ArticlePDF Available

Resolution of Chronic Headaches Following Reduction of Vertebral Subluxation in an 8-Year-Old Utilizing Chiropractic Biophysics Technique

Authors:

Abstract

Objective: To describe the outcome of Chiropractic Biophysics (CBP) technique along with dietary changes performed on an 8-year old with chronic headaches as well as chronic sore throat, fatigue, dizziness, queasiness, and radiographic diagnosed cervical subluxation. Clinical Features: An 8-year old male presented with chronic headaches for two years. He also suffered from sore throat, fatigue, queasiness, aches, pains, and dizziness. He had been seen by a neurologist, psychologist and nutritionist with limited health improvements. Radiographs of the cervical spine revealed a cervical spine second harmonic S-shaped neck with upper spine kyphosis and lower spine hyperlordosis. Interventions and Outcomes: The boy was treated with CBP mirror-image isokinetic exercises, postural adjustments, and cervical spine extension traction. Spinal manipulation, cervical mobilization and hydrotherapy were provided. One month into care, a food diary analysis prompted dietary modifications along with nutritional supplementation. The child was originally seen on a three times per week schedule as per CBP protocol then progressed to a maintenance schedule of two times per month, a total of 86. A lateral cervical radiograph taken 6-months after initiating care revealed that his cervical lordosis was improved to near normal for his age. Conclusion: This case presents the successful outcome in an 8-year old with a variety of health issues as well as headaches. This case and others suggests CBP cervical extension traction as well as manipulation is a safe and effective intervention for the pediatric headache.
Introduction
Pediatric headache remains a frequent health problem for
children and their families.
1
In fact, headache is a common
complaint in childhood with up to 75% of children reporting a
notable headache by the age of 15 years.
2
Cervical subluxation (hypolordosis/kyphosis) has been
implicated as a contributing factor to headaches.
3-6
For
example, Nagasawa et al.
6
evaluated the presence of
straightened cervical spines in headache patients as compared
to controls and concluded that a straightened cervical spine
may play an important role in the pathogenesis of tension-type
headache.
Headaches
1. Private Practice of Chiropractic, Ontario, Canada
2. Private Practice of Chiropractic, Annapolis, MD, USA
C
ASE STUDY
Resolution of Chronic Headaches Following
of Vertebral Subluxation in an 8-Year-Old Utilizing
Chiropractic Biophysics Technique
Paul A Oakley DC, MSC
1
, Stephanie J Chaney DC
2
, Tom A Chaney DC
2
, Adam Maddox, DC
2
Abstract
Objective: To describe the outcome of Chiropractic Biophysics (CBP) technique along with dietary changes performed
on an 8-year old with chronic headaches as well as chronic sore throat, fatigue, dizziness, queasiness, and radiographic
diagnosed cervical subluxation.
Clinical Features: An 8-year old male presented with chronic headaches for two years. He also suffered from sore
throat, fatigue, queasiness, aches, pains, and dizziness. He had been seen by a neurologist, psychologist and nutritionist
with limited health improvements. Radiographs of the cervical spine revealed a cervical spine second harmonic S-
shaped neck with upper spine kyphosis and lower spine hyperlordosis.
Interventions and Outcomes: The boy was treated with CBP mirror-image isokinetic exercises, postural adjustments,
and cervical spine extension traction. Spinal manipulation, cervical mobilization and hydrotherapy were provided. One
month into care, a food diary analysis prompted dietary modifications along with nutritional supplementation. The child
was originally seen on a three times per week schedule as per CBP protocol then progressed to a maintenance schedule
of two times per month, a total of 86. A lateral cervical radiograph taken 6-months after initiating care revealed that his
cervical lordosis was improved to near normal for his age.
Conclusion: This case presents the successful outcome in an 8-year old with a variety of health issues as well as
headaches. This case and others suggests CBP cervical extension traction as well as manipulation is a safe and effective
intervention for the pediatric headache.
Key Words: CBP, cervical lordosis, cervical hypolordosis, cervical kyphosis, extension traction, headaches, vertebral
subluxation, pediatrics
J. Pediatric, Maternal & Family Health - August 11, 2011 82
Also, Vernon et al.
5
determined that a ‘greatly reduced or
absent cervical curve’ was a high occurrence characteristic in
those who suffered from tension headaches and migraines.
Consequently, the correction of cervical spine lordosis has
been documented to alleviate headache symptoms in pediatric
cases.
7-10
This case presents the successful outcome in a
pediatric who suffered from headaches as well as other health
problems having cervical subluxation
(hyperlordosis/kyphosis) who received treatments aimed at the
restoration of the cervical lordosis using Chiropractic
Biophysics technique.
