"Neck pain is the most common musculoskeletal pathology second only to low back pain. It is the fourth largest contributor to global disability with its prevalence ranging between 30 to 71% of the general population. Two thirds of adults are affected by neck pain at some time in their lives.  Most people with neck pain do not experience a complete resolution of symptoms.   Most guidelines related to mechanical neck pain are of poor quality.... Despite an increase in the evidence base, treatment recommendations have not changed significantly over time in their recommendations for interventions used to manage neck pain."  From last month's issue of Biomed Central Musculoskeletal Disorders (Comparison of Clinical Practice Guidelines for the Diagnosis, Prognosis and Management of Non-Specific Neck Pain: A Systematic Review)

"Opioids appear to be over-prescribed."  From last October's issue of Emergency Medicine Australasia (Use of and Attitudes to the Role of Medication for Acute Whiplash Injury: A Preliminary Survey of Emergency Department Doctors)

"The truth is that, among all diseases, headache is one of the hardest to diagnose and treat. It is, in fact a functional central nervous system disorder and no specific markers or organic alterations occur, except when headache is a symptom of another illness.  Moreover, after trying several medical, paramedical, or all-but-medical approaches, most patients continue to suffer from their headache and, being often dissatisfied with the responses obtained, they try self-treatments and thus become pain-killer abusers....  This is even more true if we consider that while headaches can, indeed, be described, their description is hardly objective, and they therefore fall within the domain of subjectivity.  The subjectivism of this pathology never fails to strike me. Patients describe their symptoms, but physicians can never verify them directly."  CHERRY PICKED words from Dr. Gennaro Bussone a 'headache neurologist,' from this month's issue of Neurological Sciences (Clinical Issues of Headaches: A Personal View)

"Medication-overuse headache (MOH) is a common neurologic disorder with enormous disability and suffering and plays a significant role in the transformation from episodic to chronic headache disorders. Multiple terms have been used to describe MOH such as analgesic rebound headache, drug-induced headache or a medication-misuse headache. Patients with established primary headache disorders like migraine or tension-type headaches excessively overuse medication for their acute headache and inadvertently increase the frequency and intensity of their headache.  In this manner, a vicious cycle of further drug consumption and increased headache frequency develops transforming the treatment for their headache to the actual cause of their disease (MOH)."   From this month's issue of STAT Pearls (Medication-overuse Headache (MOH)

When looking at the quotes above, it seems that the more things change, the more they stay the same.   Medical guidelines are, well, medical guidelines --- trust them at your own peril (HERE).   There still are not standard medical tests that do a good job of actually "visualizing" what may be causing people's headaches, unless of course they are being caused by gross pathology such as a brain tumor or aneurysm.   The most brutal assessment from the quotes above, however, is how common chronic headaches really are in the general population; affecting somewhere between one and two thirds of everyone.

With costs for managing CHRONIC PAIN (including headaches) continuing to soar on a parallel path with the 'we-just-can't-seem-to-get-a-handle-on-it' OPIOID CRISIS, what else can be done?  To help answer that, today we are going to take a look at some of the latest research concerning CHRONIC HEADACHES, CHRONIC NECK PAIN, and WHIPLASH --- all of which are intimately related to the cervical spine.

In a study showing the power of PROPRIOCEPTION, this month's issue of Musculoskeletal Science & Practice (Gait Speed and Gait Asymmetry in Individuals with Chronic Idiopathic Neck Pain) revealed that, "Individuals with chronic idiopathic neck pain had slower gait speed in all walking conditions compared to controls.  In preferred walking and walking at maximum speed conditions, gait was found to be asymmetric in individuals with chronic idiopathic neck pain."  In other words, the neck cannot be separated from the rest of the body musculoskeletally.  It's all one organism, connected by the nervous system (HERE) and fascia (HERE).

As you might guess, there are increasing numbers of studies linking headaches to both stress (SYMPATHETIC DOMINANCE) and Gut dysfunction.  While a dysfunctional gut can take on many characteristics, they can essentially be broken down into two; THE LEAKY GUT and THE DYSBIOTIC GUT.  Listen to next month's issue of Behavioral Pharmacology (Stress and the Gut Microbiota-Brain Axis).  "Stress is a nonspecific response of the body to any demand imposed upon it, disrupting the body homoeostasis and manifested with symptoms such as anxiety, depression or even headache."  It's why I've said repeatedly that if you want to restore HOMEOSTASIS, it all starts with GUT HEALTH, which usually takes us back to DIETARY FACTORS and ANTIBIOTIC USE / ABUSE (remember, however, that all drugs have gut-destroying antibiotic-like properties --- HERE).

Speaking of dietary factors; when I have patients with chronic headaches, one of the things I usually suggest trying first --- especially for the person who has seemingly tried 'everything' --- is an ELIMINATION DIET.  This lets us see whether or not certain foods might be driving the underlying inflammation / immune system responses, which are frequent drivers of headaches.   I've spoken in the past about a brain-destroying "PARKINSON'S-LIKE" phenomenon that ravages the lower brain (cerebellum) called CEREBELLAR ATAXIA.  A study from this month's issue of the Journal of Oral & Facial Pain and Headache (Headache in Patients with Celiac Disease and Its Response to the Gluten-Free Diet) not only revealed that 6 of 10 CELIACS had abnormal cerebellar MRI's, but that 42% had chronic headaches related to consuming GLUTEN.  The only way to avoid the "white matter lesions" of the brain that these authors talked about?  The GLUTEN-FREE diet of course.  Just be aware that Non-Celiac Gluten Sensitivity (NCGS) is multiple times more common and can be equally as severe as Celiac Disease, although it's not nearly as easy to test for using standard lab / blood tests.

Another study, this one from the same issue of the same journal (Headache in Patients with Celiac Disease and Its Response to the Gluten-Free Diet) looked at over 1,500 Celiacs with chronic headaches, describing them as mostly female (94%) with an average age of nearly 40.....

"Tension-type headache was the most prevalent headache type (52%), followed by migraine (48%). Of the included participants, 24% reported headache as the main symptom that resulted in the diagnosis of CD. Following initiation of a gluten-free diet, headache frequency and intensity improved significantly more in participants with migraine than tension-type headache. Compliance to the diet was higher among subjects with severe manifestations, and compliant individuals showed a 48% improvement in headache frequency. An association between food transgressions and headache was better recognized by migraineurs."

What this tells me is that not only are headaches a common sequalae of Celiac Disease, but that with Celiacs struggling with tension-type headaches there are more likely to be secondary factors at play --- probably mechanical factors like SUBLUXATION or ADHESED FASCIA.  While these can and do play a frequent role in MIGRAINE HEADACHES, they are far more common in the tension headache sufferer.  Another study --- this one from the current issue of Pain and Therapy (The Relationship Between Musculoskeletal Pain and Picky Eating: The Role of Negative Self-Labeling) showed that of the more than 4,600 adults looked at, "The prevalence of musculoskeletal pain in every region was seen as consistently higher in subjects who self-identified as picky eaters than those who were non-picky eaters." The number one painful association of picky eating was ---- neck pain.

The latest copy of the journal Pain Medicine (Ingrowth of Nociceptive Receptors into Diseased Cervical Intervertebral Disc Is Associated with Discogenic Neck Pain) described a model almost identical to what you see on my CHRONIC PAIN PAGE, although their model was used to describe deteriorating spinal discs in the neck.  There is a buildup or ingrowth of inflammation-sensitive fibers into degenerating discs and soft tissues that can make them absurdly pain-sensitive (FAMED NEUROLOGIST, CHAN GUNN, described this phenomenon as causing a neuro-chemical reactivity that could potentially make these tissues over 1,000 times more pain-sensitive than normal).   BTW, this testing was done via biopsy instead of MRI.  What about MRI findings for these sorts of patients?

I've previously shown you how futile MRI can be in many --- maybe even the majority --- of lumbar disc cases.  This is because study after study has shown that somewhere between half to three quarters of the adult population is walking around with MRI-visible disc herniations in their low backs, but have no idea because they do not hurt (HERE --- and the same thing is true of SHOULDERS AS WELL).   Now we see that it's also true of necks.   A study from January's issue of the Journal of Magnetic Resonance Imaging (Cervical Spine Findings on MRI in People with Neck Pain Compared with Pain-Free Controls: A Systematic Review and Meta-Analysis) looked at the findings of over 4,000 subjects from 32 studies, coming to these conclusions.   Other than the fact that the cross-sectional area of a specific muscle --- rectus capitus posterior --- was smaller in people with chronic pain, "The remaining meta-analysis comparisons showed no group differences in MRI findings.  Definitive conclusions cannot be drawn on the presence of MRI findings in individuals with whiplash-associated disorders or non-specific neck pain compared with pain-free controls."

