We are often asked, “..what can chiropractors do for headaches?” To answer this question, let’s look at what a patient might expect when they present with headache complaints.
Previously, we reviewed the differences between tension-type headaches, migraine headaches, and dangerous types of headaches. Keeping that in mind, the history and examination will focus on differentiating between these three types of headaches.
The presenting patient will be given the “usual” paper work to fill out that includes biographical information (name/address, type of insurance, HIPAA forms, and so forth), as well as a history, past history, medication list, family history, current habits, and systems review. Specific questionnaires about headaches that can be scored and compared with future scores are particularly helpful in determining the percentage of change in the condition. The main historical piece of information that differentiates the tension vs. migraine headache is the presence or absence of nausea or vomiting, which is unique to migraines. Migraine headaches are usually preceded with an “aura” or a pre-headache symptom such as ringing in the ears, flashes of light in the visual field, a numbness or tingling sensation, or some odd type of “hint” that a migraine may soon strike, often within 30 minutes after the aura. This is important as a chiropractic treatment given prior to the onset of the migraine can sometimes stop the migraine from starting or progressing. Migraines will often occupy half the head vs. tension-type headaches that often occupy both sides. The history can also give us information about things that may trigger a headache (primarily migraines) such as odors or certain foods (like chocolate, nuts, spicy food), which can lead to specific diet oriented treatment recommendations.
The physical exam include observing the patient’s posture, head carriage, skin color/moisture, and touching the muscles (palpation) feeling for spasm/tightness, temperature/moisture, and/or pain location or radiation. Various “orthopedic tests” include movements of the head and neck in attempt to reduce, reproduce, or increase symptoms with the primary goal of trying to figure out which structures may be generating the pain. Cervical range of motion tests are performed to see which movements increase or decrease the pain. The neurological exam – testing reflexes, muscle strength, sensation (sharp/dull) – may reveal areas of the skin on the head that are either increased / hypersensitive or reduced in sensation (numb). Looking in the back of the eyes is a unique place where blood vessels can be viewed and increased blood pressure, diabetes, increased pressure in the head, and more can sometimes be detected, which can help determine if a dangerous headache is lurking. A cranial nerve exam is also sometimes done as part of the neurological examination.
The chiropractic treatment protocols for headaches include (but are not be limited to): spinal manipulation or mobilization (this is applied to the areas of the neck and/or upper back where the joints are either fixed, displaced, or are applied to a region where the neurological function may be compromised), exercise training, traction, electrical current, ultrasound, stress management, and dietary recommendations.