CHIROPRACTIC : HELP TREAT MIGRAINE

WHAT IS CHIROPRACTIC?

(from Wikipedia)
Chiropractic is a form of alternative medicine^[1] concerned with the diagnosis and treatment of mechanical disorders of themusculoskeletal system, especially the spine, under the belief that these disorders affect general health via the nervous system.^[2] It is the largest alternative medical profession,^[3] and chiropractors often aspire to become primary care providers, though they lack the medical and diagnostic skills necessary to fulfil this role.^[4] The main chiropractic treatment technique involves manual therapy, especially manipulation of the spine, other joints, and soft tissues, but may also include exercises and health and lifestyle counseling.^[5] The "specific focus of chiropractic practice" is chiropractic subluxation.^[6] Traditional chiropractic assumes that a vertebral subluxation or spinal joint dysfunction interferes with the body's function and its innate intelligence.^[7] Some chiropractors fear that if that do not separate themselves from the traditional vitalistic concept of innate intelligence their profession will continue to be seen as fringe.^[3]

Effectiveness

There is no good evidence that chiropractic is effective for the treatment of any medical condition, except perhaps for certain kinds of back pain.^[9][10] Generally, the research carried out into the effectiveness of chiropractic has been of poor quality.^[83][84]

There is a wide range of ways to measure treatment outcomes.^[85] Chiropractic care, like all medical treatment, benefits from the placebo response.^[86] It is difficult to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT), as experts often disagree about whether a proposed placebo actually has no effect.^[87] The efficacy of maintenance care in chiropractic is unknown.^[13]

Available evidence covers the following conditions:

• Low back pain. A 2013 Cochrane review found very low to moderate evidence that SMT was no more effective than inert interventions, sham SMT or as an adjunct therapy for acute low back pain.^[11] The same review found that SMT appears to be no better than other recommended therapies.^[11] A 2012 overview of systematic reviews found that collectively, SM failed to show it is an effective intervention for pain.^[88] A 2011 Cochrane review found strong evidence that suggests there is no clinically meaningful difference between SMT and other treatments for reducing pain and improving function for chronic low back pain.^[89] A 2010 Cochrane review found no current evidence to support or refute a clinically significant difference between the effects of combined chiropractic interventions and other interventions for chronic or mixed duration low back pain.^[90] A 2010 systematic review found that most studies suggest SMT achieves equivalent or superior improvement in pain and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up.^[91] Specific guidelines concerning the treatment of nonspecific (i.e. unknown cause) low back pain are inconsistent between countries.^[92]
• Radiculopathy. A 2013 systematic review and meta-analysis found a statistically significant improvement in overall recovery from sciatica following SM, when compared to usual care, and suggested that SM may be considered.^[93] There is moderate quality evidence to support the use of SM for the treatment of acute lumbar radiculopathy^[94]and acute lumbar disc herniation with associated radiculopathy.^[95] There is low or very low evidence supporting SM for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration and no evidence exists for the treatment of thoracic radiculopathy.^[94]
• Whiplash and other neck pain. There is no consensus on the effectiveness of manual therapies for neck pain.^[96] A 2013 systematic review found that the data suggests that there are minimal short- and long-term treatment differences when comparing manipulation or mobilization of the cervical spine to physical therapy or exercise for neck pain improvement.^[97] A 2013 systematic review found that although there is insufficient evidence that thoracic SM is more effective than other treatments, it is a suitable intervention to treat some patients with non-specific neck pain.^[98] A 2011 systematic review found that thoracic SM may offer short-term improvement for the treatment of acute or subacute mechanical neck pain; although the body of literature is still weak.^[99] A 2010 Cochrane review found low quality evidence that suggests cervical manipulation may offer better short-term pain relief than a control for neck pain, and moderate evidence that cervical manipulation and mobilization produced similar effects on pain, function and patient satisfaction.^[100] A 2010 systematic review found low level evidence that suggests chiropractic care improves cervical range of motion and pain in the management of whiplash.^[101]
• Headache. A 2011 systematic review found evidence that suggests that chiropractic SMT might be as effective as propranolol or topiramate in the prevention of migraine headaches.^[102] A 2011 systematic review found evidence that does not support the use of SM for the treatment of migraine headaches.^[103] A 2006 review found no rigorous evidence supporting SM or other manual therapies for tension headache.^[104] A 2005 review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine.^[105] A 2004 Cochrane review found evidence that suggests SM may be effective for migraine, tension headache and cervicogenic headache.^[106]
• Extremity conditions. A 2011 systematic review and meta-analysis concluded that the addition of manual mobilizations to an exercise program for the treatment of knee osteoarthritis resulted in better pain relief then a supervised exercise program alone and suggested that manual therapists consider adding manual mobilisation to optimise supervised active exercise programs.^[107] There is silver level evidence that manual therapy is more effective than exercise for the treatment of hip osteoarthritis, however this evidence could be considered to be inconclusive.^[108] A 2008 systematic review found that the addition of cervical spine mobilization to a treatment regimen for lateral epicondylosis (tennis elbow) resulted in significantly better pain relief and functional improvements in both the short and long-term.^[109] There is a small amount of research into the efficacy of chiropractic treatment for upper limbs,^[110] limited to low level evidence supporting chiropractic management of shoulder pain^[111] and limited or fair evidence supporting chiropractic management of leg conditions.^[112]
• Other. A 2012 systematic review found insufficient low bias evidence to support the use of spinal manipulation as a therapy for the treatment of hypertension.^[113] A 2011 systematic review found moderate evidence to support the use of manual therapy for cervicogenic dizziness.^[114] There is very weak evidence for chiropractic care for adultscoliosis (curved or rotated spine)^[115] and no scientific data for idiopathic adolescent scoliosis.^[116] A 2007 systematic review found that few studies of chiropractic care for nonmusculoskeletal conditions are available, and they are typically not of high quality; it also found that the entire clinical encounter of chiropractic care (as opposed to just SM) provides benefit to patients with cervicogenic dizziness, and that the evidence from reviews is negative, or too weak to draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including ADHD/learning disabilities, dizziness, high blood pressure, and vision conditions.^[117] Other reviews have found no evidence of significant benefit for asthma,^[118][119] baby colic,^[120][121] bedwetting,^[122] carpal tunnel syndrome,^[123] fibromyalgia,^[124] gastrointestinal disorders,^[125] kinetic imbalance due tosuboccipital strain (KISS) in infants,^[120][126] menstrual cramps,^[127] or pelvic and back pain during pregnancy.^[128]