10,11
Case Report
Clinical Features
An 8-year old male (67 kg) presented with headaches, muscle
aches, fatigue, allergies, and digestive problems. It was
reported that he suffered daily from headache, sore throat, and
fatigue, suffered most days from queasiness, and some days
from aches, pains, and dizziness. His headaches would range
from a 6-10/10 (0=no complaint, 10=worst pain/sensation
ever) on an 11-point numerical rating scale (NRS), his sore
throat a 4-8/10, fatigue a 7-8/10, dizziness a 6/10, and
queasiness a 3-4/10 when bothered by these symptoms.
The headaches were described as sharp and throbbing, worse
with noise, better when lying down, and located in the frontal
skull area and reported to occasionally last an entire day where
he is sometimes awakened because of them at night.
Health history revealed that during delivery he was unable to
breath after cutting of the cord. The attending staff gave him
‘something’ and he seemed normal thereafter. The mother
took medications to ease delivery pains approximately 45
minutes prior to birthing. The child received all the regular
recommended vaccinations, had been on antibiotics
approximately 6 or more times mostly due to sinus infections.
He was breast fed for 6-months, formula fed for 2-months
following, and solid foods were first introduced at 4-months.
His development was described as normal and he was able to
walk alone at 11.5-months.
Over the last year the child had felt too sick to partake in
activities he used to such as rock climbing. Due to his
declining health the parents had taken him to a pediatric
neurologist-headache specialist, an allergist, a nutritionist, and
a psychologist. Despite the guidance from these medical
practitioners throughout the Annapolis and Baltimore area, the
boy’s health continued to fail. Any recommended medications,
dietary restrictions, and relaxation techniques only gave slight
and temporary relief if any at all.
Chiropractic Examination
During examination palpation revealed tenderness in upper
cervical (C1-Co) and lower cervical (C3-T1) areas, para-
vertebral muscle spasms were present through the entire
cervical spine (C0-C7), and motion palpation revealed
dyskinesia in the upper cervical spine (Co-C1), mid cervical
spine (C3-6), and upper thoracic spine (T2-T5).
Radiographs of the cervical spine (Fig 1) revealed a cervical
spine second harmonic configuration;
12-13
that is, an S-shaped
neck with upper spine kyphosis (C2-3= +6.1°) and lower spine
hyperlordosis (C3-7= -36.2°) creating an absolute rotation
angle (ARA) from C2-7 of -30.1°. The atlas plane line was
21.8°. Lumbar radiographs revealed pelvic unleveling
indicative of an anatomical short left leg. The primary
diagnosis was cervicogenic headache resulting from global
subluxation of the cervical spine. One month into care, a food
diary analysis was performed with the help of his mother.
Food diary analysis revealed a diet that consisted primarily of
processed grains, dairy and meats, such as hot dogs and lunch
meats, and lacking in fresh fruits and vegetables with no
addition of nutritional supplements.
Intervention and Outcome
The child was given a total of 86 treatments over the course of
a year and two thirds. Initially he was on 3-times per week
schedule progressing to a maintenance schedule of 2-times per
month. Two nutritional consultation visits were scheduled to
discuss findings of the food diary and the recommendations
for dietary modifications, which included elimination of dairy
and gluten-containing grain products and the introduction of
fresh fruits and vegetables. Additional supplementation
included a pediatric serving (1/2 oz) of a liquid organic
multivitamin and 1 Tbsp daily of cod liver oil and a daily
pediatric serving of powdered magnesium and calcium.
Cervical spine extension traction was applied via 2-way
counter stressing mechanical traction
14
performed for initially
5 minutes and progressing to 15 minutes with weight of 5lbs
on the front and 2.5 lbs on the back. Spinal manipulation was
occasionally performed and cervical mobilization was
provided. Isokinetic mirror-image exercises were also given
for the cervical spine and thoracolumbar spine. To normalize
cell metabolism, speed up tissue repair, and enhance muscular
vasodilation, hydrotherapy was done for 10 minutes duration.
Radiology
A lateral cervical radiograph taken revealed that cervical spine
lordosis had improved in shape, the C2-3 kyphosis was
reduced to +2.2° (from +6.1°) and the C3-7 hyperlordosis
reduced to -27.7° (from -36.2°); overall, the absolute rotation
angle C2-7 was reduced to -25.6°(from -30.1°) much closer to
approximating a normal 8-year old lordosis (-22.
10,15
). The
child was ‘graduated’ to a maintenance care program of twice
a month as his symptoms had subsided concomitant with the
improvement in distribution of lordosis throughout his cervical
spine.