When it comes to chronic whiplash-related neck pain, what are the chief factors that indicate that a poor outcome might be on the horizon?  Next month's issue of the Clinical Journal of Pain (Precollision Medical Diagnoses Predict Chronic Neck Pain Following Acute Whiplash Trauma) answered that question after comparing 700 WHIPLASH PATIENTS to 3,600 controls.    While I expected to see patients with a list of either AUTOIMMUNE or INFLAMMATORY diseases, what we saw instead was...

• People with "pre-collision pain".
• People with "medically unexplained physical symptoms" (MUPS --- many specialists say MUPS is the single biggest medical problem facing modern America).
• People with a "low threshold for contacting health care services" (people who live at the doctor).

The conclusion was that the people who fit this mold were thought to be undergoing varying degrees of CENTRAL SENSITIZATION prior to the WHIPLASH ACCIDENT.

As far as treatment of neck pain and headache, whether caused by whiplash or not, numerous studies showed exercise and stretching programs to generally be at least somewhat effective, but not as much so as you would think.  The same thing was true of massage, with a study from eight authors found in this month's issue of the Journal of Alternative and Complementary Medicine (Massage for Pain: An Evidence Map).  After looking at 49 systemic reviews on the subject, the authors determined that "High quality reviews concluded that there was low strength of evidence of potential benefits of massage for labor, shoulder, neck, low back, cancer, arthritis, postoperative, delayed onset muscle soreness, and musculoskeletal pain."  Does this tell us that massage doesn't work?  Because the vast majority of those utilizing massage pay out-of-pocket for these services --- something they would not continue if it didn't work --- I would argue that there is something inherently wrong with the study; something I've been hollering about in my EVIDENCE-BASED MEDICINE COLUMN for a decade.  BTW, the exact same thing has been said of both chiropractic and physical therapy, which I'll show you momentarily.

Speaking of the combination of adjustments and therapy, a study from last month's Journal of Physical Therapy Science (The Effect of Massage Technique plus Thoracic Manipulation versus Thoracic Manipulation on Pain and Neural Tension in Mechanical Neck Pain: A Randomized Controlled Trial) showed that even though "The exact pathology of mechanical neck pain has not yet been fully elucidated but it has been suggested that it relates to various pain-sensitive structures, including the muscles, ligaments, zygapophyseal joints, uncovertebral joints, intervertebral discs, and neural tissue, a significant reduction in resting neck pain was seen in the thoracic manipulation plus massage group, compared to that achieved using thoracic manipulation alone. The use of thoracic manipulation and massage is recommended to reduce resting neck pain and increase pain-free neural tissue extensibility."  While it's certainly not massage, I could say the same thing about the TISSUE REMODELING we do in-house.

A French study from this month's issue of Frontiers in Psychiatry (Bright Light as a Personalized Precision Treatment of Mood Disorders) cemented some non-mainstream facts that I wrote about in my recent articles, OBESITY, LIGHT, LEPTIN RESISTANCE, AND THE BRILLIANT MADNESS OF JACK KRUSE and THE IMPORTANCE OF SUNSHINE BEYOND VITAMIN D.    After mentioning headaches as a potential "transient, mild and rare" side effect, the authors revealed of bright light therapy.....

"Bright light therapy (BLT) has physiological effects by resynchronizing the biological clock (circadian system), enhancing alertness, increasing sleep pressure (homeostatasis), and acting on serotonin and other pathways.   A growing body of evidence has been generated over the last decade about BLT evolving as an effective depression treatment not only to be used in seasonal affective disorder (SAD), but also in non-seasonal depression, with efficiency comparable to fluoxetine [Prozac], and possibly more robust in patients with bipolar disorders (BD). The antidepressant action of BLT is fast (within 1-week) and safe, with the need in BD to protect against manic switch with mood stabilizers."

I brought this up because the latest issue of Current Treatment Options in Neurology (Antidepressants for Preventive Treatment of Migraine) talked about using, just as the title stated, antidepressants, as a "preventative" for MIGRAINE HEADACHES.  The authors prefaced this by revealing that (whisper whisper), "SSRIs including fluoxetine [Prozac] are not effective for most patients..."  If not using ultra-common SSRI's, what are they using?  SNRI's like amitriptyline / nortriptyline (Elavil / Pamelor and Aventyl) --- drugs with common nasty side effects).  The authors prefaced their giddiness by letting readers know that "The side effect burden of antidepressants can be substantial. Patients should be particularly counseled about the possibility of a withdrawal effect from SNRIs."  Remember that we've seen just how ineffective these drugs really are for solving depression (HERE) as well as their SEXUAL SIDE-EFFECTS.  You need to be aware of this (HERE) because "Antidepressants are commonly used as migraine preventives."

But what happens when the medications, as is often the case, don't work?  Worse yet, what if your medications were actually causing the very problem you were using them to solve (a common problem with depression --- HERE)?  Although side-effects to all drugs are orders of magnitude greater than typically reported (HERE), when it comes to headaches, this particular phenomenon is so common that it has its own special name ---- medication overuse headaches or simply "rebound".  How common are rebound headaches?  Just days ago, Neurological Science (Epidemiology and Management of Medication-Overuse Headache in the General Population) answered that question by revealing that "Medication-overuse headache is a worldwide challenge as it affects 1-2% of the general population."  What do these numbers tell us?  160 million people worldwide --- a number equivalent to about half the US population --- are dealing with rebound headaches.   It also means that in my little town of 3,000 people, there are probably 60 people stuck in this vicious cycle.

A title of a study from this month's issue of Nature Reviews Neurology (Complete Withdrawal More Feasible and Effective than Restriction in Medication-Overuse Headache) said it all via it's title --- describing very same thing I promote for breaking sugar addictions (COLD TURKEY).  A study from this month's issue of Frontiers in Neurology (Negative Short-Term Outcome of Detoxification Therapy in Chronic Migraine With Medication Overuse Headache: Role for Early Life Traumatic Experiences and Recent Stressful Events) tried to predict which people would succeed with a headache medicine "DETOX PROGRAM" and which would fail. 

"Among the most popular and disabling neurological disorders, migraine is at the top of the list. In most sufferers, attacks recur episodically, even if in a small—but significant—portion of migraineurs the disease evolves into a chronic pattern, that is, chronic migraine (CM). Transition from episodic to CM often occurs in association with a progressive increase in the intake of acute medications, so that the large majority of patients with CM also fulfill criteria for Medication Overuse Headache (MOH).   Data suggest that early life traumas and stressful events have a negative impact on the outcome of the detoxification program in subjects overusing acute medication for headache. The history of emotional childhood traumas is associated to the failure to cease overuse, whereas recent very serious life events are associated to the persistence of headache chronicity."

Last month's issue of Frontiers in Neurology (Features of Primary Chronic Headache in Children and Adolescents) stated, "Chronic migraine (CM), chronic tension-type headache (CTTH) and new daily persistent headache (NDPH) are classified as CPH.  Chronic primary headaches (CPH) are a disabling disorder for children, adolescents, and adults, with a reported prevalence of 2% in adults and .78% in adolescents, while the prevalence rises up to 1.75% when including medication overuse headaches."  Another study, this one from the February copy of Cephalgia (The Prevalence of Headache in German Pupils...) provided more detail of just how common and severe headaches are in the pediatric (under 18) population.   So; what about treating children with headaches similar to adults with headaches as far as manual therapy is concerned?

This month's issue of BMC Complementary and Alternative Medicine asked the same question of manual therapy for children that they did pertaining children and massage we looked at earlier.  After looking at 50 studies on using manual treatment to affect a wide variety of problems, including back pain, neck pain, and headaches, the authors concluded that "Moderate-positive overall assessment was found for 3 conditions: low back pain, pulled elbow, and premature infants.  Unfavorable outcomes were found for 2 conditions: scoliosis and torticollis. All other condition's overall assessments were either inconclusive favorable or unclear. Adverse events were uncommonly reported."  In other words, sometimes it works and sometimes it doesn't.  The super cool thing, however, is the extremely low side effect profile --- an especially big deal after what we've read about the freaky side effect profiles of some of the most commonly used headache and neck pain medications.

