Medication Overuse Headache vs. Migraine

Medications can be a lifesaver when you are suffering from frequent migraine headaches. However, a major problem observed in the past 30 years has been the rise of medication overuse headache.⁣

When patients with frequent headaches turn to both prescription and over the counter medications over the course of years, they may be susceptible to headaches that are induced by the medication itself.⁣

It turns into a vicious cycle where you need a medication to break the actual migraine, but taking the medication will lead to another type of headache that can be just as debilitating.⁣

For most, the rebound headache can feel just as bad as their migraine, and sometimes the pain can be indistinguishable from a migraine.⁣

𝗦𝗼 𝗵𝗼𝘄 𝗱𝗼 𝘆𝗼𝘂 𝘁𝗿𝗲𝗮𝘁 𝗶𝘁?⁣

Prevention is always the best medicine. If you are a migraine patient and you notice that your headache frequency is gradually increasing, there is a likelihood that medication overuse headache is starting to occur.⁣

Ultimately reducing the burden of medication overuse headache is to taper/stop the medication.⁣

Of course this is easier said than done. It means not only bearing the pain and suffering of the rebound headaches, but also bearing the pain of the migraines too.⁣

Not having medication doesn’t mean there are no options. There are a number of drug-less therapies that can take the bite out of headaches including:⁣
– Upper Cervical Chiropractic⁣
– Acupuncture⁣
– Mindfulness⁣
– Neurofeedback⁣

There’s also promising trials showing that thr new generation of monoclonal antibodies like Aimovig can help by decreasing medication burden.⁣

Head Tilts and Eye-Misalignment – The Ocular Tilt Reaction

Patients with dizziness can present with abnormalities in their head and eye positions. A classic example of this is called an ocular tilt reaction.⁣

An ocular tilt reaction occurs when damage occurs to some of the pathways that affect the brain stem or the vestibular system. These pathways help to keep your eyes level with the horizon and form the basis of the righting reflex.⁣

The righting reflex ensures that you see the world level with the horizon even when you tilt your head to the side. Whenever you tilt your head to the side, your eyes roll to compensate. This is why you can tilt your head sideways, and you still perceive the world as straight.⁣

When there is an injury to the vestibular system (otoliths) or something affects the eye movement pathways in the brainstem, this ability can be broken.⁣

This results in the patient having eyes rotating abnormally and can cause an abnormal tilt of the head.⁣

Clinicians can use knowledge of these pathways to pinpoint where in the brainstem or vestibular pathway that damage may have occurred. It can also help them differentiate between a strabismus from a cranial nerve 4 lesion or a vestibular/brainstem problem.⁣

This is important to know because these pathological tilt reactions are an important sign of a peripheral or central cause of dizziness/imbalance that may look like a cervical spine/alignment issue.⁣

We have to be knowledgeable about some of these pathways because these are cases in which we may not be able to fix someone’s head tilt from something like an upper cervical adjustment because the neural pathways allowing for a normal righting reflex just aren’t there anymore so we shouldn’t chase after it.⁣

It may allow us to provide compensation mechanisms to help improve balance and stability.⁣

Can Your Brain Program an Immune Response?

Late last year, a study was published that really brought surprising findings about how your brain can store and program an immune response.⁣

For decades, it was thought that the Brain and the immune system operated independently from each other, but research in the past 20 years have put that idea to rest.⁣

How the brain can regulate immune function has been largely unknown. Does it happen as a by product of neuro-endocrine regulation, or can higher neural centers in the cerebral cortex play a role?⁣

Koren et al did a really interesting study published last year that showed an area of the brain called the insular cortex may actually store and trigger very specific immune responses. ⁣

Their team took mice and gave them either a lab induced form of colitis or peritonitis. Both conditions will cause abdominal pain and inflammation, but in very different ways. Colitis will cause inflammation within the digestive organs while peritonitis will cause inflammation outside of the organs.⁣