An assessment revealed that, although the child had been in an
automobile collision since his last assessment, he had no
complaints. Upon examination there was deep spastic
paraspinal musculature bilaterally in the lower cervical spine
with articular fixations in the cervical, lower thoracic and
lumbar areas. All spinal ranges of motion were normal; all
orthopedic tests were also negative. It was recommended that
moving forward he be treated on an ‘as-needed’ basis for
continued care.
Headaches
83
J. Pediatric, Maternal & Family Health - August 11, 2011
Discussion
Pediatric headache is a common complaint
2
and accordingly,
the chiropractor must practice due diligence to ensure a
comprehensive exam and diagnosis. This is because, although
rare, there is an increased likelihood of a serious pathology
with pediatric headache presentations such as benign and
malignant tumours, cerebrovascular disease, primary disorders
of raised intracranial pressure and depression. However, this
risk is reduced if a diagnosis of a primary headache disorder
can be made.
16
Cervical Lordosis
Lack of cervical lordosis, such as kyphosis or hypolordosis, is
commonly associated with presence of headache
symptomatology
3-6
and should be targeted for correction as it
is a prime suspect in headache pathogenesis. Although the
cervical spine in adults has been well studied and modeled,
17-20
the pediatric spine has not been. Bagnall et al. demonstrated
the cervical lordosis is present in 83% of fetuses and illustrates
a fetus having a clearly established lordosis at 91/2 weeks in
utero.
21
Data from Kasai et al.
22
indicates the lordosis is most
prominent in ages 2-4, where it decreases steadily from ages 4
- 9, then the lordosis steadily increases up to age 18
approaching normal adult lordosis.
The adult cervical lordosis has been determined to be normal
in the range of 31° through to 42°, the upper end being the
CBP ‘ideal’ or essentially the gold standard. Re-analyzing the
data from Kasai,
22
Harrison et al.
10
presents a table of normal
Cobb and ARA values for pediatrics aged 2-18 years. In a
letter to the editor, Oakley
15
has pointed out the fault of
applying the CBP adult lordosis of 42° in the evaluation of
children as it may result in gross ‘over-corrections’ if
consideration for pediatric lordosis is neglected.
Although there are clinical trials documenting routine
correction to the cervical spine in adults receiving extension
cervical traction
12,23-24
(in conjunction with chiropractic
manipulation and exercise) there are only a few sporadic case
reports documenting restoration of lordosis by CBP technique
in relief of headaches in the pediatric population.
7-10
In fact, we located only eight documented cases where CBP
technique was successfully employed in the pediatric
headache population. These eight cases came from four
different sources.
7-10
The cases ranged in ages from 4-16yrs,
including males and females. The treatment periods to restore
the pediatric cervical lordosis in these cases ranged from 4-
weeks to 12-weeks, and the number of treatments ranged from
22 to 30 treatments for the ‘correction phase.’ Most cases did
not include any maintenance treatments, as is the case with the
current report.
It should be noted, however, that in two of the cases reported
by Harrison et al.
10
after correction and resolution of
headache, trauma to the cervical spine resulted in both
subluxation and concomitant headache symptomatology. In
one of these cases, (Harrison case #1) a subsequent second
round of 4-weeks treatments including extension traction was
required to both correct the lordosis and alleviate the
headaches. This points to a direct causal relationship.
The current case as well as the others discussed point to a
connection between cervical lordosis and pediatric health.
Further, likened to the association between cervical
hypolordosis/kyphosis and headache in adults, it seems
prudent to suggest that a plausible pathogenesis to headache in
pediatrics is cervical subluxation in all its variations, i.e.
hypolordosis; kyphosis; buckled configurations. Although a
caveat is that more research needs to be done, it seems that
evidence points to the cervical spine and it’s alignment as a
critical factor in the diagnosis, treatment and prevention of
cervicogenic headache in the pediatric population.
Dietary Effects
While structure is undoubtedly of importance when discussing
causation of chronic headaches, it is impossible to ignore the
effect of diet. The efficacy of magnesium as a safe method of
alleviation of headaches and migraines has been documented
in the literature.
26,27, 28, 29
Magnesium is utilized in hundreds
of chemical pathways in the body and is known to relax
tension of any muscle in the body, including that of the heart
and blood vessel walls. This may partly explain its positive
impact on headaches. The best source of magnesium is from
green leafy vegetables.
