Chiropractic and headache

On May 9th 2005 I came early to Dr Michael Kricken's office, to talk about chiropractic and headache. The clinic was still closed, but Dr. Kricken invited me in and we went to a small room to talk. The chiropractor with the memorable name has been treating me for several years.

Kricken started in Canada at the University of Calgary as a premed student, going on to the Canadian Memorial Chiropractic College in Toronto. The chiropractic college has an intensive four year program, sharing many medical instructors with the University of Toronto medical school. In his fourth year, he was expected to do 1000 hours of supervised practice in a clinic. He graduated with Clinical Honours. Finally, he passed provincial exams to get his license. The province requires him to do at least 25 hours of post graduate training each year, and he had just completed a twelve hour program when I spoke with him. This summer he will begin his 16th year of practice.

He was anxious to share his experience with chiropractic and headache. I soon found that he wanted to talk not just about chiropractic care, but how it fit into the big picture...

You've seen many patients with headache or migraine. How can a headache sufferer or migraineur be helped through chiropractic treatment?

We're learning that most people's head pain seems to come from structures in the neck. The joints and nerves in the upper neck, the muscles of the upper shoulder, and the muscles of the TM joint, which is in the jaw. Those three are the keys to headache pain.

But what I've found, as a headache sufferer myself who has been greatly helped by chiropractic, is that there are several factors involved.

One is sleep. I think that the number one cause certainly of tension headaches is that people are just plain overtired. Sometimes sleep patterns have to be consistent. In other words, going to bed and getting up at the same time seems to be really important.

There are other factors, such as dietary considerations. There are people whose migraines are set off by drinking a little red wine, or by eating chocolate.

Everything in the human body is mediated by the central nervous system. The spinal cord and nerves are involved in every process. That's why I think so many conditions show up in the spinal column.

For instance, say you're eating chocolate – it goes into your mouth, there are chemicals released, and there are sensory nerve endings all down the digestive tract. These relay information to the brain, and in some people those chemicals can set off a cascade of events leading to migraine attacks. So the nervous system is key in every condition, and I think that's why chiropractic has more success than any other form of treatment for people with headaches.

It's important to emphasize that chiropractic is not a treatment of conditions. It's a way to help the body to function better.

The central nervous system (CNS) -- brain, spinal cord and spinal nerves control the function of every organ, tissue and cell in the human body. If there is any interference to the function of the CNS then the body cannot function in a healthy way. Chiropractic adjustments specifically and directly remove (or in some cases reduce) interference to the CNS thereby allowing the body to function properly.

Does that mean that I am saying that chiropractic treatment is "a cure for all diseases?" Absolutely not. What I am saying is that every human being is far better off from a health and function standpoint without nerve interference in their body. Do we chiropractors sometimes see patients get relief and improvement from conditions other than neck and back pain? Unequivoquely, yes! However, the intent of chiropractic is to help the CNS and therfore the entire body, to function more normally not to treat diseases, conditions or even pain for that matter. Do you see the difference? That's why every man, woman and child should be checked regularly by a Doctor of Chiropractic - so that their body can function in the healthiest manner possible, regardless of the presence of migraines, irritable bowel or even cancer. The condition that the patient has isn't nearly as important as the person who has the condition!

One thing you have to realize about the nervous system is that it works in pathways. If that pathway has been set off a lot, then over time that pathway gets set off with less and less stimuli. In other words, if there's a nerve somewhere in the neck that's been irritated for years, then that nerve is what we call facilitated. In other words, it will get set off with less and less stimuli. The nervous system learns patterns. For a migraine sufferer, it will take less and less for them to get a migraine attack.

So it's the upper neck joints and nerves, and the muscles of the upper shoulder and jaw. Those are the big three. And every migraine sufferer has some combination of those, without exception.

Could you tell us one success story of a patient that had migraine?

Well, there's several. I've had several patients who have been migraine patients all their lives who do not get migraines at all since they've had chiropractic care. I would say that group would probably be 25-30%. The majority of migraine sufferers find if they're getting consistent chiropractic care they just don't get as many migraines. And then there's a small group chiropractic doesn't seem to make any difference to their migraines. I don't have those statistic but just in general terms that's what I find.

Let me tell you one that I would say is more of a realistic example. She's not a person whose migraines have gone completely away. She would be 42 years of age now. She's been a patient of mine for probably 13 years. She finds that if she sees me every 3-4 weeks for a neck adjustment, and we also work on her upper back to align her upper back, that she typically can go that amount of time now without a migraine. And as I recall migraines were a part of almost daily life for her for the first 20-some years of her life.

