Research


What a Headache!
Research
Written by Dr. Daniel J. Murphy D.C., D.A.B.C.O.   
Monday, 27 February 2006 01:41

Reference:

Cervicogenic Headache:
A Review of Diagnostic and
Treatment Strategies

Journal of the American
Osteopathic Association
April 2005, Vol. 105, No. 4
Supplement, pp. 16-22
David M. Biondi, D.O.

Key Points from Dan Murphy:

cervicogenicheadache1. “Cervicogenic headache is a relatively common cause of chronic headache that is often misdiagnosed or unrecognized.”

2. Cervicogenic headache is chronic hemicranial pain that is referred to the head from tissues of the neck.

3. Head pain that is referred from the tissues of the neck is called cervicogenic headache.

4. Cervicogenic headache was not officially recognized until 1983.

5. The key neurological structure in cervicogenic headache is the trigeminocervical nucleus.  The trigeminocervical nucleus is a region in the upper cervical spinal cord where sensory nerve fibers from the trigeminal nerve (cranial V) interact with sensory fibers from the upper cervical nerve roots.

6. The convergence of upper cervical and trigeminal sensory fibers is the basis for upper cervical problems causing pain in the face and head.

7. Cervicogenic headache is often a sequela of head or neck injury, but may occur in the absence of trauma. [Important]

8. The prevalence of cervicogenic headache is as high as 20% of patients with chronic headache.

9. Cervicogenic headache is four times more prevalent in women.

10. “Patients with cervicogenic headache will often have altered neck posture or restricted cervical range of motion.”

11. Cervicogenic headache pain can be “triggered or reproduced by active neck movement, passive neck positioning, especially in extension or extension with rotation toward the side of pain, or on applying digital pressure to the involved facet regions or over the ipsilateral greater occipital nerve.”

12. X-ray, magnetic resonance imaging (MRI), and computed tomography (CT) are non-diagnostic in cervicogenic headache patients.

13. Zygapophyseal joint, cervical nerve, or medial branch blockade is used to confirm the diagnosis of cervicogenic headache.

14. Trauma to or pathologic changes to the C1-C2-C3 joints can cause head pain.

15. The third occipital nerve (dorsal ramus C3) innervates the C2–C3 facet joint.  The C2-C3 facet joint and the third occipital nerve are the most vulnerable to trauma from acceleration-deceleration whiplash injuries of the neck. [Important]

16. It can take a year or longer for post-whiplash cervicogenic headache to resolve.

17. Disc problems as low as C5–C6 can cause chronic cervicogenic headache.

18. The treatment of cervicogenic headache usually requires manipulation of the upper cervical facet joints. [Important]

19. Drugs alone are often ineffective for cervicogenic headache treatment.

20. “Many patients with cervicogenic headache overuse or become dependent on analgesics.”

21. COX-2 inhibitors [Celebrex] cause both gastrointestinal and renal toxicity after long-term use.

22. COX-2 inhibitors [Celebrex] cause an increased risk of cardiovascular and cerebrovascular events.

23. “All patients with cervicogenic headache could benefit from manual modes of therapy and physical conditioning.”

24. Manipulative techniques are particularly well suited for the management of cervicogenic headache, including high velocity, low amplitude manipulation.

25. Based upon this article, I have created the following form to assist in the diagnosis of cervicogenic headache.

Diagnostic Criteria for Cervicogenic Headache

(Developed by the Cervicogenic Headache International Study Group)

The patient must have at least one of the following:

1. The head pain must be preceded by:
  Neck movement or Sustained awkward head positioning
  External pressure over the upper cervical (C1-2-3-4) or occipital region on the symptomatic side

2.  Restricted cervical spine range of motion (active and passive)

3.  Ipsilateral neck, shoulder, or arm pain of a vague nonradicular nature or Occasional arm pain of a radicular nature

If all three criteria are present, one is essentially assured of cervicogenic headache.