Chiropractic for Headache/Migraine

Several clinical trials indicate that spinal manipulation therapy may help treat migraine headaches. In one study of people with migraines, 22% of those who received chiropractic manipulation reported more than a 90% reduction of attacks. Also, 49% reported a significant reduction of the intensity of each migraine.

In another study, people with migraine headaches were randomly assigned to receive spinal manipulation, a daily medication (Elavil), or a combination of both. Spinal manipulation worked as well as Elavil in reducing migraines and had fewer side effects. Combining therapies didn't work any better.

In addition, researchers reviewed 9 studies that tested chiropractic for tension or migraine headaches and found that it worked as well as medications in preventing these headaches. More research is needed to say for sure whether chiropractic care can prevent migraines.

Migraines and Chiropractic Treatment

It often starts with lines or spots or different colored lights performing a dance in front of your eyes. After a short period of time these symptoms develop into a whole raft of more serious symptoms such as general irritability, visual hallucinations, emotional depression, a sensation of numbness, gastrointestinal changes such as constipation and diarrhea. Finally the pain begins and it can range form a mild pain through to more intense feelings of agony that can last for hours or days.

If you get migraines, then you'll know that a migraine is more than just a headache. It's an intense and throbbing pain, which often occurs in one side of the head, although it can be more generalised. This is the classic migraine that people all over the world suffer with on a daily basis. Migraines fall into two main categories,

1. Without aura which is commonly known as a common migraine
2. With an aura which is commonly known as a classic migraine.

Around 1 in 6 cases of migraine are classic and are preceded by an aura. 80% of migraines are common with no aura. An aura is a warning sign that appears between 15 minutes to one hour before the headache starts. Auras are symptoms of the nervous system that is usually visual disturbance or olfactory (smell) disturbance. About 60% of classic migraines report a prodrome which develops in the days to hours before a headache.

Signs and Symptoms:

Migraine without aura common symptoms

• Nausea/vomiting
• Sensitivity to light (photophobia)
• Sensitivity to noise (phonophobia)
• Sensitivity to smell (osmophobia)
• Headache

Migraine without aura additional symptoms

• Feeling cold or hot
• Inability to think clearly or perform normal activities
• Loss of concentration

Migraine with aura has additional symptoms

• Visual disturbances - wavy lines, flashing lights, blind spots
• Stiffness or tingling in neck, shoulders, or limbs
• Lack of co-ordination
• Slurred or muddled speech
• Loss of consciousness (very rare)

Post migraine

• Feeling "washed out"
• Fatigue
• Poor concentration
• Either lethargy or full of energy and revitalised

Causes of Migraine

The causes of migraines are not fully understood. There are a number of different theories as to the cause.

1) Vascular Theory. It is thought that the initial vasoconstriction of the arterioles causes the prodromal and aura symptoms in advance of the headache. The lack of oxygen causes the localised release of serotonin and this results in vasodilation that causes arteries here to widen, leading to the headache. As the arteries widen the pain gets worse and worse. Migraines appear at intervals with days, weeks or months between attacks rather than being a daily headache.

2) Nervous System Nervous system theories suggest that rapid changes in activity of nerve cells in the brain cell and in particular the brain stem have been implicated in migraine and a chemical messenger called seratonin is also thought to be involved. This can be the result of an unstable autonomic nervous system, reduced magnesium levels that result in destabilised nerve membranes or abnormal brain electrical activity ( EEG.

Although migraine is not life threatening, we know how it can impact on your quality of life.

How will Chiropractor be assessed for Migraine?

Your Chiropractor will conduct an extensive background history as well as a thorough examination and possibly even x-rays.

History: 
Usually there is some specific triggering factor may include any one following:

• Physical exertion
• Tension headaches
• Emotional stress
• Rapid blood sugar changes
• Vasoactive foods such as histamine in citrus juice, tyranine in chocolate nuts cheese and red wine, MSG in processed foods coffee tea and alcohol
• Some medications
• Environmental toxins, allergies and sensitivities, chemicals

Pain can be mild, moderate or extremely severe, throbbing in nature, unilateral or bilateral.

Examination: 
Your Chiropractor will assess your posture and look for the underlying cause of the headaches which will look at all of the following factors:

• General posture and flexibility,
• Palpation may reveal muscle tenderness and tightness,
• Specific orthopedic tests to the neck ,
• Muscle tests to determine the extent of weakness,
• Neurological assessment if required,
• X-rays of the neck and or spine may be conducted depending on the extent of your problems and the examination findings.
• Your Chiropractor will discuss with you exactly what examinations will be appropriate and will require your consent before undertaking an examination.

Once a diagnosis has been confirmed then specific treatment options can be discussed.