulation for Headaches with Upper Cervical Joint Dysfunction

• 26 patients (16 males, 10 females)

• All having chronic headaches with upper cervical joint dysfunction

• Results: significant diminishing of the severity and frequency of headaches reported

Whittingham, W, Ellis WB, and Molyneux TP,   J Manipulative Physiol Ther. 1994 (Jul-Aug); 17 (6): 369-375

STUDY : Spinal Manipulation in the Treatment of Cervicogenic Headache

• Consisted of 53 patients out of 450 who fit the criteria for CGH according to the IHS and suffering from frequent headaches

• 28 patients received Spinal Manipulations

• 25 patients received massage and low-level laser.

• Patients were treated 2x’s/wk for 3wk’s

Nilsson N, Christensen HW, Hartvigsen J.   J Manipulative Physiol Ther. 1997 (Jun); 20 (5): 326-330

STUDY : Spinal Manipulation in the Treatment of Cervicogenic Headache

• Results– Use of analgesics decreased 39% in the

manipulation group, unchanged in the LLL and Massage group

– Duration decreased 69% manipulation and 37% in Massage/LLL

– Intensity decreased 36% manipulation and 17% in Massage/LLL

STUDY : Spinal Manipulation, Amitriptyline and Combination

• For Prophylaxis of Migraine Headache– Study compared the effectiveness of

1. chiropractic care alone,

2. with antidepressant/antianxiety drug amitriptyline (Elavil),

3. Or combination of both.

Nelson CF, Bronfort G, Evans R, et al.   J Manipulative Physiol Ther. 1998 (Oct); 21 (8): 511-519

Spinal Manipulation, Amitriptyline and the Combination of both therapies

• Results – The headache diary kept by each patient

showed Chiropractic to have reduced severity and frequency of headaches as well or better than the combined therapy or the Amitriptyline alone at each stage of the study.

Nelson CF, Bronfort G, Evans R, et al.   J Manipulative Physiol Ther. 1998 (Oct); 21 (8): 511-519

STUDY : Occipital Headaches – Treatment of Vertebragenous Headache

• 332 patients received an average of 8.6 chiropractic adjustments

• Results – 80% of patients had excellent (pain-free)

and good (almost pain-free) outcomes

Droz JM, Crot F.   Swiss Annals Vlll, 1985; 127-36.

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