Blog

What Triggers Headaches?

As we know headaches can occur due to multiple reasons ranging from structural, functional, biochemical to hormonal factors. Headaches are sometimes caused by a hidden condition known as vertebral segmental subluxation of the cervical spine.

Understanding Vertebral Segmental Subluxation

In chiropractic “subluxation “ is defined as the alteration in the position of the vertebra, with nervous system interference. This can cause physiological and biochemical changes in the adjoining structures resulting in loss of function of that vertebra. When subluxation affects cervical spine (the vertebras in neck), it limits mobility and becomes a cause of chronic pain in neck referred to head(cervicogenic headache).

Causes and Impact of Vertebral Subluxation

Vertebral subluxation in cervical area can occur at any age and can be caused by falls, muscle sprains, stress or whiplash injuries sustained either in a car accident or other causes. A research study determined the association of vertebral subluxations with headaches and showed that amongst 5000 headache sufferers ,about 2000 (40 %) of incidents originated in the cervical spine. In two thirds of these cervical spine cases , vertebral subluxation was found to be the causative factor.

Mechanism: How Vertebral Subluxations Cause Headaches

How vertebral subluxations cause headaches is explained on the basis of two connections:

Muscle Connection

First is the Muscles connection; cervical vertebras are connected through tendons and ligaments to the muscles of the head, neck and upper back. Any trauma causing subluxation alter the muscles dynamics in the neck region inciting pain and muscle strain.

Nerve Connection

Second connection is with nerves. Spinal cord contains nerves that emerge between the vertebras to connect body with brain. Vertebral subluxation may impede these nerves and disrupt nerve flow to and from brain resulting in pain and abnormal sensations .
Chiropractor’s treatment for vertebral subluxation is preceded by detailed history, past history , social and family history and a complete physical examination. Diagnostic Tests such as X-ray, CT, MRI, EMG/NCV and blood and urine analysis may also be performed depending upon the extent of condition.

The Chiropractic Approach: Diagnosing and Treating Vertebral Subluxations

For managing vertebral subluxations, chiropractors use procedure called “spinal adjustments” to restore the alignment and mobility of the vertebra to their proper position in spinal column. Firstly, chiropractors detect the vertebras that are not moving to ascertain the location of spinal manipulation, they also take note of your spinal curves, movements of your neck and posture before performing spinal adjustment. Usually chiropractors use their hand to apply gentle manual pressure or thrust to bring back vertebra in alignment and restore their mobility, it also improves blood circulation and reduces nerve irritation. In few cases, chiropractor may make use of certain instruments for diagnosis and adjustment of spinal subluxation. Usually chiropractor adjustments are pain free but depending upon the severity of inflammation incurred in trauma such as car accident some discomfort might be experienced during the procedure.

Spinal Adjustments: A Key Chiropractic Procedure

Most common question that arises regarding any treatment is; Does it work? Best resource for searching the answer is scientific research studies as they are done following standardized protocols and provide the most reliable evidence.

Case Study: Spinal Adjustment and Cervicogenic Headaches

A spinal adjustment for vertebral subluxation is not a new or recent concept. One research study, a randomized control trial, was performed in a Denmark university to see the effect of high-velocity, low-amplitude cervical manipulation on cervicogenic headaches. For the study, 53 headache sufferers who fulfilled the International Headache Society criteria for cervicogenic headache were recruited. First group of 28 received high-velocity, low-amplitude cervical manipulation twice a week for three weeks, while the second group of 25 were given low-level laser in the upper cervical region and deep friction massage in the lower cervical/upper thoracic region, for the same time period. Findings of the study showed that in cervical manipulation group requirement of pain killers decreased by 36% ,conversely it remained unchanged in the other group. Similarly, number of headache hours per day reduced significantly by 69% in the manipulation group and only 37% in the second group. Moreover, headache severity per episode was reported to be 36% lesser in the manipulation group as compared to 17% in the other group. All these differences were statistically significant thus researchers concluded that spinal manipulation has a proven positive effect in cervicogenic headaches.¹

Systematic Review: Chiropractic Treatment of Adults with Headaches

In 2011, a systematic review of evidence was undertaken to generate guidelines for the chiropractic treatment of adults with headaches. Systematic review included 23 randomized control trials after following rigorous inclusion criteria. Review concluded that there is scientific evidence suggesting the use of chiropractic adjustments including spinal manipulation for managing cervicogenic head aches and migraine. The research team also recommended that decision about which treatment, how much and how often and for how long has to be based on Guidelines recommendations and the clinical assessment and findings of the practitioner.

Comparative Review: Chiropractic Interventions vs Traditional Physical Therapy

A more recent review conducted in 2016, compared the effects of cervical mobilization and manipulation on headache frequency and pain to traditional physical therapy interventions in patients with cervicogenic headache. The originally selected 66 relevant studies were passed through a vigorous evaluation strategy to taper down to 25 most suitable studies, which were further narrowed to finally 10 studies included in review. Review established that spinal manipulation has benefit for people suffering from cervicogenic headaches as 70%(7 out of 10) included studies had cited statistically significant results that patients who received spinal manipulation or mobilization experienced lesser headaches and symptoms as compared to patients with traditional physical therapies.²

Another study revealed this pertinent point that spinal manipulation in combination with an exercise program is even more effective to treat cervicogenic headaches, improve joint flexibility and posture.

1. The effect of spinal manipulation in the treatment of cervicogenic headache.N. Nilsson, H. W. Christensen, J. Hartvigsen. J Manipulative Physiol Ther. 1997 Jun; 20(5): 326–330.

2. Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence?Jodan D. Garcia, Stephen Arnold, Kylie Tetley, Kiel Voight, Rachael Anne Frank Front Neurol. 2016; 7: 40. Published online 2016 Mar 21