Neck Pain & Headache

On occasion every man, woman, and child has or will experience minor neck aches, pain, and stiffness. This condition is usually due to overuse or holding the head in an awkward position. The good news is that situations such as these clear up on their own after a day of rest or a good night’s sleep. However, neck pain and stiffness that persists for more than a 24 hour period should have professional evaluation.Aside from pain and stiffness, several other complaints can be generated by problems in the cervical spine (aka: neck). These symptoms include: dizziness, headache, pain in the ears, face, and scalp; pain in the shoulder-arm-hand, and numbness/tingling in one or more of the fingers; all of which are some of the more common complaints seen in a chiropractic office.

The neck is very susceptible to stresses and strains from any source and is strained more than any other structure in the body. Why is this you may ask? Well keep in mind that the cervical spine is composed of seven small vertebrae and supported by muscles and ligaments which have to hold and balance a head, which on average, weighs ten pounds!

Chiropractic care has been shown to help complaints such as these and the research tells us this:

• In 2001, a study conducted at the Institute for Research in Extramural Medicine in the Netherlands compared manual therapy (i.e. soft tissue mobilization & joint manipulation), physical therapy, and general practitioner care for acute and chronic neck pain. The patients that received manual therapy had faster improvement and significantly less pain than the other two groups both in the short and long term.1

• A study published in the September 2002 edition of Spine found that manipulative therapy when combined with exercise can reduce the symptoms of cervicogenic headache (headaches where the pain originates in the cervical spine, neck and upper shoulders), and the palliative effects of this combined form of treatment were sustainable.2

• Treatment of headache via chiropractic manipulative therapy has a strong base of evidence. The current research definitely supports the treatment of cervicogenic headache with spinal manipulation and also indicates that patients who suffer from tension-type and migraine headaches may receive benefit from this form of care as well.3

• In a recent randomized controlled trial, researchers at Western States Chiropractic College and other institutions funded by the National Center for Complimentary and Alternative Medicine (NCCAM), the Federal Government's lead agency for scientific research on complementary and alternative medicine, evaluated the dose (number of treatments) and relative effectiveness of spinal manipulative therapy (SMT) in a group of 80 patients with chronic cervicogenic headache (CGH). They found that SMT is a viable option for treating CGH but admit these findings should be considered preliminary.8

The research also finds that the treatment of neck pain via manual therapy is also an economical way to address issues in the cervical spine.

• The 2001 study conducted at Wageningen University in the Netherlands provides one of the finest examples to date in the back and neck pain literature of a cost-effectiveness analysis in conjunction with a randomized control trial. 45* This study compared manual therapy (i.e. soft tissue mobilization & joint manipulation), physical therapy, and general practitioner care for neck pain. The palliative effects obtained from each form of therapy, regardless of the associated demographic, as well as, all the costs associated with the application of each form of care, regardless of who paid for treatment was examined. Subsequently a comprehensive assessment of costs relative to that perspective was then performed.6 Effectiveness measures included perceived recovery, pain, intensity, and disability. Quality of life (measured by the EuroQol 5D)7 was used as the utility measure and expressed in quality-adjusted life years (QALYs). The results indicated that manual therapy was more cost effective and less costly than physical therapy and general practitioner care. 4

 

1 Hoving JL. Neck pain in primary care: The effects of commonly applied interventions [thesis/dissertation]. The Netherlands: Institute for research in Extramural Medicine (EMGO Institute) of the Vrije Universiteit, 2001.

2 Jull G, et al. A Randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002:27: 1835-1843

3 Haldeman S,ed., et al. Principles and Practice of Chiropractic. New York: McGraw Hill, 2005

4 Haldeman S,ed., et al. Principles and Practice of Chiropractic. New York: McGraw Hill, 2005

5 Korthals-de Bos IBC, Hoving JL, van Tulder MW, et al. Manual therapy is more cost-effective than physical therapy and GP care for patients with neck pain. In: Hoving JL, ed. Neck pain in primary care: The effects of commonly applied interventions. Wageningen: Pons & Looijen, 2001:76-89

* The randomized control trial is considered an absolutely indispensable aspect of research methodology because it provides the most reliable estimate of treatment effect with the least biased method of causal inference.

6 Brazier J, Deverill M, Green C. Harper R, Booth A. A review of the use of health status measures in economic evaluation. Health Technol Assess 1999; 3(9): 1-161

7 EuroQol – A new facility for the measurement of health-related quality of life. Health Policy 1990;16: 199-208

8 Haas M, Spegman A, Peterson D, et al. Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial. Spine Journal. 2010;10(2):117–128.