A recent systematic review in the prominent journal Headache showed that spinal manipulation could have an effect on headache days and pain intensity in patients with migraine headaches. While this is old news to many practicing chiropractors, this is one of the first instances that a major headache journal has acknowledged that manipulation could have a legitimate positive effect in patients suffering with migraines.
When it comes to migraine headaches and chiropractic, there’s a big gap in knowledge between what clinicians see in the field everyday and what the published literature says about our effectiveness. The published literature has generally shown that chiropractic might be good for tension headaches, but clinical trials on migraines have suggested that it’s not significantly better than placebo.
On the other side, patients with migraine headaches are often our most successful cases in upper cervical chiropractic. It’s not even that we tend to be just a little bit successful with chronic migraines patients, many of us expect these 85-90% of these patients to get a lot better in a matter of weeks. It’s usually not the easy migraine patient that comes into our offices either. Typically people don’t find an upper cervical chiropractor until they’ve tried a wide variety of treatments and medications.
So what gives? Why is there such a gap between private practice and published research?
I believe there’s 2 main reasons:
- Most spinal manipulations done in research have used non-specific contact, general manipulation of the neck, where as upper cervical techniques use a very precise and targeted force to one part of the neck. To date, there are no clinical trials investigating migraine headache and upper cervical work. (But this is a soap box for another day)
- Previous clinical trials haven’t done a great job in identifying patients that have the signs of a cervical spine dysfunction.
Identifying Cervical Spine Dysfunction in Migraine Patients
One of the most important things we do during a Complimentary Consultation is to figure out if you’re a good candidate to respond to the type of chiropractic we perform in our office.
While getting your spine corrected is healthy in of itself and anyone could benefit from it, I only take on cases that I believe can significantly improve your quality of life. In order to do that, I always screen patients to make sure that I am going to have a high likelihood of success in helping you reach your goal.
In the case of a migraine patient, we are looking for clues that tell us that your migraine symptoms are primarily being generated by the neck. Migraines can have different causes:
- Some have a biochemical issue in the brain and may benefit from something like a ketogenic diet.
- Some have a higher hormone component and need to be addressed by modifying the endocrine system
- And many have a major cervical spine component
How can you tell if it’s coming from the neck? Beyond just looking for neck pain, here are some major clues that have been identified in migraine research:
- Worse ability to turn their upper neck side to side – A test of upper neck rotation called the flexion rotation test has been shown to be more asymetrical in some migraine patients compared to normal controls [Source]
- Decreased sensitivity to 2 point discrimination in the upper neck – A study showed that migraine patients have decreased ability to differentiate between 2 points when applied to their neck. [Source]
- Increased pain and tenderness in the upper neck – patients with cervical spine issues show increased tenderness to touch in their upper neck. It becomes even more significant if pressing on a sensitive area recreates the pattern of head pain [Source]
Can The Neck Be Fixed?
A 2015 study looked at the effects of an atlas realignment in patients with chronic migraine headaches. The study showed that a gentle correction to the upper neck showed significant improvements in headache days and quality of life in migraine patients over the course of 8 weeks.
We rely on 3 big factors for improving the neck.
- We need to see a structural change in the biomechanical alignment of the neck after an atlas correction.
- We want to see a global change in posture in response to correcting the alignment of the neck
- We want to see a change in the tenderness of the muscles and nerves stemming from the upper neck. Just as we saw that those tender spots predicted migraine, when we feel those tender points subside right after a correction, it’s a strong marker that we are on the right track.
While we can’t fix everyone, there’s a large segment of the migraine population that would do well with this form of care, but we have to make sure we identify the right candidates.