Characteristics of Cervicogenic Headache

 Frequently, a history of indirect neck trauma [whiplash injury]
 Unilateral headache that does not change sides
 Occasionally, the pain may be bilateral
 The pain is located occipital, frontal, temporal, or orbital regions
 The pain can last hours to days
 The headache usually begins in the neck
 The headache is moderate to severe
 The headache is non-throbbing
 The headache is non-lancinating

The following features may also be occasionally noted:

 Nausea 
 Phonophobia  
 Photophobia
 Dizziness 
 Difficulty swallowing
 Ipsilateral blurred vision
 Vomiting
 Ipsilateral lacrimation
 Ipsilateral edema, especially in the periocular region

A 1978 graduate of Western States Chiropractic College, Dr. Dan Murphy is on the faculty of Life Chiropractic College West, and is the Vice President of the International Chiropractic Association. For more information, visit
www.danmurphydc.com.

 
Is it Still Possible to go to Jail for Chiropractic?
Research
Written by David Jackson, DC   
Saturday, 26 November 2005 22:58

jailchiroThere has been a lot of news lately about what might happen to non-medical health care if the controversial Codex Alimentarius regulations are enacted in the U.S. Many critics are concerned that the Codex Guidelines are a serious threat to continued free access to dietary supplements of choice. They envision a world where people are forced to get a prescription for a bottle of vitamin E, or alternative health care practitioners are fined—or even arrested—for providing herbal or dietary advice or supplements.

While it may seem like a far-fetched sci-fi premise, I wouldn’t be so quick to dismiss the concerns. There is a global effort underway to stem the tide away from the “drugs and surgery” approach to health care. Spearheaded by the multi-billion dollar pharmaceutical industry, the drug and medical industries are continuing their battle to maintain a health care monopoly. That battle is becoming more desperate as the public learns of the failures and risks inherent in many medical procedures—and adopts an entirely new mindset about wellness.

We, as chiropractors, face an even more subtle threat than Codex. The attacks on chiropractic are coming from many different directions.

Our opponents continue to harp on the stroke issue, despite ample evidence that claiming chiropractic causes strokes is ludicrous. Their bottom line goal is to make chiropractic as restrictive as possible, and to make it impossible—and even illegal—for DC’s to provide chiropractic care:

• to children,
• to asymptomatic patients,
• for subluxation correction,
• to address non-back pain issues.

This isn’t a mere war of words, either. Our enemies are taking us to court, pressuring the media into running anti-chiropractic articles, convincing insurance companies to deny claims, and using the Internet to disseminate damaging misinformation about chiropractic. They put up “Chiropractic Adjustments Can Kill or Permanently Disable You” billboards, continually push for gatekeeper restrictions in public chiropractic programs, and publish books like Chiropractic: the Greatest Hoax of the Century? or At Your Own Risk: The Case Against Chiropractic.

They would love nothing more than to see all of us either behind bars or so restricted that we couldn’t survive in practice.

And right now, their biggest weapon against us is the perceived lack of scientific evidence to convincingly prove that chiropractic is safe and effective and that subluxation correction is a key to overall health and wellness. They’re hitting us over the head with it like a club. Even the RAND study (which DC’s love to quote) says that: “The lack of high-quality studies reported in the medical literature makes it difficult to arrive at comprehensive conclusions about the value of chiropractic care.” Newsweek magazine put it succinctly, when they said the problem with chiropractic was a “dearth of good research to prove efficacy.”

That’s become the mantra of our enemies. No research. No proof.

That puts chiropractic in the “experimental” category, which is precisely how many insurance companies are labeling chiropractic for children (and their excuse not to pay for chiropractic pediatric services).

How many people are going to want to go to a DC for “experimental” health care? How many people are going to walk into your office for help if we can’t provide them with persuasive research to show them what benefits they might expect to get from our care?

