CF 033: Did You Need Proof That Chiropractors Help Headaches? - chiropracticforward

Did You Need Proof That Chiropractors Help HeadachesIntegrating Chiropractors

Today we’re going to talk about how chiropractors help headaches, we’ll discuss a couple of pretty cool papers that came out fairly recently, one of them only a couple of weeks ago from this recording, that had to do with spinal manipulation and the effectiveness in treating headaches and migraines. Psssst…..here’s a hint…..it’s good for chiropractors. Except for the very ending.

 

But first, here’s that bumper music

 

OK, we are back. You have shimmied into Episode #33. Chiropractors help headaches is basically our topic.

 

Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I have to say that in the last month specifically, this podcast really started to take off in terms of downloads and listens.

 

You know, when you first start something, there’s an excellent chance that nobody really gives a hoot. Lol. Isn’t that always the fear when starting something new? Does anyone care? Am I going to be able to offer any value? I have diagnosed myself with an anxiety issue. I over think and over think things. In the end, it’s simply because, no matter what it is I’m doing, I just want to do a good job.

 

I tell my son that, even if I don’t necessarily like somebody on a personal level if they are a hard worker, I will respect them. Everyone can respect a hard worker. Well, that’s what I try to be. I try to work hard and I try to bring things of value to me to you through writings, videos, social media, and podcast.

 

I’ll be honest with you. I have zero clues where all of this will eventually lead me. Lol. No clue at all. There’s no grand plan behind it.

 

All I know is I see it’s value and more and more of you are finding it’s value every week and it’s exciting. Maybe I’ll eventually put a course together for marketing your practice from an evidence-based perspective. Maybe I’ll have in-office patient education products. I’d love to be a speaker and travel the world bringing this information to evidence-hungry crowds. I have no idea where it can go but for now: I’m having fun.

 

Maybe it’s the old traveling musician in me. Maybe I just have to have people tuned in or I’m just lost. Lol. I have no idea but I know it’s fun and I’m glad you’ve come along with us so far. I’ll keep working hard if you’ll keep listening and we’ll just see where things go down the road together. I’m always keeping my eyes out for colleagues that see what I see. If that’s you, send me and email and let’s connect. Also, we’d like to ask you to join not only our Chiropractic Forward Facebook page but we also have a Chiropractic Forward Facebook GROUP where we have started sharing the papers we use, accepting comments, and will probably be including some of them in future episodes. We want our podcast to be a group effort if you’d like to participate. Come join us. The link is in the show notes.

 

https://www.facebook.com/groups/1938461399501889/

 

On a completely different note, I had mentioned back in mid-June or so that I was at the ChiroTexpo event in Dallas that was put on by the Texas Chiropractic Association and I met Dr. Tim Bertelsman down there. He was there for two reasons. One reason was as a vendor for his and Dr. Brandon Steele’s ChiroUp product and the other reason was to teach the Low Back portion of the Diplomate of American Chiropractic Orthopedists (DACO) program put on through the University of Bridgeport.

 

As this episode is recorded, I am about a week and a half from going through my second ten-hour course. This one will be taught by Dr. Brandon Steele down in Dallas again and I’m looking forward to it.

 

This is a really valuable program these guys are teaching and I encourage you all to check it out but, what I really wanted to tell you about is this ChiroUp thing they have going on. It’s crazy. Crazy in a good way.

 

I saw in one of the private groups on Facebook where a poster was asking for some good pointers on a report of findings.

 

Immediately, about 7 of the 10 posts had to do with recommending ChiroUp and, one of those posts was mine. I said it’s a game changer because, well….it is. I started using it about a month ago and it has literally changed the game for my busy office without adding a lot of demand to my staff. We’re talking patient education, activities of daily living, patient follow up, patient exercise-rehab recommendations, and even expediting online reviews. I have tried several products and services during my 20 years and most of them are just hype and take your money.

 

In my experience, so far….ChiroUp has been beyond what I expected. I’m jaded as hell. But, when Dr. Bertelsman started showing it to me, my jaw dropped a bit. I think I started slobbering. I’m not sure. Anyway, he showed it to me for about a minute and a half and that was it. Shut up and just take my money.

 

I want you to know, I don’t have any “deal” set up with those guys. Not yet anyways!! Lol. If it’s up to me I will because they’re amazing but, as of now, they don’t sponsor this show, no affiliate marketing deal….nothing like that. I’m just like your buddy down the road telling you hey man, I’m doing this thing and it’s been pretty freaking great. You should look at it. That’s all.