"Classical Conditioning" was a phrase coined by Russian physiologist, Ivan Pavlov, back in the late 1800's.  In his famous dog experiments he associated feeding time for his dogs with ringing a bell, discovering that even in the absence of food, tinkling his bell would cause the hounds to salivate profusely.  Simply Psychology said this of the phenomenon as a form of treatment.  "For classical conditioning to be effective, the conditioned stimulus should occur before the unconditioned stimulus, rather than after it, or during the same time. Thus, the conditioned stimulus acts as a type of signal or cue for the unconditioned stimulus."  Why is "before" such a big deal when compared to "during or after" --- especially when it comes to headaches?  This month's issue of Current Headache Reports (Pavlov’s Pain: The Effect of Classical Conditioning on Pain Perception and its Clinical Implications) explains....

"It has been known for decades that classical conditioning influences pain perception.  We first review studies regarding how classical conditioning alters pain perception with an emphasis on two phenomena where conditioning increases pain sensitivity (i.e., conditioned hyperalgesia) or decreases it (i.e., conditioned hypoalgesia). Specifically, we critically examine empirical studies about conditioned hyperalgesia and conditioned hypoalgesia, explore reasons why conditioning leads to these two seemingly opposite phenomena, and discuss the neural mechanisms behind them. We then highlight how conditioning contributes to the development and maintenance of chronic pain, and present neuroscientific evidence for maladaptive aversive conditioning in chronic pain patients. Moreover, we propose a framework for understanding how to exploit conditioning to optimize pain treatment, including minimizing conditioned hyperalgesia, maximizing conditioned hypoalgesia, and eliminating excessive fear and overgeneralization in chronic pain."

I was not going to pay $40 to look at the whole study, but suffice it to say that "conditioning" may be driving your headaches and pain as opposed to being used as a tool against.  What are some of the things that we know can adversely condition people's pain levels beyond stress and inflammatory diets?  Our national addiction to media (social media, porn, cell phones, computers, TV, etc, etc) has been in the news lately and is proving to be a HUGE PROBLEM in this arena, most particularly for children.  It's why I talk on my site so much about getting your mind right.  After all, one of King Solomon's proverbs (23:7) tells us that "as a man thinketh in his heart, so is he."  

To see our complete (nothing is ever really "complete") ANTI-INFLAMMATION / RESOLUTION PROTOCOL for getting out of pain and starting the process of taking your life back, just click the link.  While not everything there will pertain to everyone, there are some great tidbits to be gleaned and digested.  And if you appreciate our site, be sure and spread the wealth by liking, sharing, or following on FACEBOOK as it's still a nice way to reach the people you love and value most! 

Dr. Rebecca Wells is a neurologist at Winston-Salem's Wake Forest University, who was also on the faculty of the American Headache Association's recent symposium in Scottsdale, AZ (held the same time the FASCIA CONGRESS was held).  She also happens to be into CAM (complementary and alternative medicine).  Last year she was co-author of a study published in Medical Clinics of North America titled Complementary and Integrative Medicine for Neurological Conditions: A Review, which among other things concluded...

"Although many neurological conditions are common, cures are rare and conventional treatments are often limited. Many patients therefore turn to complementary and alternative medicine (CAM)."

In this piece she talked about lifestyle changes (which should under no circumstance be considered an alternative, although unfortunately they are --- HERE), acupuncture, nutritional supplements, and several others.  Interestingly, she made the statement, "The lack of well-conducted research for chiropractic treatment along with the potential risks of cervical manipulation limit its recommendation for use for migraine."  That was in September of last year.  At the Symposium she listed chiropractic adjustments as one of the six categories of CAM used for treating people with migraines (caveat included).  Aside from nutrition and lifestyle changes, it might actually be the most commonly used treatment on the list, despite her warnings about the side effects of both.

Wells also made this statement concerning the reason more people don't opt for CAM, instead choosing standard medical care (i.e. drugs).  "For some people, it's just easier to take a pill. Some treatments require a change in lifestyle or a change in the way people manage their time."  I would heartily agree.  I created an extremely generic template to help people start the process of getting out of pain by diminishing their inflammatory load (INFLAMMATION IS AT THE ROOT OF NUMEROUS HEALTH-RELATED ISSUES), but will take some time and effort to follow (HERE).  Is it worth it?  Depends on who you ask. 

Rest assured, however, that the traditional medical approach to dealing with chronic MIGRAINE HEADACHES (or other HEADACHES for that matter) will cause problems.  This is because even OTC meds such as ASPIRIN, TYLENOL, and NSAIDS are downright dangerous, causing tens of thousands of deaths per year (along with WHO-KNOWS-HOW-MANY side effects); and this doesn't even begin to touch on the vast number of PRESCRIPTIONS taken for headaches.  The problem comes in because whether people are using dangerous drugs or safer therapies, the treatment(s) must be done over and over and over again --- something that's always been a knock against both chiropractic (HERE) and therapy (HERE).  How might the approach I frequently use in my clinic be better than manipulation alone?

The first thing to remember is that headaches can have numerous causes that can typically be broken down into three categories, chemical, mechanical, or electrical (HERE).  Secondly, while I am a huge fan of CHIROPRACTIC ADJUSTMENTS for people with different varieties of headaches, these individuals may require something to break the tethered tissues so they actually hold the adjustment. In other words, they may have to deal with their underlying and invisible FASCIAL ADHESIONS.  In my clinic there are no drawn out treatment schedules or high dollar care plans.  It's rather simple --- you will know in one treatment whether or not I can help you with your chronic headaches (HERE or HERE).

So, while I appreciate the fact that some in the mainstream are pushing certain aspects of CAM for headaches, there are tens of millions of people shaking their collective heads because they figured out years ago that drugs aren't the answer.  To learn more about HEADACHES, MIGRAINES, NECK PAIN, WHIPLASH, and RELATED TOPICS, just follow the links.  And be sure to take a look at at least some of the items on this DIY SOLUTIONS LIST, as you might find something there that could help reduce your systemic inflammation, free your body up, and help you with any number of health-related problems, headaches included.  If you enjoy our site, be sure and share it with others.  A great way to do this?  FACEBOOK, of course!

Back in June a team of Swedish researchers put together a study for the Journal of Pain Research titled Exploring Patients' Experiences of the Whiplash Injury-Recovery Process.   Knowing what we already know about recovery from whiplash injuries (OVER 50% OF THOSE INJURED --- MOSTLY WOMEN --- WILL DEAL WITH CHRONIC SYMPTOMS FOR THE REST OF THEIR LIVES), listen to how these authors described the feelings that are found hand-in-hand with whiplash.  Before you write someone off who has been "whiplashed," read through this CHERRY-PICKED paragraph a couple of times.....

"Approximately 50% of patients with WAD (whiplash-associated disorders) have long-term symptoms after their injury, and a large proportion are reported to have poor quality of life. Additionally, 13–50% are unable to work or participate fully in their daily activities.  Changes in self-image were difficult to cope with and likely led to perceived stigmatization. Struggling with feelings of loss of control appeared to lead to low confidence and insecurity.  The participants talked about pain and other symptoms interfering with their lives and about the loss of hope, ability, social roles, autonomy, and spontaneity. The participants also noted that it was difficult to continue exercising even though they believed exercise was beneficial. The participants believed that they had lost the physical capacity they had before the injury, and they felt sad and helpless about all physical, psychological, and social losses that were consequences of WAD.  The participants struggled with their confidence in their ability to control their pain and daily life. Low perceived control appeared to lead to low confidence and insecurity regarding the ability to manage injury-related problems and the future.  The perceived severity, manageability, and realistic expectations of symptom development also influenced the participants’ feelings of control. Severe symptoms were difficult to tolerate and manage and decreased the participants’ beliefs and confidence regarding their ability to control the situation. The participants did not always know what worsened pain and other WAD-related symptoms. The participants tried to determine how to control their situation but did not often succeed.  Returning to work was perceived as a challenging outcome. The combination of expectations regarding recovery and daily experiences of fluctuating symptoms decreased the participants’ confidence concerning the future and their return to work."

Thus, it's not too surprising that the same study went on to use these words / terms when describing the effect that chronic whiplash symptoms have on people. 

"Loss of ability, loss of confidence, loss of freedom, loss of hope, slavery [to pain] abandoned by those around, loss of social roles, frustration, fear, distress, sadness, worry, negative moods, stigma, chaos, mystery, a riddle needing answers, incongruities, unsure about future, changed self-image, struggling with control....."