Right now, we’re serving a mere five percent of the population and, without that research, we may very well lose ground in the future. With fewer patients and more statutory restrictions, more DC’s will be in precarious financial situations and many will leave for other jobs. Those who stay in practice will find it increasingly difficult to attract patients. And those who dare to adjust a child or provide wellness care may end up where our chiropractic pioneers did—behind bars.

The answer—the ONLY answer—is research. We must conduct massive research on a global scale that will produce the type of evidence that our critics cannot dismiss or refute. We must have outcomes research that will show direct and long-lasting benefits of subluxation correction, and establish the absolute safety of chiropractic for all patients.

I urge all doctors of chiropractic to act now to support such research if...you envision a future where chiropractic still exists and is available to all people...you hope to still be in practice in five, 10 or even 20 years and not working part time as a technician in an MD’s office or flipping burgers at McDonalds...you dream of a subluxation-free world rather than a drugged up one.

One way to support that research and actually contribute to it is to join Research & Clinical Science (RCS) as an Authorized Clinical Investigator. You’ll recruit hundreds—possibly thousands—of volunteers in your area and enter their data into the global RCS research database, to be analyzed by a world-class International Scientific Advisory panel of researchers. You’ll have the unparrellled opportunity to speak one-on-one with these volunteers about the benefits of chiropractic. You’ll even get assistance writing your own case history research papers, for submission to major peer reviewed journals.

You knew when you first became a doctor of chiropractic that you also needed to be a teacher. Now, you have to accept the fact that—one way or another—you need to be a researcher as well. Fortunately, once you take on that extra role, you’ll find it’s not a burden, but a blessing that will allow you to make an even greater contribution to your profession and your world.

Dr. David A. Jackson is chief executive officer of Research and Clinical Science (RCS). Previously, he served as president of the Chiropractic Leadership Alliance and Creating Wellness Alliance and was owner/operator of several private practice offices in California and Idaho that specialized in high volume, family wellness based care. For a no-obligation information packet about chiropractic research and the work of RCS, call 800-909-1354 or 480-303-1694, or visit 
www.rcsprogram.com.

 
Research: How much is enough?
Research
Written by David Jackson, DC   
Friday, 26 August 2005 20:52

The biggest criticism leveled against chiropractic is that it is unscientific. Or, in the words of the now infamous Newsweek article on “Treating Back Pain” (April 26, 2004), it suffers from a “dearth of good research to prove efficacy.”

The statement is particularly surprising since the article dealt with chiropractic for back pain. Nearly all the research done to date on chiropractic has involved back pain and there are an impressive number of scientific research studies to validate our effectiveness in this area. Yet, still, we are considered unscientific.

Is it any wonder, then, that insurance companies consider chiropractic for children “experimental,” or that few people ever think of chiropractic for problems other than back pain?

When it comes to research, we have to ask ourselves, “How much is enough?” How many studies will we have to conduct in order to, once and for all, be considered scientifically based, to change the perception of chiropractic and to silence our critics?

Obviously, it won’t be enough to produce one or two studies on chiropractic’s broader applications. We already know, from our personal practice experience, that chiropractic has long-term benefits on health. But, to prove that to the wide audience, we’ll need to conduct research of “shock and awe” proportions. We’ll have to compile data from a huge number of people from vastly different geographic areas. And, since chiropractic, itself, is so diverse, our research will have to include nearly all techniques, rather than focus on one or two specific areas.

Even then, we won’t be able to stop. You’d think that once you conducted research showing that chiropractic can boost the immune system, for instance, we could move on to other matters. But that’s not the case. We have to keep “proving” the same thing over and over again.

Such research redundancy is the norm in medicine. How many research studies have been conducted to prove that obesity is a contributing factor in hypertension? A quick search of PubMed, the National Library of Medicine’s online index of research journals, came up with 11,269 citations between 2002 and 2005.

No matter what subject you choose, you’ll find hundreds of research articles in scientific journals, many duplicating previous ones or verifying hypotheses that are already considered proven “facts”. That’s what we have to do—produce an overwhelming amount of research on every aspect of chiropractic.