Harel et al.,
30
reported on the significant reduction of
headache frequency in adolescents after consuming fish oil
over a 2-month period. Simopoulos
31
also reports on the
impact that omega 3 fatty acids have on lowering
inflammation and reducing migraine headaches, along with
positively impacting many other inflammatory and
autoimmune diseases. Huss
32
et al. reported in a cohort study
the significantly positive outcomes of omega-3 and
magnesium consumption over a 12-week period on the
behavior of a pediatric and adolescent population displaying
sleep and behavioral disturbances, including ADHD and
impulsivity.
This study emphasizes the importance of essential fatty acids
on brain development, hormone balance and general cell
membrane function. Cod liver oil contains both EPA and
DHA, as well as vitamin D. Vitamin D has also been shown to
be efficacious in the amelioration of mental outlook, energy,
and headaches.
33
Monosodium glutamate (MSG) has been shown to be a causal
factor in pericranial muscle tenderness and headaches.
34
MSG
is found in an increasing number of foods and glutamate may
be found in many other ingredients in processed foods and
thus listed as ingredients other than MSG. Common foods
containing MSG include processed meats, fast foods and many
commercially flavored and processed snack foods, soups,
sauces and dressings.
Conclusion
This case presented the successful outcome in an 8-year old
with a variety of health issues as well as headaches. This case
and others suggests CBP cervical extension traction as well as
manipulation may be an effective intervention for the pediatric
headache, along with diet modification specifically targeting
improvement of brain and nerve health and function and
reduction of inflammation.
Headaches
J. Pediatric, Maternal & Family Health - August 11, 2011 84
Since prior nutritional and dietary counseling alone did not
positively impact the headaches of this subject, it is likely that
either the CBP treatments alone, or the combination of both
CBP treatments and the dietary changes implemented created
the complete resolution of the complaints of the subject.
Further research is needed to determine what subset of
pediatric patients presenting with headaches may be best
suited for structural-based chiropractic care.
References
1. Hershey AD. Recent developments in pediatric headache.
Curr Opin Neurol. 2010 Apr 12. [Epub ahead of print]
2. Hershey AD. Current approaches to the diagnosis and
management of paediatric migraine. Lancet Neurol. 2010
Feb;9(2):190-204.
3. Ng SY. Upper cervical vertebrae and occipital headache. J
Manipulative Physiol Ther 1980; 3:137-141.
4. Schimek JJ. Mohr U. The importance of manual therapy
in the treatment of chronic headache. Manual Med 1984;
22:41-5.
5. Vernon H. Steiman I, Hagino C. Cervicogenic
dysfunction in muscle contraction headache and migraine:
a descriptive study. J Manipuluative Physiol Ther 1992
Sep;15(7):418-29.
6. Nagasawa A. Sakakibara T. Takahashi A.
Roentgenographic findings of the cervical spine in
tension-type headache. Headache 1993; 33:90-95.
7. Pope M. Applied Chiropractic Biophysics. (chap 12, p.23-
24) In: Harrison DD. Chiropractic: The physics of spinal
correction CBP technique. CBP Seminars, 1994.
8. Fedorchuk C., Wheeler G. Resolution of headaches in a
13 year-old following restoration of cervical curvature
utilizing chiropractic biophysics: A case report. J Pediatr
Matern & Fam Health - Chiropr: Fall 2009(2009:4):
Online access 7 p.
9. Fedorchuk C., Cohen A. Resolution of chronic otitis
media, neck pain, headaches & sinus infection in a child
following an increase in cervical curvature & reduction of
vertebral subluxation. J Pediatr Matern & Fam Health -
Chiropr: Spr 2009(2009:2): Online access 8 p.
10. Harrison DE, Harrison DD, Hass JW. Structural
rehabilitation of the cervical spine. Evanston, WY:
Harrison CBP® Seminars, Inc., 2002.
11. Oakley PA, Harrison DD, Harrison DE, et al. Evidence-
Based Protocol for Structural Rehabilitation of the Spine
and Posture: Review of Clinical Biomechanics of Posture
(CBP®) Publications. J Canadian Chiro Assoc 2005;
(49:4): 270-296.
12. Harrison DE, Harrison DD, Janik TJ, et al. Comparison of
axial and flexural stresses in lordosis and three buckled
configurations of the cervical spine. Clin Biom 2001;
16:276-284.
13. Harrison DE, Harrison DD, Troyanovich SJ. Three-
dimensional spinal coupling mechanics: Part II.
Implications for chiropractic theories and practice. J
Manipulative Physiol Ther 1998; 21(3):177-186.
14. Harrison DE, Cailliet R, Harrison DD, et al. A New 3-
Point Bending Conservative Method of Restoring
Cervical Lordosis: Non-randomized clinical control trial.
Arch Phys Med Rehab 2002; 83(4): 447-453.
