Chiropractic and Headache

Chiropractic and Headache

by: Leslie Banic, DC

Chiropractic is now more than a century old, and it is licensed throughout the United States and Canada and recognized in more than 60 countries worldwide. Doctors of Chiropractic receive training that is focused on the treatment of NMS conditions through manual and physical procedures, such as manipulation, massage, exercise, and nutrition. Most patients present to chiropractors with low back pain, neck pain, whiplash, and headaches. Numerous studies and expert panel reviews have supported the use of chiropractic and manipulation for these complaints. Chiropractic, in general, offers safe and cost-effective procedures for selected musculoskeletal problems.

( 1) Headache and neck pain sufferers make up as much as one third of patients seeking treatment from doctors of chiropractic.

(2) Chiropractors have a long tradition of anecdotal success in managing headaches, as reported in case studies. In addition, several randomized controlled clinical trials have been conducted that demonstrate positive results. Spinal manipulative therapy appears to have a better effect than massage for cervicogenic headache. It has also been reported that SMT has an effect comparable to commonly used first-line prophylactic prescription medications for tension-type headache and migraine headache.

(3)
Several studies have linked altered cervical curve configurations to the presence of chronic headache pain. In a survey of more than 6000 chronic headache sufferers, Braff and Rosner, in investigation of whiplash trauma, found that complete or segmental loss or reversal of the cervical curve is the most consistent characteristic feature and is often the only abnormality found.

(4) Another study, published in the medical journal, Headache, compared 372 patients with tension-type headache to 225 control subjects. The headache patients were found to have abnormally straightened cervical curves compared to the control subjects. The researchers conclude that the abnormally aligned neck position requires greater muscular effort to support the weight of the head and neck, leading to muscle fatigue and tension-type headache.

(5) Finally, in a study of 47 subjects with tension and migraine headaches, a high incidence of straightened and reversed cervical curve configurations was found.


(6)In lordosis, the normal curve of the cervical spine, anterior and posterior stresses in the vertebral body are nearly uniform and minimal. [There is shared weight bearing between the articular pillars / facets and the cervical discs.] In areas of straightened and reversed cervical curve, termed kyphosis, combined stresses changed from tension to compression at the anterior vertebral margins and were very large (6-10 times as large in magnitude) compared to lordosis. In kyphotic areas at the posterior vertebral body, the combined stresses changed from compression (in lordosis) to tension. The stresses in straightened and reversed areas are very large and opposite in direction compared to a normal lordosis. As osteophytes and osteoarthritis are found at areas of altered stress and strain, this analysis provides the basis for the formation of osteophytes (Wolff's Law) on the anterior margins of vertebrae in kyphotic regions of the sagittal cervical curve. This indicates that any kyphosis is an undesirable configuration in the cervical spine. As related to muscular fatigue and tension-type headache, axial and flexural stresses at kyphotic areas in the sagittal cervical spine are abnormally high.


(8.7 )In addition to the long term detrimental effects, osteophytes and osteoarthritis, associated with abnormal postures of the cervical spine, chronic pain may be generated by many of the innervated tissues in the area. “The presence of mechanoreceptive and nociceptive [pain generating] nerve endings in cervical facet capsules proves that these tissues are monitored by the CNS and that neural input from the facets is important to proprioception and pain sensation in the cervical spine. “Studies of peripheral joints suggest that these receptors monitor joint excursion and capsular tension and may initiate protective muscular reflexes important in preventing joint degeneration and stability.”

(9) Multiple studies have found that the discs outer annular fibers, the ALL, PLL, Supraspinous and Intraspinous ligaments are all innervated with nociceptive nerve endings. Abnormal postures of the cervical spine create abnormally high stress and strain in the numerous innervated tissues in the region.

At Banic Chiropractic Clinic, we practice the Chiropractic BioPhysics technique.

(www.IdealSpine.com, click Research, follow links to Medline) We utilize exercise, adjusting, and a unique form of cervical traction to restore the cervical spine to within the normal range of lordosis. In the Archives of Physical Medicine and Rehabilitation, 2002, thirty subjects had statistically significant changes in pain scales and lateral cervical radiographic measurements compared with no change in 24 control subjects. Average improvement in cervical lordosis for global angles between C2-C7 was ~14 degrees. For the treatment group, at 15 month follow-up, the total cervical lordosis remained stable without maintenance care. (10) Other studies of the Chiropractic BioPhysics method for restoring cervical lordosis yielded similar results.

Conclusion: Chiropractic, in general, offers safe and cost-effective procedures for selected musculoskeletal problems. Spinal manipulative therapy appears to have a better effect than massage for cervicogenic headache. It has also been reported that SMT has an effect comparable to commonly used first-line prophylactic prescription medications for tension-type headache and migraine headache. Several studies have linked altered cervical curve configurations to the presence of chronic headache pain. Abnormal postures of the cervical spine create abnormally high stress and strain in the numerous innervated tissues in the region.

Recently developed techniques in chiropractic have demonstrated the ability to restore cervical curvature and reduce pain and these results are stable at long-term follow-up. Chiropractic care at Banic Chiropractic Clinic may be a good choice for a patient with chronic headache pain.


(1)Dagenais S, Haldeman S., Prim Care. 2002 Jun;29(2):419-37.(2)Hurwitz EL, Shekele PG., Am J Public Health. 1998:88:771-776(3)Bronfort G, Assendelft WJ, Evans R, Haas M, Bouter L . Efficacy of spinal manipulation for chronic headache: a systematic review. J Manipulative Physiol Ther. 2001 Sep;24(7):457-66.(4)Braff MM. Rosner S. Trauma of the cervical spine as a cause of chronic headache. J Trauma. 1975;22 (5)Nagasawa A. et al. Roentographic findings of the cervical spine in headache. Headache. 1993;33:90-95(6)Vernon et al. Cervicogenic dysfunction in muscle contraction headache and migraine. JMPT 1992;15 (7) Harrison DE, Harrison DD, Janik TJ, Cailliet R, Normand M. Comparison of axial and flexural stresses in lordosis and three buckled configurations of the cervical spine. Clin Biomech. 2001 May;16(4):276-84.(8) Harrison DE, Jones EW, Janik TJ, Harrison DD. Evaluation of axial and flexural stresses in the vertebral body cortex and trabecular bone in lordosis and two sagittal cervical translation configurations with an elliptical shell model. JMPT. 2002. July-August;25(6):391-401.(9)McLain RF. Mechanoreceptor endings in human cervical facet joints. Spine. 1994; 19:495-501.(10) Harrison DE, Cailliet R, Harrison DD, Janik TJ. A new 3-point bending traction method for restoring cervical lordosis: a nonrandomized clinical controlled trial. Arch Phys Med Rehabil. 2002 Apr;83(4):447-