 

If you want to look into ChiroUp, go to www.chiroup.com and give it a look-see. And, if you like what you see and join up, you may mention our podcast and me, Dr. Jeff Williams. It never hurts for people to know who was out there pumping their tires, ya know. Sometimes what goes around comes around and I believe in always trying to project the good mojo.

 

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

 

It’s all about headaches from this point forward today. I want to first direct you to a podcast we did that cited a bunch of headache papers that I hope you’ll go and listen to right after you listen to this one. It was Episode #14 but 14 is right smack dab in the middle of a series of podcasts I did on Debunking the myth that Chiropractors cause strokes. Specifically, the series starts on episode #13, #14 is the one with the headache research, and #15 is the conclusion of the stroke series we did. I CANNOT stress enough how valuable I feel those three episodes are.

 

We will have them linked in the show notes.

 

https://www.chiropracticforward.com/debunked-the-odd-myth-that-chiropractors-cause-strokes/

 

https://www.chiropracticforward.com/cf-episode-14-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-2-of-3/

 

https://www.chiropracticforward.com/cf-015-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-3-of-3/

 

We will get going with this paper from February of 2018 called, “Dose-response and efficacy of spinal manipulation for the care of cervicogenic headache: a dual-center randomized controlled trial.” It was done by Haas et. al[1]. and was published in the prestigious Spine Journal on February 23, 2018. Here’s how chiropractors help headaches.

 

Why They Did It

Although the researchers know that spinal manipulation chiropractors help headaches (which is nice to see) there has been little information on the dosage of spinal manipulation for them. They wanted to evaluate the efficacy of chiropractic by comparing it to a light massage control group.

How They Did It

  • This is a two-site, open-label randomized controlled trial.
  • Participants were 256 adults with chronic cervicogenic headache.
  • The primary outcome was the number of days with cervicogenic headache in the previous 4 weeks evaluated at the 12- and 24-week primary endpoints
  • Secondary outcomes included cervicogenic headache days at remaining endpoints, pain intensity, disability, perceived improvement, medication use, and patient satisfaction.
  • Participants were randomized to four dose levels of chiropractic SMT: 0, 6, 12, or 18 sessions
  • They were treated three times per week for 6 weeks and received a focused light-massage control at sessions when SMT was not assigned
  • Linear dose effects and comparisons with the no-manipulation control group were evaluated at 6, 12, 24, 39, and 52 weeks.

 

Wrap It Up

In the authors’ conclusions, they say, “There was a linear dose-response relationship between spinal manipulative therapy visits and days with cervicogenic headache. For the highest and most effective dose of 18 spinal manipulative therapy visits, cervicogenic headache days were reduced by half and about 3 more days per month than for the light-massage control.”

Here’s one I thought was pretty darn cool when we talk about how chiropractors help headaches and it’s buried all the way down in the middle of a website for the Wiley Online Library. This site has all of the research covered at the 60 thAnnual Scientific Meeting American Headache Society June 28-July 1, 2018 at the San Francisco Marriott Marquis in San Francisco, CA.

This particular paper covered was by C. Bernstein and called “Rationale and Design of a Randomized Controlled Trial of Chiropractic Therapy for Migraine Pain Alleviation[2]”

Why They Did It

While medications are often the first‐line treatment for a migraine, many migraineurs do not experience clinically meaningful responses to preventive drug treatments or discontinue medication use due to side effects. Chiropractic care is a non‐pharmacologic intervention commonly used for the treatment of pain conditions, including a migraine. You got that right!

 

They go on to say, “Observational studies and small trials have shown that spinal manipulation may be an effective therapeutic technique to reduce migraine pain and disability. We present results of a meta‐analysis of spinal manipulation on migraine pain and disability and describe the design of a randomized controlled trial (RCT) evaluating comprehensive chiropractic care for the treatment and prevention of migraines.”

 

Oh yeah!! Sounding good. It appears that indeed, chiropractors help headaches. This talk appears to be on a new study they will be going through based on some preliminary work here.

 

How They Did It

  • They searched PubMed and Cochrane Library databases for clinical trials that evaluated spinal manipulation and migraine-related outcomes published through April 2017
  • The effect sizes and heterogeneity for pain and disability were estimated using meta‐analytic methods.
  • The Cochrane Risk of Bias Tool was used to evaluate the methodological quality of retrieved studies
  • The results of this meta‐analysis informed the design of a randomized controlled trial evaluating the addition of chiropractic care to usual medical care for women diagnosed with low-frequency episodic migraine.