Unless you deal with these types of patients on a day-to-day basis, it doesn't make sense.  It seems overblown.  Over-the-top.  Exaggerated.  Pretentious hyperbole.  Not only is it not an elaboration, the above quotes should help one understand a concept commonly seen in those injured by whiplash --- something known as "catastrophizing". 

Catastrophizing is the belief that something, one's pain, the ability to function, or possibly even the future, is or may be much worse or bleaker than it actually is or will be.  Also known as "cognitive distortion," Wikipedia describes it as "exaggerated or irrational thought patterns involved in the onset and perpetuation of psychopathological states, especially in those more influenced by psychosocial factors, such as depression and anxiety."  All the more important to understand once you realize how often DEPRESSION and ANXIETY plague whiplash sufferers.  Allow me to show you just how real this phenomenon of catastrophizing really is in many trying to cope with chronic neck pain.

Lat month's issue of Somatosensory & Motor Research (Observing Neck Movements Evokes an Excitatory Response in the Sympathetic Nervous System Associated with Fear of Movement in Patients with Chronic Neck Pain) showed that for someone with serious neck pain related to movement, just looking at neck movements (pics or video) can invoke a fear-based response of the SYMPATHETIC NERVOUS SYSTEM (fight or flight). 

"The objective of this study was to evaluate the response of the sympathetic-excitatory nervous system in patients with chronic neck pain compared with a control group of asymptomatic subjects who underwent an intervention of watching activities involving movements in the neck region. The ANOVA test revealed significant differences in the increase in skin conductance in the chronic neck pain group after observing the activities (both in the photographs and video) at the end of the observation and 5 minutes after the intervention. Ultimately, the correlation analysis revealed a moderate positive correlation between kinesiophobia [fear of movement] and skin conductance at 30 seconds and at 60 seconds of observing the activities in the video for the chronic neck pain group. Based on the results of the present study, we suggest that observing activities involving neck movements causes an activation of the sympathetic-excitatory nervous system in patients with chronic neck pain. These changes could be related to a fear of movement when faced with visual exposure to neck movements that could be interpreted as 'harmful' or 'dangerous'."

Although some may balk at using the term PTSD (post-traumatic stress disorder) to describe whiplash sufferers, whiplash and MVA (motor vehicle accidents) have been widely recognized as a common cause for decades.  Less than a month ago, the European Journal of Pain (Trajectories of Post-Traumatic Stress Symptoms After Whiplash) came to some shocking conclusions.  The Danish research team looked at PTSD 'predictors' ("pain, fear-avoidance-beliefs, pain-catastrophizing, depression......") and determined that although most people (75%) involved in a whiplash accident showed little or no signs of PTSD, 25% did.  Of that 25%, about 40% recovered fully from the PTSD within six months. 

However, the rest of the rest (60%) were labeled "chronic," and were described as having, "high initial PTSD symptom levels and a small increase over time. Initial higher pain and depression levels predicted the recovering and chronic trajectories.  The chronic trajectory suggested that a significant subset of people does not recover from PTSD symptoms.  This class also reported more pain-related disability."  In other words, about 15 out of 100 who had at least a degree of PTSD got worse.  15% may not seem like a big number until you start grasping that there are several million such injuries each year.

What's regrettable about this situation is how these individuals are dealt with by the largest portion of the medical community.  Even though whiplash research abounds, the chief forms of medical treatment have remained the same as they were since long before I was in practice (I graduated in 1991).  In fact, things may have gotten worse.  Case in point, a study from last month's issue of Emergency Medicine Australasia (Use of and Attitudes to the Role of Medication for Acute Whiplash Injury: A Preliminary Survey of Emergency Department Doctors) looked at the most commonly prescribed drugs for WAD in an ER setting (NSAIDS --- 78% of the time, PARACETAMOL, what the rest of the world calls acetaminophen --- 75% of the time, OPIOIDS --- 44% of the time, and benzos --- 11% of the time).  The authors also concluded that "most [ER docs] were comfortable to prescribe pregabalin" and that "opioids appear to be over-prescribed".  For the record, pregabalin (LYRICA) is a terrible drug for most people (HERE).   Bottom line, far too many people end up on "THE BIG FIVE" or worse after an MVA.

Although there are an almost unlimited number of ways that people end up being "WHIPLASHED," MVA (motor vehicle accidents) are far and away the most common. Although there are many potential tissue culprits as far as the source(s) of said pain, the CERVICAL FASCIA is arguably one of the most common causes --- particularly when it comes to CHRONIC NECK PAIN.  The only reason I use the word 'arguably' is because since the CF does not show up on standard advanced imaging such as MRI (HERE), it's completely off the radar of the average physician.  It's a large part of what makes fascia chronic pain's PERFECT STORM.  And although the authors were talking about TRIGGER POINTS as opposed to the flip side of the myofascial syndrome (SCAR TISSUE / FIBROSIS), listen to what the National Fibromyalgia & Chronic Pain Association (Cervical Myofascial Pain) said about this phenomenon -- a phenomenon you will see as a common theme in today's post.  "The diagnosis of this syndrome is clinical, with no confirmatory imaging or laboratory tests available."

Although the pictures below do not show much fascia (aside from the GALENA APONEUROTICA --- the fascia on top of the skull), don't forget that it's there.  The large arrow in the middle of the page is where the external occipital protuberance (EOP) is, which happens to be the center of the occipital ridge (see arrows on all three pictures).  As you can see, a number of large muscles anchor to this ridge, and thanks to Wolf's Law (bone grows in response to mechanical stress, whether that stress is normal or abnormal), you can feel these attachment points --- particularly if you have been living with extensive amounts of mechanical stress (excessive pulling) in your neck region (FHP is one of the more common of these).  Just how big is this problem of Forward Head Posture (perpetual cervical flexion)?

The August issue of the Journal of Electromyography and Kinesiology described this relationship between PROPRIOCEPTION AND FASCIA and other connective tissues in a study titled Disturbance of Neck Proprioception and Feed-Forward Motor Control Following Static Neck Flexion in Healthy Young Adults.   To understand how big a deal this study really is, it's important to grasp the fact that CERVICAL EXTENSION (the opposite of cervical flexion, which describes one's ability to tip one's head backwards, hopefully to the point that the forehead is parallel to the floor) is arguably the most important range of motion in the body.

"The highly complex proprioceptive system provides neuromuscular control of the mobile cervical spine. Static neck flexion can induce the elongation of posterior tissues and altered sensory input from the mechanoreceptors.... Following flexion, the absolute and variable errors in head repositioning significantly increased. The results also showed that there was a significant delay in the onset of myoelectric activity of the cervical erector spinae muscles after flexion. The results of this study suggested that a 10-min static flexion can lead to changes in the neck proprioception and feed-forward control due to mechanical and neuromuscular changes in the viscoelastic cervical spine structures. These changes in sensory-motor control may be a risk factor for neck pain and injury."

And if you already have pain and injury, there is great potential to form a vicious cycle of pain, dysfunction (including abnormal proprioception), and the subsequent degeneration that always follows close on their heels.

Because neck pain can be both debilitating and progressively degenerative (the "vicious cycle" mentioned above), it makes sense that drugs from the "Big Five" class are not going to help you, even though if you have read this far you have probably been prescribed all of them and then some.  Something must be done to take mechanical stress off of the soft tissues and facet joints.  While I am a huge fan of various forms of body work and massage, I frequently deal with the people who, while they might be helped by massage, chiropractic adjustments, or various forms of THERAPY, the relief is always short-lived (HERE), much of which is due to the nature of FASCIA and the subsequent "FASCIAL ADHESIONS" that can form in these tissues due to trauma, repetitive movements or jobs, or postural considerations. 

As I've shown you in the past, the endproduct of inflammation is always fibrosis (HERE).  While a certain amount of this is a good thing (LOCAL INFLAMMATION is critical for healing injured connective tissues), too much inflammation (SYSTEMIC INFLAMMATION) coursing through your body is not only detrimental but highly detrimental.  This is why those of you struggling with situations like these or others (UPPER CROSSED SYNDROME, LOWER CROSSED SYNDROME, etc, etc) must get your act together as far as what you are eating, how you are living, as well as the chemicals you are exposing yourself to on a day-by-day basis.  Before we delve more into the specific issue of what it might take to get you on the road to recovery, let's take a few moments to look at the latest research on all things neck pain.