It’s exhausting just thinking about all this research. In the pharmaceutical and medical industries, research has become an incredibly large—and lucrative—business, in itself. Billions of dollars are pumped into research efforts and grants from drug companies, and government agencies are major sources of income for most medical schools. Chiropractic, unfortunately, doesn’t have that research infrastructure or income. We have to look for other incentives.

Actually, we don’t have to look far, since research has many very real and immediate benefits. As George McClelland, D.C., recently noted in the Foundation for Chiropractic Education and Research publication, Advance, “Many D.C.’s may not see the immediate relevance of chiropractic research on their practices; however, they should understand that chiropractic related research and research projects have played an invaluable role in promoting the expansion of chiropractic services in federal and private programs, as well as in public support and acceptance of chiropractic care. The overall impact is PRICELESS.”

Back in the 1970’s, women used to say, “Whatever women do, they must do twice as well as men to be thought half as good.” Well, the same is true for chiropractic. Whatever D.C.’s do, they must do twice as well as M.D.’s to be thought half as good. It’s not fair, but that’s the way things are—at least for now. In the future, the tide will turn and we’ll see other disciplines trying to catch up to chiropractic.

Dr. David A. Jackson is chief executive officer of Research and Clinical Science (RCS), a private sector research program exploring issues of subluxation correction and chiropractic care as they relate to health and wellness. Previously, he served as president of the Chiropractic Leadership Alliance and Creating Wellness Alliance and was owner/operator of several private practice offices in California and Idaho that specialized in high volume, family wellness based care. For a no-obligation information packet about chiropractic research and the work of RCS, call 800-909-1354 or 480-303-1694, or visit the RCS website at www.rcsprogram.com.

 
The Political Impact of Research
Research
Written by David Jackson, DC   
Tuesday, 26 July 2005 19:04

capitolusaI’ve often discussed the use of research as a marketing tool. But a recent article in the Journal of Vertebral Subluxation Research, by its editor, Matthew McCoy, DC, discussed the relationship between research and politics. Although most of us cherish our image of research as “pure” and untainted by mundane considerations like business or politics, the reality isn’t that pristine.

Dr. McCoy noted in his article, “Politics drive policy. And politicians need the research and evidence to create and/or alter polity. Ignoring politics is suicide.”

The most obvious example is public policy on second hand smoke. Without the clinical research showing that non-smokers are affected by exposure to cigarette smoke, legislators would not have imposed smoking regulations. A more recent example is stem cell research. Government decisions on stem cell research are based almost entirely on the results of biomedical research. (More precisely, they are based on public opinion, which, in turn, is based on media reports about that research.) If research increasingly shows dramatic potential for stem cell use to have a positive effect on human health, the public will clamor for it. Government will fund research and the field will become an integral part of medicine. Public policy will be driven by research.

If health care research remained within the sanctuary of the lab or classroom, it would not have the impact it has on society. Only by using that research to influence government leaders can significant legislative changes be instigated. While the idea of a relationship between research and politics may make us cringe, it’s a necessary one and one that could actually benefit chiropractic.

The fact is, we need millions of dollars in government funding for research. We need laws that safeguard the right of all people to seek chiropractic care without interference by medical gatekeepers. We need sanctions against insurance companies that impose prejudicial policies against chiropractors. We need to have chiropractors recognized as health care professionals on an equal footing with medical doctors, both in public and private sectors. In short, we need politics. But to influence politics, we must present hard, scientific evidence to lawmakers, both in the US and the rest of the world. We have to go to the politicians with research proving that chiropractic has long-term beneficial effects on human health.

That’s how we managed to carve our small “back pain” niche. We had research showing that chiropractic was more efficient, and more cost-effective, than medical treatment for reducing low-back pain in adults. Unfortunately, that’s been the bulk of our research efforts to date. According to the National Center for Complementary and Alternative Medicine (a part of the National Institutes of Health), “So far, the scientific research on chiropractic and low-back pain has focused on if, and how well, chiropractic care helps in relieving pain and other symptoms that people have with low-back pain.” Based on this research, chiropractors have become established as (or, in my opinion, limited to being) “back pain specialists.”