The researchers showed that colitis and peritonitis produced unique signatures of activation on the area of the insular cortex in mice.⁣

Using some advanced techniques, they were able to specifically turn on the same neurons that were activated during the colitis or peritonitis flares.⁣

They found that turning on those pattern of neurons in the brain reproduced a similar immune response in the guts of the colitis or peritonitis model 🤯⁣

This is remarkable because it suggests that the brain may keep a map of different immune patterns like it keeps a map of your body parts and the space around us.⁣

The implications are interesting because what it opens the possibility that some inflammatory pain issues have a brain-based cause.⁣

Something may start as an immune disorder like rheumatoid arthritis or spondyloarthritis, but plasticity may encode these responses in a way that it gets turned on without a trigger.⁣

Could this be a bridge for how autoimmune disorders and plasticity become entangled creating chronic pain issues?⁣

The Gut Microbiome and Neurological Disease

Studies on the impact of the bacteria that live in our guts has exploded in the last 20 years. While most can understand how gut microbes can affect digestion and cause irritable or inflammatory bowel issues, some of the most interesting science of the last decade has looked at how gut bacteria affects our brains.⁣

Dysbiosis is a condition in which the normal bacterial environment has been disrupted. This means that important good bacteria may be deficient as is the case when patients take antibiotics. It can also mean that there is increased growth of pathogenic bacteria like E. Coli.⁣

Gut dysbiosis has been identified in neurological conditions like Alzheimer’s Disease, #parkinsonsdisease #autism as well as psychiatric conditions like depression and anxiety.⁣

Animal models have shown that replacing the gut bacteria of a healthy mouse with the bacteria of a sick human can actually reproduce the symptoms of the person in the mouse! It’s also been demonstrated that placing the healthy microbes of a healthy person can reverse the symptoms in a sick rodent. ⁣

3 mechanisms for gut-brain communication:⁣

1️⃣ 𝗩𝗮𝗴𝘂𝘀 𝗡𝗲𝗿𝘃𝗲 𝗧𝗿𝗮𝗻𝘀𝗺𝗶𝘀𝘀𝗶𝗼𝗻: The vagus nerve is responsible for monitoring the status of the gut. Products of bacterial metabolism can signal the vagus nerve which can alert the brain to pro or anti inflammatory states. ⁣

There are also theories that suggest that some proteins can travel from the gut into the brain via the vagus nerve, which is a proposed mechanism for how Parkinson’s Disease may evolve from the gut.⁣

2️⃣ 𝗜𝗺𝗺𝘂𝗻𝗲 𝗧𝗿𝗮𝗻𝘀𝗺𝗶𝘀𝘀𝗶𝗼𝗻: There’s a constant battle between the immune system and gut bacteria to prevent overgrowth. Good bacteria release products that can temper the immune system and reduce inflammation.⁣

Pathogens can trigger strong immune responses that promote inflammation, especially with a leaky gut.⁣

3️⃣ 𝗛𝗣𝗔 𝗔𝘅𝗶𝘀: Bacterial products can affect the release of hormones. This is particularly true for the hypothalamus and pituitary gland and how it affects cortisol from the adrenal glands.



When Arm and Neck Pain Are Coming from the Neck

Problems that come from the neck don’t always stay in the neck. In fact, many neck pain problems are known to migrate to the head, arms, or even the upper back.⁣

The most well established patterns are when there is with 𝗿𝗮𝗱𝗶𝗮𝘁𝗶𝗻𝗴 𝗽𝗮𝗶𝗻. Radiating pain has a well defined line of pain or numbness that can usually be traced out by the patient. ⁣

Most radiating pain is caused by disc herniations with narrowing of the openings where the nerve travels. This narrowing makes the nerve susceptible to inflammation, edema, or even direct compression by disc or ligament tissue.⁣

These issues can be corroborated by the location of pain along with deficiencies in reflex or sensory loss. Moderate to severe radiating pain my get confirmatory testing from electro diagnostic tests.⁣