 

What They Found

  • On the basis of 6 identified RCTs, random effects models indicated that spinal manipulation significantly reduced pain with an overall moderate effect size
  • Spinal manipulation also significantly decreased disability with an overall moderate effect size
  • However, the existing studies focused primarily on isolated spinal manipulation and not on comprehensive chiropractic care. To address this gap in the literature, our RCT will assess the safety, feasibility, and effectiveness of multi‐modal chiropractic care for women aged 20‐55 who experience 4‐10 migraines per month and are not using preventive medications
  • Our modular chiropractic care approach may include, as needed, posture correction/spinal stabilization exercises, soft‐tissue relaxation techniques, spinal manipulation/mobilization, breathing and relaxation techniques, stretches, self‐care, ergonomic advice, and/or bracing and supports

 

Conclusion

The authors said the following, “Our meta‐analysis indicated that spinal manipulation shows promise as a therapeutic technique to reduce migraine pain and disability, yet highlighted the need for rigorous studies evaluating the full scope of chiropractic care for migraineurs. The results of our meta‐analysis provide the rationale for the design of our RCT.”

I can’t wait to see the result of the RCT. Wanna know why? Because I already know the results. At this point, it’s anecdotal but the results will show that chiropractors help headaches and migraines. I’m looking forward to hearing all about it.

 

If I don’t find it first, I know my colleague, Dr. Craig Benton down in Lampasas, TX. He’ll probably find it before me though. Lol. He’s on it every single day. I get a lot of information from a lot of different places but that guy just gets it first.

 

Lastly, I want to direct you to Episode #6 of our podcast. This one was with Dr. Tyce Hergert down in Southlake, TX called “Astounding Expert Information On Immediate Headache Relief. “

 

https://www.chiropracticforward.com/dr-tyce-hergert-astounding-expert-information-immediate-headache-relief/

 

We covered a paper. A paper that I thought had an outstanding quote in the conclusion.

 

The quote from the authors themselves reads as follows, “Upper cervical translatoric spinal mobilization intervention increased upper, and exhibited a tendency to improve general, cervical range of motion and induce immediate headache relief in subjects with cervicogenic headache[3].”

 

Now, in that episode, we explain that it was authored by Physical Therapists and that they have come up with their own term for a chiropractic adjustment and their term is “translatoric spinal mobilization.”

 

The point being that chiropractic adjustments can provide immediate relief for cervicogenic headaches. That’s sexy folks. Straight up awesome. Chiropractors help headaches.

 

The sub-points or something extra I’d like you to notice is the fact that physical therapists are moving in, adopting our ONE THING. So much so that they have taken it upon themselves to re-name our ONE THING for their own use.

 

This goes back to what we covered in episodes 28, 29, and 30….. We must integrate into the medical field and quit being out on the fringe. Otherwise, those that are already in the medical realm (physical therapists) will simply take our ONE THING, steal it, and we will still be sitting out there in the rain knocking on the window and watching them all eating steaks inside the private club. Lol.

 

That’s a little dramatic. There are those in our field that want to stay separate and distinct and I understand that. I understand your stance and your viewpoint. I just don’t agree with it. That’s all.

 

For me, integration into the medical realm ensures our profession’s survival and the health or our ONE THING. We make sure it sticks around. I’m afraid that if we stay out on the fringe, we LOSE our ONE THING to other professions, our reimbursements continue to fall, our income falls year after year because they getting “translatoric spinal manipulation” rather than chiropractic adjustments, and eventually, we cease to exist.

 

Just some random thoughts but, I truly think it’s time. Move toward the middle or suffer the consequences. I honestly see very few other options.

 

The research proves time and time again that we can EASILY move toward the middle. It’s coming out every week. More and more validation.

 

But, then there’s this. The ACA sent out an email recently discussing the fact that, in a continuing effort to be the absolute worst health insurance company in the world, United Healthcare is now discontinuing any coverage of chiropractic for the treatment of headaches[4]. What? What in the hell? Wait, let’s go through the website for UHC real quick so we know exactly what’s going on here. Got your gripey pants on? You’re going to need them. Chiropractors help headaches but UHC hasn’t received the message apparently.

