BMJ's "BEST EVIDENCE" FOR TREATING HEADACHES
As many of you know, I not only love what I do, but I love evidence for what I do (HERE). And although Video Testimonials certainly aren't double-blinded placebo-controlled trials, they provide some degree of proof that what I do in my clinic is effective. Enter EBM. The practice of medicine has literally been overrun by EVIDENCE-BASED MEDICINE. I use the word "overrun" because honestly, who can really trust it ---- especially with such an absurd amount of FINANCIAL CONFLICT OF INTEREST between BIG PHARMA, the FDA, and UNIVERSITY RESEARCHERS? That's just it folks, we can't (Great Britain's most prominent Cardiologist addressed this fact just YESTERDAY). A prime example is the clinical guidelines document from one of the publications put out by the British Medical Journal (BMJ Clinical Evidence) called Overview - Headache (Chronic Tension Type).
Stress Headaches --- frequently referred to as Tension Headaches or Cervicogenic Headaches ---- are headaches that, as the name implies, originate in the cervical spine (neck). The pain will frequently spread up the neck and back of the head, settling in the temples, forehead, and / or around the eyes. This article from February of this year provides physicians the "best evidence" for treating people who suffer with these sorts of headaches. And because I was interested in the Chiropractic Guidelines, that's where I went first.
Although the study did not as much as mention Chiropractic Manipulation in their list of 12 common treatment methods for headaches, they did say that it remained unchanged from the previous guidelines and they provided a link. The Department of Health and Human Services AHRQ site revealed that the government looked at 21 studies, determining that only one was acceptable as far as the quality of evidence was concerned. Let's talk about why this might be for a moment.
When Big Pharma wants to experiment on patients with a new drug (I call it "GUINEA PIGGING"), they do double-blinded, placebo controlled trials. This means that not only do the patients not know whether or not they are getting the placebo (or possibly an older generation drug), but the doctor / nurse does not know either. That way there is not supposed to be any tainting of the evidence from bias. The problem is, the lab is not the real world. Drug studies are very strictly controlled, with far fewer side effects than the real world --- HERE, as well as the fact that the patients actually signed up to be part of the study (and probably have their fingers crossed that they are not given the PLACEBO). It's impossible to do this sort of research with Chiropractic.
In order to follow the "gold standard" of research, not only would some of the Chiropractic patients have to have "sham" adjustments, the doctors giving them would have to not know he / she is giving a sham adjustment. Is that even possible? Of course not! The truth is, most patients know pretty quickly whether their chosen chiro is good at what they do. This does not even get into the fact that there is an entire industry built around drug research. The only research going on in the Chiropractic profession is going on in the Chiropractic Colleges. Mind you, some of this research is pretty cool (HERE). But when compared to Big Pharma, there's not much of it.
When it was all said and done, the HHS document revealed Chiropractic had "moderate evidence" for treating people with Cervicogenic Headaches, Tension Headaches, and Migraines. Their recommendations for the amount of treatment ranged from six sessions (Cervicogenic) on up to eighteen sessions (Migraines). One of the cool things that came out of this document was that, "No side effects were experienced by any subjects in a study using spinal manipulation for the treatment of episodic tension-type headache.... No conflicts of interest were reported for this study." (For the record, Chronic Tension-Type Headaches are just Episodic Tension-Type Headaches that occur more frequently.) Which brings us to the headache research from the other side of the fence --- the medical side.
The number of studies looked at for medical treatment of headaches was significant. "Searching of electronic databases retrieved 125 studies. After deduplication, 77 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 56 studies and the further review of 21 full publications. Of the 21 full articles evaluated, three systematic reviews and one RCT were included at this update."
Some of the specific treatments they looked at included ANTIDEPRESSANTS, PARACETAMOL, OPIOIDS, NASAIDS, BENZOS / VALIUM, and ANTI-CONVULSANTS. The only two treatments they listed that were said to be "beneficial" or "likely beneficial" were two different non-SSRI Antidepressants. Everything else on their list (including Acupuncture and Cognitive Behavioral Therapy) was listed as "unknown effectiveness" or "ineffective or harmful". What does all of this reveal? It tells us that despite spending billions upon billions of dollars on treatments for headaches (not to mention advertising said treatments), we as a nation are still not getting it right --- mostly not even close. What would I recommend for headaches instead of drugs?
When it comes to headaches, there can be an array of causes. The problem with the drugs mentioned above is that they don't really address any of these. They cover the symptoms, making solving the underlying problem(s) that much harder in the future. Once you realize that most non-pathological headaches are either functional or inflammatory, you can begin to formulate a systematic plan to solve your headache problem.
If you are riding the MEDICAL MERRY-GO-ROUND in regards to your HEADACHES, it's very likely there is a solution out there for you. It's just a matter of you finding it. My mission is to help you solve your problem. The really cool thing is that I am not selling you anything --- I'm giving you potential solutions. Furthermore, if I can help you with your headaches, you won't need to come in and see me twice a week for 8 weeks. You'll know AFTER THE FIRST TREATMENT if my approach is going to help you.
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).