Then there’s the problem of 𝗿𝗲𝗳𝗲𝗿𝗿𝗲𝗱 𝗽𝗮𝗶𝗻. Referred pain is when damage is happening in one body part, but a pain is felt a distant body region. In the neck, joint capsule and facet injuries can cause pain in other body regions. Upper neck joints can trigger pain in multiple regions of the head while lower neck joints can refer pain to the middle back. This can happen with or without actual pain in the neck.⁣

#pain #neuroscience #protecttheneck

Breathing for the Brain: Exhaling for Vagus


The the function of the autonomic nervous system is critical for the health of the body. The autonomic system consists of two branches.⁣

1. The sympathetic system which reacts to stress and dictates a fight or flight response.⁣

2. The parasympathetic system which calms the body down for resting and digesting.⁣

Both systems are important for survival and health. But many of us spend far too much time in fight or flight which comes with detrimental long term health impact.⁣

Prolonged and unchecked fight or flight is suspected to play a role in heart disease, stroke, diabetes, and Alzheimer’s disease. ⁣

It’s not easy to change our personalities & how we react to stress. But it’s important that if we have a lot of stress, that we keep the stress physiology in check.⁣

A simple and free way to do that, that takes no additional use of your time is changing your 𝗯𝗿𝗲𝗮𝘁𝗵𝗶𝗻𝗴 𝗽𝗮𝘁𝘁𝗲𝗿𝗻𝘀.⁣

Many of us breath in a way that is fast and shallow, but neurologically this can bias our sympathetic nervous system.⁣

When we inhale rapidly, our sympathetic nerves tend to fire more which keeps our heart rates slightly elevated.⁣

Breathing out has the opposite effect. It tends to activate our vagus nerve and slows down our heart rate.⁣

A simple way to get more parasympathetic activation from our vagus nerve is just to spend more time breathing out! ⁣

It’s too simple, but really effective.⁣

Here’s how you can work on this:⁣

1. When you are reading, watching TV, working on the computer, getting ready for sleep, start focusing on slowing your breath.⁣

2. Take normal breaths in, but start focusing on doubling the number of seconds breathing out. ⁣

If it takes 2 seconds to breathe in, spend a full 4 seconds breathing out. If it takes 3 seconds to breathe in, spend 6 seconds out.⁣

Try to go as slow as possible. ⁣

Initially the breath out will feel strange, but you are training yourself to breathe differently so it is normal to be uncomfortable.⁣

Within weeks of practice, your natural pattern will change, and this can have significant effect on your physiology.

Clues for Cervicogenic Dizziness


Dizziness attributed to the neck has historically been a sketchy diagnosis. For a long time, many ENTs and neurologists denied that it even existed because there weren’t any tests that can confirm as a diagnosis.⁣

It lead to a lot of dizzy patients getting normal inner ear/vestibular testing, and a 🤷🏻‍♂️ diagnosis defaulting to psychogenic illness.⁣

Fortunately, we have some evidence that has come from the #whiplash #concussion and neurosurgery research that has provided some clarity on when to suspect cervicogenic dizziness.⁣

Some important clues include:⁣
– History of neck or head trauma⁣
– Dizziness without vertigo/spinning that is agitated by neck movement⁣
– Degenerative changes in the upper neck⁣
– Absence of vestibular findings⁣
– History of neck or radiating arm pain⁣

In addition to those findings, I have found a few functional exams that help point towards cervical origin. ⁣

One shown here is a neck torsion balance test.⁣

Lots of clinicians test balance, but adding a challenge to a balance exam where you have a patient turn their torso, or turn their head can put stress on the neck that may worsen a sense of imbalance.⁣


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A post shared by Keystone Chiro Neuroplasticity (@keystoneneuro)

Have your clinician give this test a try, to see if the neck might be a cause of your dizziness.⁣