There are other factors with her, and I think this is important to note. We had to work with her on her posture. We had to work with her on her diet. We had to work on her because she's a real maybe a driver type of a personality and so she maybe didn't get enough rest sometimes. So I feel like I'm a bit of a coach for her, in asking her how are you doing, are you getting enough rest, how's your diet, those types of things. With migraine sufferers as with a lot of patients, the chiropractic adjustment is very important because it keeps the nerves more calm, but also there's trying to encourage the patient in just healthy living. She rarely gets migraines now, but she does occasionally if she pushes a bit too hard.

Many people have had bad experiences with chiropractors in the past. What do you suggest people look for when they're trying to choose a chiropractor?

Good question. I sometimes hear these so-called bad experiences. I think one of the challenges for the chiropractor is to communicate what chiropractic is, what the patient's issue is as seen by the chiropractor, and what the chiropractor is trying to accomplish. I've found that a lot of the so-called bad experiences are just poor communication by the doctor to the patient.

For the patient, seeing any kind of doctor, the main thing is that the doctor listens to you; are they truly interested in you and are they truly listening to you.

If you can get a personal reference from another patient that a certain chiropractor has really helped, that's always the best way to find somebody.

Is there any treatment or assessment that you do beyond the basic "adjustments"?

Yes, I've done a lot in the last two years now on x-ray assessment of the skull and the alignment of the skull as it relates to the vertebrae of the neck. I've found that this is really important in determining how people respond to chiropractic, what kind of treatment is best and for how long it's necessary.

There's supposed to be a normal curve in the neck, and when that curve is lost – and it can be lost through injury and different reasons, often we find that when we can restore that curve we can normalize the nerve flow. I got into this almost three years ago with my own neck, and it's just a certain technique and use of x-ray that I've found with some patients is incredibly powerful. And a lot of times for headache sufferers.

There are lots of good things out there. There are a lot of chiropractors that like to specialize in different things, so I like to specialize in the structure of the spinal column, in the alignment of the spinal column. There's other chiropractors that I send people to who just do muscle soft tissue, and I've sent people there. So I think for me I don't want to try to be all things, I want to be really good at what I do.

What do you enjoy most about being a chiropractor?

I honestly enjoy most the ability to affect people's quality of life. When people come in and say,"I can now hold my grandchildren" or "I can now play with my grandchildren" "I can now golf" "I can now sleep through the night" - that to me is very gratifying.

What other suggestions do you have for people with headache or migraine that are thinking about chiropractic care?

I think it should be the first thing that people do, because of all the modes of treatment that I know, it is the thing that provides the most relief for the largest majority of people.

I've been a tension headache sufferer, and I have had a couple of migraines in my life and they are – I don't think there's any pain worse than severe head pain. I think it's the most debilitating thing. I've talked to women who've delivered babies who've said that a full-blown migraine is worse. I think what I've learned about the human body and health care is that there's no blanket solutions. What works for one person doesn't work for another. But there are some common threads. The nervous system, the muscles, I think thoughts can be part of what can trigger migraines. There's lots of triggers.

I would highly encourage any migraine sufferer to keep a diary, and to record everything in their environment that they encounter. So if they were painting one day, or what they ate, what they were thinking, if they went through stress, somebody yelled at them, everything that happens to them, everything that they do, I had to write an examination, I was at a car accident. Then keep a diary of headaches or other aches and pains or other physical abnormalities. And when a person does this they start to learn and see some common themes for them.

Then if you go to any kind of practitioner for treatment, continue with that diary and see if there's a change and if you can attribute it to that treatment or that diet or whatever you're trying. Because otherwise it's somewhat subjective.

Don't be closed minded about trying new things, even if you've heard from someone else that it's maybe not good, because probably that other person doesn't have a full experience of it anyway. So be open minded.

Try to live as normal a life as you possibly can, and don't give in to the pain. You may not be able to deal with it completely, but deal with it the best you possibly can. Continue to pursue health and continue to pursue answers – because there are answers and solutions.

Thanks to Dr Michael Kricken for this helpful interview on chiropractic and headache. Dr Kricken can be found in Calgary at the Hands On Health Clinic. Visit their website for more success stories and general information about chiropractic care.