15. Oakley PA. Letter to the Editor: [Fedorchuk C., Wheeler
G. Resolution of headaches in a 13 year-old following
restoration of cervical curvature utilizing chiropractic
biophysics: A case report. J Pediatr Matern & Fam Health
- Chiropr: Fall 2009(2009:4): Online access 7 p.] J Pediatr
Matern & Fam Health - Chiropr: Summer 2010(2010:3):
Online access 2 p.
16. Kernick D, Stapley S, Campbell J, et al. What happens to
new-onset headache in children that present to primary
care? A case-cohort study using electronic primary care
records. Cephalalgia. 2009 Dec;29(12):1311-6.
17. Harrison DD, Janik TJ, Troyanovich SJ, et al.
Comparisons of lordotic cervical spine curvatures to a
theoretical ideal model of the static sagittal cervical spine.
Spine 1996; 21:667-675.
18. Harrison DD, Janik TJ, Troyanovich SJ, et al. Evaluation
of the assumptions used to derive an ideal normal cervical
spinal model. J Manipulative Physiol Ther 1997; 20:246-
256.
19. Harrison DD, Harrison DE, Janik TJ, et al. Modeling of
the sagittal cervical spine as a method to discriminate
hypo-lordosis: results of elliptical and circular modeling
in 72 asymptomatic subjects, 52 acute neck pain subjects,
and 70 chronic neck pain subjects. Spine 2004;
29(22):2485-2492.
20. McAviney J, Schultz D, Bock R, et al. Determining the
relationship between cervical lordosis and neck
complaints. J Manipulative Physiol Ther 2005; 28(3):187-
93.
21. Bagnall KM. Harris PF. Jones PR. A radiographic study
of the human fetal spine. 1. The development of the
secondary cervical curvature. J Anat. 1977 Jul;123(Pt
3):777-82.
22. Kasai T, Ikata T, Katoh S, et al. Growth of the cervical
spine with special reference to its lordosis and mobility.
Spine 1996; 21(18):2067-2073.
23. Harrison DD, Jackson BL, Troyanovich SJ, et al. The
efficacy of cervical extension-compression traction
combined with diversified manipulation and drop table
adjustments in the rehabilitation of cervical lordosis: a
pilot study. J Manipulative Physiol Ther 1994;17:454-
464.
24. Harrison DE, Harrison DD, Betz J, et al. Increasing the
cervical lordosis with seated combined extension-
compression and transverse load cervical traction with
cervical manipulation: Nonrandomized clinical control
trial. J Manipulative Physiol Ther 2003;26:139-151.
25. Harrison DD, Harrison DE. The basics of CBP technique.
Todays Chiropr. 2004 May/June; 33(3):34,36-38,74-75.
26. Guerrera MP, Volpe SL, Mao JJ. Therapeutic uses of
magnesium. Am Fam Physician. 2009 Jul 15;80(2):157-
62
27. Sun-Edelstein C, Mauskop A. Foods and supplements in
the management of migraine headaches. Clin J Pain. 2009
Jun;25(5):446-52.
28. Sun-Edelstein C, Mauskop A. Role of magnesium in the
pathogenesis and treatment of migraine. Expert Rev
Neurother. 2009 Mar;9(3):369-79.
29. Tepper SJ. Complementary and alternative treatments for
childhood headaches. Curr Pain Headache Rep. 2008
Oct;12(5):379-83.
Headaches
85
J. Pediatric, Maternal & Family Health - August 11, 2011
30. Harel Z, Gascon G, Riggs S, et al. Supplementation with
omega-3 polyunsaturated fatty acids in the management
of recurrent migraines in adolescents. J Adolesc Health.
2002 Aug;31(2):154-61.
31. Simopoulus AP. Omega-3 fatty acids in inflammation and
autoimmune diseases. J Am Coll Nutr. 2002
Dec;21(6):495-505.
32. Huss M, Volp A, Stauss-Grabo M. Supplementation of
polyunsaturated fatty acids, magnesium and zinc in
children seeking medical advice for attention-
deficit/hyperactivity problems-an observational cohort
study. Lipids Health Dis. 2010 Sep 24;9:105.
33. Prakash S, Shah ND. Chronic tension-type headache with
vitamin D deficiency: casual or causal association?
Headache. 2009 Sep;49(8): 1214-22. Epub 2009 Jul 8.
34. Baad-Hansen L, Cairns B, Ernberg M, et al. Effect of
systemic monosodium glutamate (MSG) on headache and
pericranial muscle sensitivity. Cephalgia. 2010
Jan;30(1):68-76.