When you see the term "Cervicogenic Headache," know that it refers to headaches that are being generated by abnormal structure or function of the cervical spine (chiros refer to this dysfunctional alignment and motion as "SUBLUXATION").  I bring this up because authors of an article from a June issue of the medical educational journal, StatPearls, wrote of the relationship between the nerves in the top of the neck and headaches.  "A cervicogenic headache is thought to be referred pain arising from irritation caused by cervical structures innervated by spinal nerves C1, C2, and C3; therefore, any structure innervated by the C1–C3 spinal nerves could be the source for a cervicogenic headache.  It is predominant in females.  Pain can mimic primary headache syndromes such as tension headache or migraine headache." 

Best way to solve this issue?  "Manipulative therapy and therapeutic exercise regimen are effective in treating a cervicogenic headache.   .....72% of patients had achieved a reduction of 50% or more in headache frequency at the 12-month follow-up, and 42% of patients reported 80% or higher relief of some sort."  Hang on because I will shortly address a common reason that adjustments don't work (or don't hold very long) for a significant portion of the population.

For the record, this study also stated that "the source of the pain must be in the neck and perceived in the head or face."  If you have followed my site you are already aware that I have written extensively about both SKULL PAIN and FACE PAIN.  What I have found with face pain is that it's more frequently solvable when it can be tied to a specific trauma.  A recent study from Neuroimage Clinical helps spell out the reason for this --- the pain can come from BRAIN ABNORMALITIES. 

"Chronic orofacial pain (COFP) disorders are prevalent and debilitating pain conditions affecting the head, neck and face areas.  Overall, these findings provide evidence of brain abnormalities in pain-related regions, namely the thalamus and insula, across different COFP disorders."

This is of particular interest once you realize how important the role of the thalamus is in chronic pain that originates in the brain itself as opposed to injured tissues, and is otherwise known as CENTRAL SENSITIZATION.  Without going into detail, suffice it to say there are numerous studies linking CS to whiplash. 

We've briefly discussed cervicogenic headache, but what about cervicogenic dizziness?  A study from last month's issue of the European Archives of Otorhinolaryngology (Approach to Cervicogenic Dizziness: A Comprehensive Review of its Etiopathology and Management) stated that, "Though there is abundant literature on cervicogenic dizziness with at least half a dozen of review articles, the condition remains to be enigmatic for clinicians dealing with the dizzy patients."  Would it make sense that if the source of the dizziness is the same or at least similar to the source of cervicogenic headaches, you might want to try treating it the same way?  Although this and similar situations might call for the expertise of a FUNCTIONAL NEUROLOGIST, this is typically a great starting point, with the potential to help many in this category.

Because MIGRAINE HEADACHES and TEMPOROMANDIBULAR DISORDERS are so frequently seen after whiplash as well, the importance of a study titled Muscle Tenderness Score in Temporomandibular Disorders Patients: A Case-Control Study from this month's issue of the Journal of Oral Rehabilitation cannot be overlooked.  Whiplash patients (again, mostly women) showed jaw muscle tenderness and trigger points that were associated with, "female sex, whiplash history, parafunction [poor or abnormal function], co-morbid pains such as headaches and body pain, pain intensity, onset, frequency, and duration."  And as for migraines, a study from the September issue of Musculoskeletal Science and Practice (Cervical Musculoskeletal Dysfunction in Headache: How Should it be Defined?) debated whether neck pain is the result of headache, or headache is the result of neck pain.  I would argue that the point is moot because the nerve pathways are largely a two way street, with one almost always being able to cause the other (notice below that this study --- by a team of Australian researchers --- gave us an amazing definition of 'subluxation,' actually mentioning the difference between SEGMENTAL AND SECTIONAL NECK MOTION).

"Neck pain commonly accompanies migraine and tension-type headache.  Reliance on pain sensitivity or the presence of neck tenderness/trigger points as measures be discarded, as they are not uniquely tied to a musculoskeletal disorder. Instead, place reliance on tests of musculoskeletal (dys)function. A typical presentation includes at a fundamental level, interrelated changes in cervical movement, segmental joint and muscle function."

Another study, this one from Acta Neurologica Belgica (Neck Pain: Is it Part of a Migraine Attack or a Trigger Before a Migraine Attack?) pushed this issue even further when it stated, "Neck pain may actually be the most common migraine symptom despite the fact that it is rarely listed among usual symptoms such as nausea and light sensitivity." The authors, however, could not answer the question posited in the study's title because 90% of the participants said that they started at the same time.  Before we head to the next section (treatment), I need to briefly mention a study on neck pain in athletes.

Lat month, the Asian Spine Journal published a systematic review of the scientific literature titled Prevalence of Neck Pain among Athletes that encompassed numerous studies on the subject.  "Neck pain was shown to be prevalent in athletes, with a 1-week prevalence ranging from 8% to 45%, a 1-year prevalence ranging from 38% to 73%, and a lifetime prevalence of about 48%. The prevalence of neck pain in athletes is high."  Although studies on prevalence of neck pain in the general population are all over the place, the statistics for athletes appear to be at least 10-20 percentage points higher.

What are some of the things we can say for sure about treatment of whiplash injuries?  Although treatment theories abound, the rock-solid foundation of whiplash rehabilitation is that it's critical to restore normal neck function / range of motion as quick as possible because research has shown that after ninety days, the odds of dramatic improvement plummet.

A few months ago the journal Scientific Reports (Neck-Specific Exercise May Reduce Radiating Pain and Signs of Neurological Deficits in Chronic Whiplash) provided some sobering figures before telling us how bad nerve-related whiplash problems can be.  "Up to 90% of people with neurological deficits following a whiplash injury do not recover and cervical muscle dysfunction is common."  They concluded that neck-specific exercises are helpful in the recovery.  Another study, this on from the journal Musculoskeletal Science and Practice (Relationship Between Neck Motion and Self-Reported Pain in Patients with Whiplash Associated Disorders During the Acute Phase), found that the level of neck pain a whiplash sufferer is dealing with can be mapped via "kinematic parameters of neck mobility tests, ranges of motion, motion velocities, repeatability and harmonicity of movements [proprioception]."

This summer the European Journal of Pain published a study titled Seeing the Site of Treatment Improves Habitual Pain but not Cervical Joint Position Sense Immediately after Manual Therapy in Chronic Neck Pain Patients, which concluded that it may actually be helpful for manual therapists to have a way of allowing their patient to visually see what they are doing.  "Real-time visual feedback reduces habitual [chronic] pain immediately after the intervention." Just remember that this will tend to throw some people into a sympathetic response that we discussed earlier.  In a study titled Comparison of Ozone and Lidocaine Injection Efficacy vs Dry Needling in Myofascial Pain Syndrome Patients, researchers did exactly what the title suggests; observing 72 patients to determine that all injections were about the same efficacy --- a characteristic of DRY NEEDLING that has proven that the action of the needle itself is far more important than the substance being injected through the needle.  "No remarkable preference between them."

As far a cupping and acupressure go, there were studies on both.  After looking at 18 studies on cupping, a group of nine Korean researchers publishing in this month's issue of BMJ Open (Is Cupping Therapy Effective in Patients with Neck Pain? A Systematic Review and Meta-Analysis) concluded that "Neck pain is a significant condition that is second only to depression as a cause of years lived with disability worldwide.  Cupping was found to reduce neck pain in patients compared with no intervention or active control groups, or as an add-on treatment. Depending on the type of control group, cupping was also associated with significant improvement in terms of function and quality of life..."  In another Korean study, this one from the September issue of Integrative Medicine Research (Clinical Effects of Acupressure on Neck Pain Syndrome (nakchim): A Systematic Review), the authors looked at the effects of acupressure on a type of non-traumatic neck pain syndrome not associated with trauma they refer to as nakchim.  Their conclusions?  After looking at 15 studies of over 1,000 subjects, the authors determined that "acupressure may be effective on nakchim."

What about chiropractic care? The West Coast's giant managed care organization (Kaiser Permanente), along with several major universities, published a study in a recent issue of the Journal of General Internal Medicine (Comparative Effectiveness of Usual Care With or Without Chiropractic Care in Patients with Recurrent Musculoskeletal Back and Neck Pain).  Not surprisingly, the care for the chiropractic group cost about half that of usual medical care.  "As clinical outcomes were similar, and the provision of chiropractic care did not increase costs, making chiropractic services available provided an additional viable option for patients who prefer this type of care, at no additional expense."  It costs less, but was it as effective?

