There are two ways to categorize headaches—primary and secondary. Secondary headaches are headaches with definitive causes, such as strokes or tumors. These causes tend to be more serious and potentially life threatening, and is not the focus of this discussion.
Primary headaches, on the other hand, are a lot more elusive. The intensity of a primary headache may not be any less than a secondary headache, but there isn’t a blood test or MRI that can confirm a primary headache.
Not all primary headaches are the same. The pain can come from nerves, joints, or muscles of the neck, scalp, TMJ, tissues that cover the brain (meninges), or arteries in the brain. Most of these pain generators promote pain through isolated or combined trigeminal (sensory system for the face and head) and cervical mechanisms.
It is essential for the practitioner to understand the nervous system, particularly the trigeminal system, and how it interacts with the structures and nerves of the neck to lead to different headache presentations.
Case Study: Headaches
Patient: 61 year-old female
Chief complaint: Debilitating headaches for 30 years
Back Story: This is a patient who experienced headaches all her life, and were significantly worsened after a car accident when she was 31. Her headaches had a helmet-liked distribution, and were relentless. In 2015, she ran out of sick days at the beginning of the year due to constant 5-7/10 headaches. She had seen many traditional chiropractors, massage therapists, physical therapists, and orthopedists throughout the years, and nothing ever helped the headaches. Even when therapies provided temporary relief, they often flared her up and she would end up with a severe headache the next day. Many of her therapists eventually gave up and told her that she must be doing something wrong in between her visits. Overall, she said her headaches had not gotten better or worse in the past 30 years. In her own words, it was a “rollercoaster”.
After the second treatment, the helmet-liked distribution of her headache changed, which had never happened before.
After the third visit, she was able to control the intensity and duration of her headaches with very simple breathing technique, which had never happened before, either.
By her 14th visit, she felt that she was 80% better. Despite the stress related to a job change, her headaches were non-existent or minimal. Even when she had occasional headaches, they were fleeting.
When I last saw her, she reported no headache at all between her visits, which at the time, was at a two-week interval.
One thing that is worth mentioning is that she experienced essentially no flare-ups with specific neuro-structural treatments. To be completely honest, she did have a 7/10 headache the day after the first treatment, because her brain could not tolerate the treatment intensity. However, once we figured that out, she had no more flare-ups with any subsequent treatments.
Take Home Message
- We must assess the stability of a patient’s nervous system, and know how much it can handle. Sometimes, less is more. Sometimes, we only know through trial and error. However, we must do this quickly, so we can attain therapeutic effects and minimize adverse responses. In other words, my job is not just knowing what to do, but when to do what and how much.
- Understand the neurological interactions among head and neck structures. During the intensive phase of treatments, she often came into the office with different headache presentations. It is absolutely crucial to have an in-depth understanding of our dynamic nervous system, so we know exactly what to do at each specific instant. I never quite knew what exactly our sessions were going to look like until I saw her. A cookie cutter approach is not likely to work for a case like this, because the therapies are not adapting to the ever-changing nervous system and meeting its needs to heal.
About the Author
Dr. Lily Semrow is a Board Certified Chiropractic Neurologist who focuses on Neuro-Structural Correction. She has a B.S. in Nutrition and a doctorate in Chiropractic. She has a passion for serving families, and helping people who could not get better through traditional and alternative means.