Fig. 1: Pre-lateral cervical radiograph. Note the mild kyphosis
(C2-3), overall straight alignment (C2-5), and hyperlordosis
(C5-7). Curved line represents adult ideal from Harrison et
al.
17
Fig. 2: Post-lateral cervical radiograph. Note the improved
shape, the C2-3 kyphosis was reduced to +2.2° (from +6.1°)
and the C3-7 hyperlordosis reduced to -27.7° (from -36.2°);
overall, the absolute rotation angle C2-7 was reduced to -
25.6°(from -30.1°) much closer to approximating a normal 8-
year old lordosis (-22.1°
10,15
).
Figures
J. Pediatric, Maternal & Family Health - August 11, 2011 86
Headaches
... All 4 papers utilized CBP technique. (14,15,16,17) There is an obvious need for more reports detailing improvements in cervical lordosis and health improvements as part of the chiropractic treatment involving children. ...
Article
Full-text available
I n t r o d u c t i o n The cervical lordosis represents normal anatomy and is a requisite for having a full range of motion, optimized joint loading, protection of the cord and nerve roots, and the preservation of upright horizontal gaze. (1, 2, 3, 4, 5, 6) Traditionally, the cervical lordosis was thought to evolve after birth, during early development when the infant crawls, holding the head up, however, Bagnall et al. has determined that in the majority of fetuses studied (83%), the cervical curve is established as early as 7-9.5 weeks in-utero. (1) There is little debate about the normal cervical alignment as being lordotic, in fact, a recent systematic review of 21 studies determined that even in asymptomatic cohorts, a cervical lordosis is the norm. (7) Regarding the precise shape of the cervical lordosis, Harrison et al. have published a circular cervical spine model for the adult. (8, 9) This model has been validated in a subsequent study using statistical methods to successfully differentiate between patients having acute or chronic symptoms versus asymptomatic participants based on lordotic or hypolordotic alignment. (10) Other studies have also veriPied that a normal lordosis in an adult should be in the range of about 31-42° as measured by the posterior tangent method (C2-C7). (11) There is much less studied about the cervical lordosis in children. However, what is known is that the cervical lordosis in pediatrics is less established than in adults. Kasai et al. presented data on the pediatric Abstract: This case series describes the increase in cervical lordosis and resolution of symptoms in two pediatric males, aged 5 and 6-years of age. Both patients presented with neck symptoms and cervical hypolordosis. Both patients were treated using Chiropractic Biophysics technique including full-spine spinal manipulative therapy, mirror image drop-table adjustments with daily home cervical extension traction on the pediatric cervical Denneroll orthotic. Both received 18 treatments over 6.5-and 7.5-weeks, respectively. Both patients attained relief of symptoms and had a significant increase in cervical lordosis.
Article
Full-text available
Objective: To examine the evidence of Chiropractic BioPhysics® (CBP®) technique methods in pediatric case reports describing the improvement of the cervical lordotic curve and concomitant effects on pain and presenting condition. Methods: We searched the CBP NonProfit website as well as Pubmed and the Index to Chiropractic literature for clinical case reports describing rehabilitation of abnormalities of cervical sagittal alignment in pediatric patients. Results: Our search found 11 pediatric patient cases reported in 10 publications. The average age was 8.8 years (5-13yrs), and included 8 males and 3 females. Number of treatments averaged 34.5 over a duration of 4.6 months. On post-treatment lateral cervical radiographs, there was an average 25° increase in lordosis, a 12.3° increase in atlas plane line, and a 7.2mm reduction in anterior head translation. There was an average 6.9 point improvement in pain severity. The range of primary complaints documented to be improved after treatment included: asthma, attention deficit hyperactivity disorder (ADHD), concentration difficulty, dizziness, headaches, neck pain, neck stiffness, nocturnal enuresis, otitis media and whiplash associated disorder. Six of 11 (55%) cases reported details of long-term follow-up, ranging from 3 months to 1.5 years after treatment. Most of the cases reporting a post-treatment follow-up lacked sufficient details of follow-up outcomes. The methodological quality of reports varied. Conclusion: There is an evolving evidence base of cases reporting on the effectiveness of CBP structural rehabilitation procedures for improving the pediatric cervical lordosis. Suggestions to improve case report design and categories of future clinical research are discussed. (J Contemporary Chiropr 2022;5:190-195)
Article
Full-text available