Can you imagine if we were able to present equally compelling research showing that chiropractic helped boost the human immune system? What about if there were scientific data showing that chiropractic care could address hypertension, asthma, diabetes, or other health problems? What if we had the “proof” that subluxation correction is a primary factor in wellness and quality of life?

With such proof, the public would demand that chiropractic be put on the top of the list of health care priorities and practitioners would be elevated to the status of wellness care specialists. We’d receive a large share of the $28 billion in annual National Institute of Health research funding and laws would be passed to secure chiropractic’s place in the health care system. We already know that research is an important marketing tool, one that can be used to convince the public to make chiropractic part of their health care routine. Now, we need to recognize the additional and vital role it can play in political activism.

Of course, research won’t get up and walk to Washington on its own. We have to take it there, present it to the legislators and make it understandable and persuasive. Whether we like it or not, chiropractic is a political issue and can be a powerful tool for positive political change.

Dr. Jackson is chief executive officer of Research and Clinical Science, a private sector research program exploring issues of subluxation correction and chiropractic care as they relate to health and wellness. Previously, he served as president of the Chiropractic Leadership Alliance and Creating Wellness Alliance and was owner/operator of several private practice offices in California and Idaho that specialized in high volume, family wellnessbased care. For more information on RCS, call 800-909-1354 or 480-303-1694, or visit the RCS website at www.rcsprogram.com.

 
Cervical Spine Trauma
Research
Written by Dr. Daniel J. Murphy D.C., D.A.B.C.O.   
Wednesday, 22 June 2005 17:18

The use of flexion and extension MRI in the evaluation of cervical spine trauma: initial experience in 100 trauma patients compared with 100 normal subjects

Emergency Radiology
(October 2002)  9: 249–253
Vincenzo Giuliano, Concetta Giuliano, Fabio Pinto, Mariano Scaglione

Background information from Dan Murphy

1. Subacute whiplash patients have about half the range of motion when compared to normal control subjects.

2. In this study, the normal control subjects showed that 4 percent had hypolordosis and 2 percent had disk herniations.

3. In this study, the whiplash injured patients showed that 98 percent had hypolordosis and 28 percent had disk herniations.

4. These authors note that plain film lateral flexion and extension views to evaluate soft tissue and diskoli-gamentous injuries are poor, that videofluoroscopy is better, and that flexion and extension magnetic resonance imaging (MRI) is best. In this study, the flexion/extension MRI’s showed much pathology that was not seen with plain radiographs.

5. Flexion/extension MRI shows the “pattern of segmental motion.”

6. The “pattern of segmental motion” is normal in non-traumatic hypolordosis and non-traumatic disk herniation, but abnormal in post-traumatic hypo-lordosis.

7. In this study, 12–14 weeks after injury, the whiplash patients complained of neck pain, headache, arm pain and arm numbness. This is more evidence that not all patients recover in a period of 6-8 weeks.

8. Flexion and extension MRI optimizes the functional significance of disk herniations in symptomatic patients, offering a distinct advantage to conventional MRI examinations performed in the neutral position.

9. These authors recommend flexion and extension MRI’s in the clinical setting of subacute cervical spine trauma (more than 12 weeks following injury). The clinical indication includes persistent neurologic deficit and clinical evidence of instability despite normal radiographs.

10.[Recent studies are showing that weight-bearing flexion/extension MRI’s show more soft tissue pathology. Life Chiropractic College West now has an upright weight-bearing MRI unit: (510) 780-4500.]

A 1978 graduate of Western States Chiropractic College, Dr. Dan Murphy is on the faculty of Life Chiropractic College West, and is the Vice President of the International Chiropractic Association. For more information, visit www.danmurphydc.com.

 
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