After saying that "Neck pain is prevalent, costly and disabling," a team of European researchers from several universities and facilities concluded that, "mobilisation participants reported significantly better global perceived effect and improvements in movement associated pain. Mobilisations produced a significant increase in ROM in side flexion and rotation when compared with placebo.... 29-47% of all movement associated pains were resolved following mobilisations and 11-27% following placebo. Patients in both groups showed a significant increase in movement velocity.... Cervical mobilisations are effective in improving movement-associated pain, increasing ROM and velocity, and patient perceived improvement when applied to patients with neck pain... Their use should be advocated."

In another study --- A collaboration between RAND and the UCLA School of Medicine (Group and Individual-level Change on Health-related Quality of Life in Chiropractic Patients with Chronic Low Back or Neck Pain) that was published in last month's copy of Spine --- the idea of trying to determine responders from non-responders was put forth.  After doing interviews and evaluations ("physical function, pain, fatigue, sleep disturbance, social health, emotional distress and physical and mental health summary scores") with over 2,000 patients at 125 chiropractic clinics throughout the United Stated, the authors concluded that....

"Chiropractic care was associated with significant group-level improvement in health-related quality of life over time, especially in pain. But only a minority of the individuals in the sample got significantly better ("responders"). This study suggests some benefits of chiropractic on functioning and well-being of patients with low back pain or neck pain."

Let's talk about these "responders" for a moment and try and flesh out why someone might fall into this category, while the next person, with a seemingly identical situation and symptoms, might wind up labeled a non-responder.  First, let me say that 30% of those surveyed showed significant improvement in their "Mental Health Summary Score" --- a big deal for a class of patients, that as I have shown you, struggle with the twin terrors of chronic pain and mental health issues (I have always suggested that chronic pain tends to lead to depression).  As far as the "significant," but far from earth-shattering results of chiropractic adjustments on these sorts of patients, I have two thoughts on this, inflammation and scar tissue.

I have heard old timers (chiros) say that getting the average patient better used to be easier (HERE).  Much of this has to do with the fact that today's average patient is inflamed beyond belief; here is a simple SELF TEST.  Inflammation is not only at the root of virtually all our most common health-related problems (including most we would rather blame on "BAD GENES"), as I showed you earlier, it always leads to the fibrosis (I call it scar tissue) that is arguably the world's number one cause of death (HERE).  When this microscopic, fibrotic, adhesed, scarring builds up in compromised connective tissues, the result is a "TETHERING EFFECT" that prevents normal ranges of motion, which thanks to loss of proprioception (see earlier link) perpetuates the cycle of degeneration (calcification, bone spurs, thinning joints and discs). 

When it comes to chronic neck pain (as well as most other problems not related to a herniated disc), I run my clinic in much different fashion than the average chiropractor.  Because of this different approach, I tell patients that they will know after a treatment whether or not I can help them.  There is no trying to up-sell you on drawn out or expensive care plans.  It's simple; you come in, I talk with you and examine you.  If I think there is a good chance of being able to help you, we go from my office to a treatment room and I do my thing.  While one treatment may certainly not be enough to do everything that needs to be done, THIS POST (not to mention my hundreds of TESTIMONIALS) shows what makes us different.  And if you are interested in taking that extra step to deal with the chronic inflammation that's wreaking havoc on your life, you can READ THIS FREE POST in your spare time and see what you think. 

My goal is to remove as many roadblocks to the healing process as possible, while empowering you to step up and do those things that unfortunately, no one else --- your doctors included --- can do for you.  If you appreciate our site and would like to see more people reached with life-changing information, be sure to like, share or follow on FACEBOOK since it's one of the easiest possible ways to reach the people you love and care about most!

When I first met Emma last April, I was shocked at just how immobile her neck really was.  No wonder she was struggling with NECK PAIN and HEADACHES.  But at least she came by it honestly.  You see, in 1992 she driving a vehicle that went off of a thirty foot embankment.  The force of impact put her through the windshield head first.  Twenty five years and seven reconstructive surgeries later, she found her way to our clinic.  Three hours ago I gave her a third treatment in the past year.  Listen to her talk about the results.  BTW, while it's certainly not the case that every patient gets results like these, neither is it uncommon (HERE).  For more TESTIMONIALS, just click the link. 

The June issue of the journal for pain doctors, Practical Pain Management, carried an article called Migraine Treatment: What’s Old, What’s New?  In it the author described just how common severe headaches are in the United States, saying they affect, "approximately 27 million American adults, or 17.1% of women and 5.6% of men."  No matter how you slice it, that's a lot of people!

After describing the myriad of symptoms that migraineurs may struggle with (including an array of GI and neurological issues), the author gets down to the nitty-gritty.  What everyone who deals with CHRONIC HEADACHES or MIGRAINE HEADACHES (both of which are commonly associated with CHRONIC NECK PAIN) wants to know is what can be done to get rid of these vile creatures?  To get there it's important to understand some of the triggers. According to this article, "the most common triggers are stress, weather changes, perimenstruation (near that time of the month), missing meals, bright lights or sunlight, under- and oversleeping, food sensitivity, perfume, cigarette smoke, exercise, and sexual activity. Some foods can be headache triggers...."   It's a heck of a list and great information to know.  If people can avoid the triggers, they will ultimately end up with fewer headaches.   But what about treatment itself?  Some of the things specifically mentioned by this specialist -- neurologist Larry Robbins of the Chicago area --- include (in no particular order)......

• PSYCHOTHERAPY
• EXERCISE / YOGA / PILATES
• STRETCHING
• DEEP BREATHING
• BIOFEEDBACK
• RELAXATION TECHNIQUES
• IMAGING
• PHYSICAL THERAPY
• CHIROPRACTIC
• ACUPUNCTURE
• MASSAGE

• BOTOX
• BITE SPLINTS
• CAFFEINE

• AVOIDING CERTAIN FOODS (MSG, ASPARTAME, alcohol, cheese, citrus, sour cream, yogurt, cured meats, and nuts / nut butters are those he mentioned, and will be found on almost anyone's list.  There are any number of others.)
  
• SLEEP HYGIENE
• WEIGHT LOSS

• NATURAL SUPPLEMENTS AND HERBS
• TRANSCRANIAL MAGNETIC STIMULATION (TMS)

• NON-INVASIVE VAGAL NERVE STIMULATION (VNS)
• DRUGS (Although there were dozens upon dozens of drugs mentioned by name, Dr. Robbins did not emphasize drugs as a first choice --- "We want to minimize meds... The goal is to decrease head pain, while minimizing medications".  He also spent a good deal of time discussing rebound headaches aka Medication Overuse Headaches or MOH.  Unfortunately, he also said that, "Polypharmacy is common in migraine prevention.")
  

Allow me to add my two cents to this list with a bit of explanation here and there.  I am putting them in the order that I feel would be most helpful most of the time (at least for the first four bullets on the list). Of course everyone is different, so nothing is set in stone.  And while there are individuals out there (KERRIE SYMES for instance) who, no matter what they do, have severe headaches each and every day of their lives, for most of you there is hope.

• TISSUE REMODELING:  If you have SCAR TISSUE and / or RESTRICTED FASCIA, it's important to realize that even though there are ways to image it (HERE for instance), standardized testing will not reveal the problem (HERE).  This means that all of these other approaches that involve restoring movement in some form or fashion, be it chiropractic, stretching, yoga, PT, etc, etc, etc, will likely be compromised.  Trying to stretch MICROSCOPICALLY TETHERED TISSUES --- particularly if there is any degree of severity --- can be a deal-breaker.  It simply will not work, and in many cases will make people worse (HERE and HERE).  Also be aware that in many cases this bullet point must be approached as if you were playing a carnival game (HERE).  Check out the short video of a woman who had seven decades of daily migraine headaches before coming in for treatment (HERE).
  

 

• CHIROPRACTIC ADJUSTMENTS:  I realize I'll be called a "homer" for putting adjustments near the top of the list, but that is where they belong.  If coupled with TISSUE REMODELING, the very cool thing is that if adjustments are going to help, you will know quickly --- one, maybe two treatments.  Not the let-me-adjust-you-fifty-times-and-we'll-move-on-from-there approach seen in way too many clinics (HERE).  If traditional CHIROPRACTIC ADJUSTMENTS don't work, upper cervical specific can likewise be a great option (Blair, Atlas Orthogonal, etc), as can be cranio-sacral work.  These first two bullets will immediately help rule out a "MECHANICAL HEADACHE -VS- A CHEMICAL HEADACHE".  The bottom line is that I cannot begin to tell you the number of headache sufferers I have been able to help in the 25 plus years I've been in practice --- usually as a last resort; often after they had spent years (not to mention lots of money) trying everything under the sun.  The beautiful thing is that when it comes to these first two bullets, no one -- and I mean no one -- makes things easier for the patient than I do (HERE).  Period.
  