Polyunsaturated fatty acids are essential nutrients for humans. They are structural and functional components of cell membranes and pre-stages of the hormonally and immunologically active eicosanoids. Recent discoveries have shown that the long-chained omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) also play an important role in the central nervous system. They are essential for normal brain functioning including attention and other neuropsychological skills. In our large observational study we monitored 810 children from 5 to 12 years of age referred for medical help and recommended for consuming polyunsaturated fatty acids (PUFA) in combination with zinc and magnesium by a physician over a period of at least 3 months. The food supplement ESPRICO® (further on referred to as the food supplement) is developed on the basis of current nutritional science and containing a combination of omega-3 and omega-6 fatty acids as well as magnesium and zinc. Study objective was to evaluate the nutritional effects of the PUFA-zinc-magnesium combination on symptoms of attention deficit, impulsivity, and hyperactivity as well as on emotional problems and sleep related parameters. Assessment was performed by internationally standardised evaluation scales, i.e. SNAP-IV and SDQ. Tolerance (adverse events) and acceptance (compliance) of the dietary therapy were documented. After 12 weeks of consumption of a combination of omega-3 and omega-6 fatty acids as well as magnesium and zinc most subjects showed a considerable reduction in symptoms of attention deficit and hyperactivity/impulsivity assessed by SNAP-IV. Further, the assessment by SDQ revealed fewer emotional problems at the end of the study period compared to baseline and also sleeping disorders. Mainly problems to fall asleep, decreased during the 12 week nutritional therapy. Regarding safety, no serious adverse events occurred. A total of 16 adverse events with a possible causal relationship to the study medication were reported by 14 children (1.7%) and only 5.2% of the children discontinued the study due to acceptance problems. Continuation of consumption of the food supplement was recommended by the paediatricians for 61.1% of the children. Our results suggest a beneficial effect of a combination of omega-3 and omega-6 fatty acids as well as magnesium and zinc consumption on attentional, behavioural, and emotional problems of children and adolescents. Thus, considering the behavioural benefit in combination with the low risk due to a good safety profile, the dietary supplementation with PUFA in combination with zinc and magnesium can be recommended.
Article
Full-text available
The aim was to describe the consulting behaviour and clinical outcomes of children presenting with headache in primary care. This was a historical cohort study using data from the UK General Practitioner Research Database. Cases were children aged 5-17 years who presented to primary care with primary headache (migraine, tension-type headache, cluster headache) or undifferentiated headache (no further descriptor). Controls were age, sex and practice matched. Their records were examined for consultations, referrals, relevant treatments and specific diseases in the subsequent year. Children with headache (n = 48 575) were identified and matched to controls. At presentation, 9321 (19.2%) of headaches were labelled primary, 549 (1.1%) secondary and 38 705 (79.7%) received no formal diagnosis. Of the latter group, 2084 (5.4%) received a primary headache diagnosis in the subsequent year. Following a diagnosis of migraine, 258 (3.5%) had received a triptan and 1598 (21%) were using propranolol or pizotifen. Total consultations were higher in cases than in controls in the year before the headache: cases ages 5-8 years, mean (s.d.) 5.0 (4.0) consultations; controls 4.0 (3.5) consultations. In 1 year controls had 43 430 consultations, of which 256 (0.6%) were for headache, of whom 64 (25%) were referred to secondary care. Headache was a risk factor for benign and malignant tumours, cerebrovascular disease, primary disorders of raised intracranial pressure and depression. This risk was reduced if a diagnosis of a primary headache disorder could be made. Although there is an increased likelihood of a serious pathology with headache presentations, the risk is small particularly if a diagnosis of a primary headache is made. General practitioners are likely to be underdiagnosing migraine. This study can inform management guidelines for new presentations of headache in primary care, particularly when a secondary pathology is suspected.
Article
Full-text available
Magnesium is an important intracellular element that is involved in numerous cellular functions. Deficiencies in magnesium may play an important role in the pathogenesis of migraine headaches by promoting cortical spreading depression, alteration of neurotransmitter release and the hyperaggregation of platelets. Given this multifaceted role of magnesium in migraine, the use of magnesium in both acute and preventive headache treatment has been researched as a potentially simple, inexpensive, safe and well-tolerated option. Studies have shown that preventive treatment with oral magnesium and acute headache treatment with intravenous magnesium may be effective, particularly in certain subsets of patients. In this review, the pathogenesis of migraine will be discussed, with an emphasis on the role of magnesium. Studies on the use of intravenous and oral magnesium in migraine treatment will be discussed and recommendations will be made regarding the use of magnesium in treating migraine headaches.
Article
This review will focus on some of the recent findings in pediatric headache including headache characteristics, epidemiology, comorbid associations and treatment updates. Pediatric headache remains a frequent health problem for children and their families, yet there remain many gaps in our knowledge. This review will broadly address some of the recent findings and highlight the gaps in our understanding and treatment of pediatric headache. There will be a focus on pediatric migraine as this has been the best characterized and studied. Our understanding of pediatric headache is improving with increased recognition of the characteristics and associated symptomology. This should further guide the individualized treatment approaches for improved outcome and reduction of progression into adulthood.