 

On their website we’re linking here in the show notes:

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/manipulative-therapy.pdf

 

UHC says the following:

Manipulative therapy is unproven and/or not medically necessary for treating: ·Non-musculoskeletal disorders, including but not limited to:

o Lungs (e.g., asthma)
o Internal organs (e.g., intestinal)
o Neurological (e.g., headaches)
o Ear, nose, and throat (e.g., otitis media)

  • Temporomandibular joint (TMJ) disorder
  • Scoliosis

Manipulative therapy is unproven and/or not medically necessary for preventive or maintenance care. The role of manipulative therapy in preventive or maintenance care has not been established in scientific literature. A beneficial impact on health outcomes has not been established.

They go on to say Craniosacral therapy (cranial manipulation/Upledger technique) or manipulative services that utilize nonstandard techniques including but not limited to applied kinesiology, National Upper Cervical Chiropractic Association (NUCCA), and neural organizational technique are unproven and/or not medically necessary for any indication.

Manipulative therapy is unproven and/or not medically necessary when ANY of the following apply:

  • The member’s condition has returned to the pre-symptom state.
  • Little or no improvement is demonstrated within 30 days of the initial visit despite modification of the treatment plan.
  • Concurrent manipulative therapy, for the same or similar condition, provided by another health professional whether or not the healthcare professional is in the same professional discipline.

I went that far into the paper just for the “huh, really?” effect but the main point here is, how can they say that spinal manipulation/mobilization is not clinically proven for headaches? In addition to the papers I pointed to here in this podcast, there are more in the links and episodes I provided. As in around 10 or so others showing and proving effectiveness. Just in episode 14 alone.

 

What exactly do they need and why the change?

 

Is this part of the Texas Medical Association’s attack on Texas Chiropractors where they are attempting to remove the neuro- from the neuromusculoskeletal treatment scope from chiropractors? It sounds like it to me when you look at it. I get the internal organs part. I get the asthma part. I do NOT understand how they classify headaches as strictly neuro in nature and have made a line where they do not cover any neuro treatment for chiropractors.

 

It’s unreal. It really is. Here on this site, they cite Chaibi et. al. (2017) and Seffinger and Tang (2017). In these papers they site, both conclude that spinal manipulation was effective. The second paper showed spinal mobilization to be more effective than physical therapy but….guess what. They need more studies. Probably studies like I’ve been telling you all about for 7 months now.

 

This kind of stuff makes me want to punch myself in the nose and go home and kid my daughter’s cat. Straight up punt that sucker. That’s nothing new though but seriously. To borrow a phrase from one of my very favorite football coaches, “This kind of garbage just makes my pee hot.” It really does folks.

 

Chiropractors help headaches. Every day all day and the research sure as hell shows it too.

 

Just keep on keepin on and stay strong, ladies and gents. What other option do you have without going back to school? It’s still the best time to be a chiropractor. It’s still the time in which there is more opportunity than ever before. This stupid insurance company cites only two papers and both of them showed effectiveness for headaches. It’s only a matter of time before all of the idiots start to catch up with the research and with what chiropractors have known for generations.

 

This week, I want you to go forward speaking with confidence and knowing that you are effective for headaches and migraines. You can change people’s lives. If you are not being effective for your patients’ headaches, seek some advice from a mentor. Sometimes it’s just a little tweak here and there and you’ll be on the road to being your patients’ hero. When done well, research backs us on this all over the place. For more proof, go check out show notes on Episode #14 or our Stroke blog at https://www.chiropracticforward.com/blog-post/debunked-the-odd-myth-that-chiropractors-cause-strokes-revisited/

Integrating Chiropractors

 

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

 

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

 

Send us an email at dr dot williams at chiropracticforward.comand let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

 

Being the #1 Chiropractic podcast in the world would be pretty darn cool.

 

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

 

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  1. Haas M, Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial.Spine, 2018: p. S1529-9430.
  2. Bernstein C. Rationale and Design of a Randomized Controlled Trial of Chiropractic Therapy for Migraine Pain Alleviation. in 60th Annual Scientific Meeting American Headache Society. 2018. San Francisco Marriott Marquis San Francisco, CA.
  3. Malo-Urries M, Immediate Effects of Upper Cervical Translatoric Mobilization on Cervical Mobility and Pressure Pain Threshold in Patients With Cervicogenic Headache: A Randomized Controlled Trial.J Manipulative Physiol Ther, 2017. 40(9): p. 649-658.
  4. Policy, U.H.C.M. Manipulative Therapy. 2018 1 June 2018]; Available from: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/manipulative-therapy.pdf.

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