 

• ELIMINATION DIET:  This is a bullet that anyone who has even the smallest of health issues should do anyway.  If food sensitivities are contributing to your problem, a properly-done ELIMINATION DIET will help you figure out what food(s) you are sensitive to.  Although this author said that, "foods tend to be overemphasized" as far as triggering chronic headaches, I feel he is underestimating this aspect of the problem.  LEAKY GUT SYNDROME is highly related to problematic foods, and when it comes to neurological issues, few foods are more problematic than GLUTEN. Besides, it's not like it's a reach to mention Gut Health and Migraine Headache in the same sentence (HERE).
  

 

• SOLVE YOUR BLOOD SUGAR ISSUES:  No, I am not merely talking about keeping your blood sugar within the range that the chart says is "normal," I am talking about keeping it level all the time, not bouncing it around, and not continually stressing your sugar-metabolizing machinery.  The best way of eating for most people will entail meals that look something like THIS.  And because there are so many neurological issues surrounding migraines (Dr. Robbins had a page full of them), you might want to try KETOGENIC as well.  It never ceases to amaze me how many people have been to any number of specialists for their chronic headaches, and no one has ever told them that REACTIVE HYPOGLYCEMIA might be a prime culprit.  BTW, if you take care of this bullet point and the previous, WEIGHT LOSS will likely take care of itself.  If it does not, you have some source of OCCULT INFLAMMATION driving problems in your body (possibly including headache).
  

 

• YOGA / STRETCHING / EXERCISE:  Great stuff, but trying to stretch without making sure that you aren't loaded with FASCIAL ADHESIONS can be an exercise in futility, no pun intended (see earlier links under "Tissue Remodeling").  And while I certainly could have thrown THIS POST in with the second bullet on this list, because the SCM MUSCLES are so crazy related to TRIGGER POINTS (not just of the SCM itself, but of the LEVATOR SCAPULAE), not to mention related to neurological issues of all sorts (including headaches), you may need to address it as well.  It's one of the many reasons I am such big a fan of EXTENSION THERAPY.
  

 

• MAKE SURE YOUR BODY'S DETOX PATHWAYS ARE UP TO SNUFF:  Toxic exposure of all kinds is a massive problem around the world, and related by numerous studies to chronic headaches.  For any number of reasons, far too many people are being exposed to external toxins such as GLYPHOSATE or ALUMINUM, cannot get rid of excess hormones such as ESTROGEN (true for too many males as well), or are not dealing well with chemicals in their food supply.  A failure to BIOTRANSFORM toxicity into a form that the body can get rid of can make things extremely difficult for the chronic headache sufferer.  What this means is that both your liver and GUT will need to be working optimally.
  

 

• ACUPUNCTURE:  Cool stuff and I used to do a lot of it back in the day (I was certified by the late Dr. Jon Sunderledge back in '90 or '91).  It's another method of treatment with a big potential upside that won't make you worse.

 

• FUNCTIONAL NEUROLOGY:  The brain and nervous system are by far the most complicated of the body's various systems (the ENDOCRINE SYSTEM would come in second). Thus, neurologists are some of the smartest people you'll find in the medical field.  If you have gross pathology causing your headaches (tumors, aneurysm, serious neurological diseases such as MULTIPLE SCLEROSIS), they'll find it and make the proper diagnosis.  The problem is that because the kinds of headaches we are now talking about --- the kinds that don't respond well to mechanical or chemical interventions --- are "FUNCTIONAL" as opposed to pathological, the average neurologist (I would not characterize the author of this article as "average") unfortunately have little to offer by way of treatment besides drugs, which you've been trying lots of for years. Neurological Migraines are where a good CARRICK-TRAINED Functional Neurologist frequently shines. 
  

 

• OTHERS:  Honestly, there are too many others to mention.  For instance, I recently had a local patient who despite anything that either myself or anyone else has ever done, could not make a dent in her headache problem of almost four decades.  She saw DR. RAMAN in the KC area, and within a week, was 70% better.  The point? I truly believe that there is a solution out there for everyone; it's just a matter of finding it.  Our basic protocol for helping people solve their chronic pain, chronic illness, and unbridled inflammation can be found HERE.
  

It's estimated that about half the adults in the UK experience tension-type headaches once or twice a month, and about 1 in 3 get them up to 15 times a month.  About 2 or 3 in every 100 adults experience tension-type headaches more than 15 times a month for at least three months in a row. This is known as having chronic tension-type headaches.  From the website of Britian's NHS (National Health Services)

The Mayo Clinic describes Tension Headaches as, "a diffuse, mild to moderate pain in your head that's often described as feeling like a tight band around your head".  Wikipedia says, "The pain can radiate from the lower back of the head, the neck, eyes, or other muscle groups in the body typically affecting both sides of the head."  Headache Australia goes a bit farther, describing tension headaches as, "a dull and persistent pain that may vary in intensity (mild to moderate) and is usually felt on both sides of the head or neck (some however experience jabs of sudden pain in the head), a constant, tight, heavy or pressing sensation on or around the head, tautness and tenderness of scalp, neck and shoulder muscles, neck movements (active or passive) restricted by muscular stiffness and discomfort, ache in the back or over the left side of the chest."

No matter who you look to, you'll see that TENSION HEADACHES (oftentimes referred to as "Stress Headaches") are the most common kind of headache --- by far --- affecting a significant portion of the population (not surprisingly, women more than men), as well as accounting for approximately 90% of all headaches.  But is "Tension" or "Stress" Headache the best or most descriptive name for these kinds of headaches?  In other words, are these terms accurately identifying what's really going on in many, if not most cases?

After Yesterday's discussion of ADRENAL FATIGUE and SYMPATHETIC DOMINANCE, it is hard to argue that stress or tension is not a factor --- after all, it's a factor in most aspects of our lives.  The kids, the spouse, the job(s), the mortgage, the car payments, braces, mom's going in the nursing home, you just got served papers, etc, etc, etc.  Life can be crazy and I didn't even begin to scratch the surface with this list.  The thing is, I know lots and lots of people who would not describe their lifestyle as particularly "stressful," yet are plagued by chronic Stress Tension Headaches.  What does this really mean?

I have been saying for a very long time that a better descriptor of what's going on in this situation (as well as a better name for the headache) might, at least in most cases, be "Cervicogenic Headache" --- meaning that the headache was 'generated' or 'birthed' by the Cervical Spine (neck).  What would make me say this?  When I see patients with headaches that start in the upper back or neck (often at the base of the skull) and then travel up the back of the head, settling in the area around the eyes, forehead, and temples ---- sort of like the Lone Ranger's mask --- I always think neck first.  Sometimes these headaches encompass the ENTIRE SKULL as well.

Part of the confusion comes from the fact that there is already a specific type of headache labeled as "Cervicogenic". The American Migraine Foundation (AMF) describes Cervicogenic Headaches thusly.....

"Cervicogenic headache is a secondary headache, which means that it is caused by another illness or physical issue. In the case of cervicogenic headache, the cause is a neck disorder or lesion.  Headache causally associated with cervical myofascial tender spots or pericranial tenderness.  Clinical features such as neck pain, focal neck tenderness, history of neck trauma, mechanical exacerbation of pain, unilaterality, coexisting shoulder pain, reduced range of motion in the neck, nuchal onset, nausea, vomiting, photophobia etc. are not unique to cervicogenic headache. These may be features of cervicogenic headache, but they do not define the relationship between the disorder and the source of the headache.  To confirm the diagnosis of cervicogenic headache, the headache must be relieved by nerve blocks.  Treatment for cervicogenic headache should target the cause of the pain (in the neck), and varies depending upon what works best for the individual patient. Treatments include nerve blocks, Botox injections, and medications.  Physical therapy and an ongoing exercise regimen often produce the best outcomes."