Article
Headache is a common complaint in childhood with up to 75% of children reporting a notable headache by the age of 15 years. Paediatric migraine is the most frequent recurrent headache, occurring in up to 28% of older teenagers. Migraine can have a substantial effect on the life of the child, as well as their family, leading to lost school days and withdrawal from social interactions. Early recognition can lead to successful treatment, improved outcome, and reduced disability. The treatment strategy needs to be multipronged and can include acute therapy (which can vary depending on the severity of the headache), preventive therapy (when the headaches are frequent or causing substantial disability), and biobehavioural therapy (to assist with coping with recurrent headaches). Additional factors can contribute to exacerbations of headaches, including comorbid disorders and pubertal changes, which might lead to the development of menstrual migraine. When all these factors are effectively managed, there should be an improvement in long-term outcome and prevention of disease progression.
Article
Magnesium is an essential mineral for optimal metabolic function. Research has shown that the mineral content of magnesium in food sources is declining, and that magnesium depletion has been detected in persons with some chronic diseases. This has led to an increased awareness of proper magnesium intake and its potential therapeutic role in a number of medical conditions. Studies have shown the effectiveness of magnesium in eclampsia and preeclampsia, arrhythmia, severe asthma, and migraine. Other areas that have shown promising results include lowering the risk of metabolic syndrome, improving glucose and insulin metabolism, relieving symptoms of dysmenorrhea, and alleviating leg cramps in women who are pregnant. The use of magnesium for constipation and dyspepsia are accepted as standard care despite limited evidence. Although it is safe in selected patients at appropriate dosages, magnesium may cause adverse effects or death at high dosages. Because magnesium is excreted renally, it should be used with caution in patients with kidney disease. Food sources of magnesium include green leafy vegetables, nuts, legumes, and whole grains.
Article
The prevalence of tension-type headache and vitamin D deficiency are both very high in the general population. The inter-relations between the two have not been explored in the literature. We report 8 patients with chronic tension-type headache and vitamin D deficiency (osteomalacia). All the patients responded poorly to conventional therapy for tension headache. The headache and osteomalacia of each of the 8 patients responded to vitamin D and calcium supplementation. The improvement in the headache was much earlier than the improvements in the symptom complex of osteomalacia. We also speculate on the possible mechanisms for headache in the patients with vitamin D deficiency.
Article
Although a wide range of acute and preventative medications are now available for the treatment of migraine headaches, many patients will not have a significant improvement in the frequency and severity of their headaches unless lifestyle modifications are made. Also, given the myriad side effects of traditional prescription medications, there is an increasing demand for "natural" treatment like vitamins and supplements for common ailments such as headaches. Here, we discuss the role of food triggers in the management of migraines, and review the evidence for supplements in migraine treatment. A review of the English language literature on preclinical and clinical studies of any type on food triggers, vitamins, supplements, and migraine headaches was conducted. A detailed nutritional history is helpful in identifying food triggers. Although the data surrounding the role of certain foods and substances in triggering headaches is controversial, certain subsets of patients may be sensitive to phenylethylamine, tyramine, aspartame, monosodium glutamate, nitrates, nitrites, alcohol, and caffeine. The available evidence for the efficacy of certain vitamins and supplements in preventing migraines supports the use of these agents in the migraine treatment. The identification of food triggers, with the help of food diaries, is an inexpensive way to reduce migraine headaches. We also recommend the use of the following supplements in the preventative treatment of migraines, in decreasing order of preference: magnesium, Petasites hybridus, feverfew, coenzyme Q10, riboflavin, and alpha lipoic acid.
Article
We conducted a double-blinded, placebo-controlled, crossover study to investigate the occurrence of adverse effects such as headache as well as pain and mechanical sensitivity in pericranial muscles after oral administration of monosodium glutamate (MSG). In three sessions, 14 healthy men drank sugar-free soda that contained either MSG (75 or 150 mg/kg) or NaCl (24 mg/kg, placebo). Plasma glutamate level, pain, pressure pain thresholds and tolerance levels, blood pressure (BP), heart rate and reported adverse effects were assessed for 2 h. No muscle pain or robust changes in mechanical sensitivity were detected, but there was a significant increase in reports of headache and subjectively reported pericranial muscle tenderness after MSG. Systolic BP was elevated in the high MSG session compared with low MSG and placebo. These findings add new information to the concept of MSG headache and craniofacial pain sensitivity.