Get to Know POTS

Postural Orthostatic Tachycardia Syndrome or POTS is a form of #dysautonomia.⁣

It used to be a rare diagnosis that often left many patients (especially women in child bearing years) left with a diagnosis of a psychiatric disorder or hysteria.⁣

Thanks to increased awareness of the phenomenon and accessible ways to test for it at bedside, we now know it is something that is actually fairly common, especially as it presents with other illnesses.⁣

Fundamentally, POTS is a miscommunication between the brain and the body’s organ systems. This miscommunication can happen in different ways and thus have different types of PoTS.⁣

Most commonly, there appears to be a loss of sympathetic nerve activity to blood vessels in the legs. This causes blood to pool in the lower body, and the heart has to compensate for less blood flow by pumping faster, but less efficiently.⁣

We now know that POtS can also be associated with low blood volume and hyperactivity of the sympathetic nervous system. Recent evidence also suggests a strong autoimmune relationship, as more PoTS patients are testing positive for various autoantibodies.⁣

While most therapeutic approaches focus on treating peripheral findings in POts, functional Neurology has found that a rehabilitation strategy focused on central decompensation can actually help many PoTS patients get their life back.⁣

In addition to the forms of POTS we see on paper, I think we will find greater evidence for dysfunction at the level of the Brainstem to be a major contributor to POTS physiology which allows for a dynamic rehab strategy. In fact, this rehab strategy is that different from what we do for concussed patients!⁣

#neuroscience #neuroplasticity #POTS #fibromyalgia

The Beautiful Brainstem

The Beautiful Brainstem


The brainstem is arguably the most important area of the brain in terms of keeping us all alive. Most medically educated people know that the Brainstem is tied heavily towards our ability to breathe and maintain heart rate.⁣

But the Brainstem does so much more! It’s a bottleneck point for neural transmission the entire body, so lesions of the Brainstem can impact any other part of the body.⁣

When we look at the function of the Brainstem, we usually separate the anatomy into 3 regions.⁣

• Midbrain⁣
• Pons⁣
• Medulla⁣

By knowing the function of each region, we can examine a patient and get a sense for any possible dysfunction, especially when we evaluate a patient’s cranial nerves.⁣

A patient with impaired ability to move their eyes up and down may have midbrain dysfunction. A patient with issues with their face/jaw may have a problem at the Pons. A patient with nausea signs and balance problems likely has issues in the medulla.⁣

By understanding these issues, it can help us see if a patient has a serious , life threatening issue that needs special tests or referrals. It can also help us design rehab for patients if these issues aren’t pathological.⁣

Either way, looking at the anatomy and physiology of the Brainstem can create a sense of awe, as you understand that this small chunk of brain is responsible for so much of what makes us alive.⁣

Chronic Pain Structurally Changes our Brain

Chronic Pain Structurally Changes our Brain

Our brains are made up of gray matter and white matter. ⁣

Gray matter is made up of pools of neurons that are responsible for specific tasks.⁣

White matter is made up of axons which carry the information from our neurons to another region of the brain or body.⁣

When we look at how chronic pain changes our brains, multiple MRI studies have shown that size of gray matter in our brains decrease. This is observed in parts of the brain that are associated with the painful body region, but it also affects other areas of the brain that affect us emotionally and cognitively.⁣

We don’t necessarily know the exact implications of this, but it’s been suggested that decreased gray matter may be associated with decreased functionality of those brain regions. This is mostly driven by aging research where decreased gray matter is associated with declining cognition.⁣

This may be a mechanism for how chronic pain can have downstream affects on cognition, autonomic function, and depression.⁣

The good news is that these changes in gray matter are actually reversible!⁣

Studies have shown that when pain is reduced or eliminated, some of these brain changes actually start to increase again.⁣

We know that pain has a functional purpose in the acute phase, but chronic pain can be quite detrimental.⁣

While we can’t always rid someone of pain, having the ability to reduce pain and the consequences of pain is really important. It’s also really important to develop emotional and cognitive strategies to best manage painful syndromes as well.⁣