For those of you struggling with Chronic Headaches, there's a lot of meat here.  The first thing to note is that all of the symptoms of the Cervicogenic Headache are the same basic symptoms seen in other types of headaches.  Secondly, while nerve blocks may certainly be "diagnostic," they don't constitute a good form of treatment; mostly because they are not solving anything, but only covering symptoms. It's important to be aware many blocks contain CORTICOSTEROIDS along with the blocking agent --- a ready way to destroy the collagen-based tissues of your C-spine (BONE, CARTILAGE, LIGAMENTS, TENDONS, MUSCLES, FASCIA, DISCS, etc).  The coolest thing we see in their quote is that physical medicine and exercise seem to get the best results.  What does this mean for you, the headache sufferer?  We'll get there momentarily.

I bring all of this up because I would argue that many, if not the majority, of the headaches that the average American is dealing with --- headaches being diagnosed and referred to as Stress Tension Headaches --- are actually mislabeled (or at the very least, misnamed).  While stress of all kinds can certainly cause tension (MENTAL STRESS, PHYSICAL STRESS, DIETARY STRESS, etc, etc), is it the stress itself, or is there an underlying mechanical issue with the cervical spine that is being aggravated by stress?  The only way to know to find out is to check.

While for the medical community, "checking" frequently involves lots of tests (CT & BRAIN SCANS, MRI, blood labs, etc) mostly to rule out rare causes of headaches such as brain tumors, there really is an easier way.  Rather than me trying to tell you what others are doing in their clinics, I will simply tell you what I do in mine. 

• CHECK RANGES OF MOTION:  Yes, I do a short neurological and orthopedic exam, but I realize the average person seeing me for the first time for Chronic Headaches has already been to any number of specialists, and been through all sorts of tests and examination.  The most important question is does the patient have good ROM in their cervical spine or don't they (HERE)?  Because it's easy to do, make sure you aren't fooled (HERE).
  

 

• ARE THERE TRIGGER POINTS PRESENT?  Just remember that TRIGGER POINTS are only one side of the coin that is the MYOFASCIAL SYNDROME, but they can cause some ugly problems that refer pain to the base of the skull (I am getting ready to do a post on the dreaded "Levator Trigger Point" that I personally deal with at times).
  

 

• IS THERE SCAR TISSUE / FIBROSIS / DENSIFICATION PRESENT?  Normal tissue is sort of like well-combed hair.  It's nice and flexible, supple and soft.  SCAR TISSUE, FIBROSIS, or DENSIFICATION are just the opposite --- they are like a matted, tangled, HAIRBALL that is both hard and inflexible.  If present, nothing else you do is going to work --- or at least work for the long haul.  It's almost like being perpetually "TETHERED".  Sure the exercises, stretches, PT, adjustments, massage, etc, help you feel better.  But only for a short while.  The problem then returns exactly like it always has, to the same place, and with the same characteristics.  This is the classic "Modus Operandi" for Scar Tissue.
  

 

• DOES THE NECK HAVE GOOD SEGMENTAL MOTION:  I don't care how good the gross ranges of motion of the neck are; if there is SEGMENTAL DYSFUNCTION is the cervical spine, results will be compromised.  Again, all of this comes back to the whole PHASE I -vs- PHASE II thing.  It's why adjustments can be so cool (HERE).  But it also explains why adjustments alone create the need for the next bullet point.
  

 

• DOES THE NECK HAVE THE APPROPRIATE LORDOTIC CURVE?  The most important range of motion in your cervical spine is your ability to tip your head back into EXTENSION.  Extension is critical, and a loss of this particular range of motion or a case of Forward Head Posture (FHP) means that you'll absolutely have to spend some time DOING THIS. 
  

 

• HAVE YOU EFFECTIVELY DEALT WITH INFLAMMATION?  Along with the whole Scar Tissue thing, dealing with effectively DEALING WITH INFLAMMATION provides the solution to yet another "missing link" in the neck pain / headache conundrum.  This bullet is such a big deal that I actually could have (maybe even should have) put it at the beginning of the list instead of the end.  Inflammation is the very thing that causes both Fibrosis (Scar Tissue) and degeneration / deterioration of the affected area (HERE). Figure out what it takes to squelch inflammation, and not only have you made everything on this list work better --- maybe way better --- in some cases you may have actually solved your problem.  Although THIS POST has a lot of valuable information for dealing with inflammation, an ELIMINATION DIET is the best starting point.  If you ignore this bullet, you potentially compromise all the others.
  

What does all of this mean in relationship to Stress or Tension Headaches, Cervicogenic Headaches, and the best way(s) to deal with them?  As we saw in the quote from the AMF, DRUGS --- by far the most common remedy the medical community has to offer --- don't change underlying pathophysiology. Plainly stated, they cover symptoms (HERE). 

If you've read this far, I already know that you are sick and tired of covering symptoms with drugs --- literally sick and tired.  Pick up the phone today and call Cheryl at (417) 934-6337 to make an appointment.  HERE is exactly what that appointment will look like.  HERE are some very cool video testimonials of people just like you, who after living on the MEDICAL-MERRY-GO-ROUND, found rapid relief in our clinic.  You've got nothing to lose but the pain.

"A personal frustration as a clinician and researcher in the field is that the incidence of full recovery following a whiplash injury as a result of a motor vehicle crash has not increased and, subsequently, the rate of transition to chronic neck pain has not lessened.   Management of whiplash, especially the challenge of lessening the rate of transition to chronicity, has yet to be achieved....."  From this month's issue of The Journal of Orthopedic and Sports Physical Therapy (Whiplash Continues its Challenge)

I can't begin to tell you how important Range of Motion (ROM) of the cervical spine (neck) is --- particularly when it comes to one's ability to go into EXTENSION (it's the most important ROM in the body).  What's simply amazing to  me is how many of the people I treat have been to any number of practitioners, including CHIROPRACTORS, THERAPISTS, and a wide array of PHYSICIANS, with little or nothing to show besides short-term results.  Why?   Besides the fact that doctors are doing little else than prescribing dangerous and useless drugs, much of the time the others on this list are putting the cart in front of the horse.

For instance, the normal ROM of cervical rotation (think nodding your head "no" here) would be about 90 degrees.  This means that not only should you be able to get your nose over your shoulder with little or no effort, when you get it there, there should be little or no play.  In other words, you can't make your nose go any further. The amount of people who come to me who have had incredible numbers of treatments mentioned above, but who still have poor range of motion, is astounding (HERE are some examples).  And the crazy part is, when I test these patients by asking them to turn their head right or left without turning their body, even though ROM is often in the 50-70% range, the patients often feel like it's normal. 

What all this means is that while a wide number of non-drug therapies might provide relief to these patients, if they are not restoring ROM, short-term relief is all they'll get.  As long as you don't have an occult (hidden) driver of INFLAMMATION (YEAST, MOLD, OTHER DYSBIOSIS, MERCURY & ALUMINUM, GLUTEN or DAIRY intolerance, PARASITES, CONNECTIVE TISSUE AUTOIMMUNE DISEASE, THYROID PROBLEMS, etc, etc, etc), the first step in solving CHRONIC NECK PAIN (HEADACHES are often included here as well) needs to be checking for the 'tethering' effects of SCAR TISSUE.

Once Scar Tissue and FASCIAL ADHESIONS have been dealt with, adjustment(s) will actually do what they are supposed to do.  From there, you can begin to deal with the FORWARD HEAD POSTURE --- usually on your own.  And for those of you who have been told that you can never get better because your problem is mostly related to degenerative or osteo-arthritis, you really need to read THIS SHORT POST.  For those of you who feel you are probably living somewhere in the previous paragraph, THERE IS HOPE FOR YOU as well.  It will just take a bit of time and discipline.   HERE are some of our video testimonials; many concerning people just like you.

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.

• FUNCTIONAL:  This could be purely a SUBLUXATION issue.  It could be due to hidden SCAR TISSUE.  It could be the result of FORWARD HEAD FORWARD POSTURE (FHP).  Often times, it is a combination of all of these.  Throw in some TRIGGER POINTS and you can understand why the drugs have not worked.  We can't leave FUNCTIONAL NEUROLOGY out of the mix either.  If your problem is "locked" into the brain (LIKE THIS), a Functional Neurologist trained by Ted Carrick could provide the solution you are looking for.
• INFLAMMATORY:  All to often people want to do the things listed above, but ignore the obvious.  Why?  Because sometimes solving the obvious can be challenging.  If you are living a life of inflammation and pain, and have not yet created your own personalized "EXIT STRATEGY," don't go another day without doing so. 

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.