Pediatric headache remains a frequent health problem for
children and their families.
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.
Cervical subluxation (hypolordosis/kyphosis) has been
implicated as a contributing factor to headaches.
example, Nagasawa et al.
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
1. Private Practice of Chiropractic, Ontario, Canada
2. Private Practice of Chiropractic, Annapolis, MD, USA
Resolution of Chronic Headaches Following
of Vertebral Subluxation in an 8-Year-Old Utilizing
Chiropractic Biophysics Technique
Paul A Oakley DC, MSC
, Stephanie J Chaney DC
, Tom A Chaney DC
, Adam Maddox, DC
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
J. Pediatric, Maternal & Family Health - August 11, 2011 82
Also, Vernon et al.
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
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
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.
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;
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
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.
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 (-22.1°
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
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
J. Pediatric, Maternal & Family Health - August 11, 2011
Pediatric headache is a common complaint
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.
Lack of cervical lordosis, such as kyphosis or hypolordosis, is
commonly associated with presence of headache
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,
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
Data from Kasai et al.
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,
Harrison et al.
presents a table of normal
Cobb and ARA values for pediatrics aged 2-18 years. In a
letter to the editor, Oakley
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
(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.
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
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
It should be noted, however, that in two of the cases reported
by Harrison et al.
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.
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.,
reported on the significant reduction of
headache frequency in adolescents after consuming fish oil
over a 2-month period. Simopoulos
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
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
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,
Monosodium glutamate (MSG) has been shown to be a causal
factor in pericranial muscle tenderness and headaches.
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.
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.
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.
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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
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°
J. Pediatric, Maternal & Family Health - August 11, 2011 86