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If you have a headache, you’re not alone. Nine out of ten Americans suffer from headaches. Headaches comprise the top three reasons why one goes to the doctor. Some are occasional, some frequent, some are dull and throbbing, and some cause debilitating pain and nausea. What do you do when you suffer from a pounding headache? Do you grit your teeth and carry on? Lie down? Pop a pill and hope the pain goes away? There is a better alternative. As a chiropractic neurologist, I have been successfully helping patients rid themselves of headaches, oftentimes in as little as one treatment. Research has demonstrated the value of manipulative therapy for a multitude of disorders including headaches. A report released in 2001 by researchers at the Duke University Evidence Based Practice Center in Durham, NC, found that spinal manipulation resulted in almost immediate improvement for those headaches that originate in the neck, and had significantly fewer side effects and longer-lasting relief of tension-type headache than a commonly prescribed medication.

As a neurologist, we have many diagnostic capabilities at our disposal, as well as adjunctive therapies, which have proven to work very well for migraineurs as well as headache sufferers who have yet to be diagnosed. Headaches have many causes, or “triggers.” These may include foods, environmental stimuli (noises, lights, stress, etc.) and/or behaviors (insomnia, excessive exercise, blood sugar changes, etc.). About 5 percent of all headaches are warning signals caused by physical problems. The other ninety-five percent of headaches are primary headaches, such as tension, migraine, or cluster headaches. These types of headaches are not caused by disease. The headache itself is the primary concern. Today, Americans engage in more sedentary activities than they used to, and more hours are spent in one fixed position or posture. Many find themselves in fluorescent lighting and/or in front of a computer monitor all day. Many are on the telephone much of the day, which is very stressful on the muscles of the head, neck and shoulder. These scenarios are fuel for headaches.

So what can you do?

If you spend a large amount of time in one fixed position, such as in front of a computer, take a break and stretch every 30 minutes to one hour. Exercise may help relieve the pain associated with primary headaches, however, this will often aggravate headaches of migraineurs. As migraine headaches are vascular headaches, they should always be evaluated prior to entertaining any course of self-treatment. Drink at least eight 8-ounce glasses of water a day to help avoid dehydration, which can lead to headaches. Naturally, I would recommend all headache sufferers to come see us for an evaluation, as most will be helped in a short amount of time without requiring drug therapies, which can often have deleterious side effects and consequences. You will be referred for these types of therapies if felt to be warranted to be used as an alternative course of care, although this is certainly not the norm but rather the minority. The vast majority of our headache patients share a common conclusion; they invariably wish that they had come in to see us sooner and avoided the years of unnecessary suffering.

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Do you suffer from migraines or headaches? Lots of people do in fact these conditions are directly affecting approximately 12% to 14% of the American population alone every day and while the cause of a migraine is still a bit of a mystery to the medical profession as to what exactly causes it, stress in it’s many forms, is a leading cause of tension headaches.

To control a tension headache, it’s important to break any patterns of stress. Stress and anxiety are one of the major causes of headaches, which very often trigger a headache within a very short period of time.

Migraine on the other hand is often misdiagnosed as a sinus headache however, this type of headache comes on when an infection is involved that causes the sinuses to become inflamed and while this type of headache can often be severe, tension and migraine headaches are excruciatingly painful too and are generally accompanied by other symptoms like visual disturbances or nausea and tend to begin on one side of the head, then typically spreading to both sides. healthyskin

Underlying symptoms can vary from person to person and generally speaking there are several types of headache, which can for example be caused by eating products that contain additives, smoking will certainly cause bring on a headache too. Some research reports state that headaches can also be brought on by certain foods such as fatty potato chips and other snacks.

Other common symptoms are emotional or psychological stress, muscle strain in the neck and back caused by poor posture, eye strain caused by tired, dry eyes, sleep deprivation, jet-lag, and hunger caused by irregular or missed meals.

Migraines and headaches although alike are not exactly the same, but are equally as distressing and painful and both can affect the everyday life of the sufferer to a great extent. People who suffer from migraine especially often have to lie down in a dark room to alleviate the pain. Headaches of any kind are among the most disabling of conditions known to most of the healing profession. However, medication isn’t the only headache relief available:

Often simple home remedies provide the best stress headache relief. Hot compresses can relax neck and shoulder muscle tension helping to relieve pain as well as a hot bath. A relaxing walk in the fresh air can often clear up a headache, especially if caused by stress. There are many pills that can be bought over the counter and home remedies that can alleviate headaches and migraines, most only work for a very short time.

The symptoms and pain associated with the various types of headache, can be difficult for a doctor to pinpoint precisely, but researchers suggest that there may be an abnormal cell passed down through generations that make family members susceptible to certain stimuli that cause headaches. Another viable theory relates to the blood vessel function in the brain that triggers headaches.

Many have had great success with hypnosis, using it to stop chronic headaches before they start. Hypnosis, which is a state of inner absorption, concentration and focused attention, is like using a magnifying glass to focus on the rays of the sun and make them more powerful. Similarly, when our minds are concentrated and focused, we are able to use our minds more powerfully. Because hypnosis allows people to use more of their potential, learning self-hypnosis is the ultimate act of self-control.

People often fear that being hypnotized will make them lose control, surrender their will, and result in their being dominated, but a hypnotic state is not the same thing as gullibility or weakness. If you’re not familiar with hypnosis - read more about it at The American Society of Clinical Hypnosis (ASCH), the largest U.S. organization for health and mental health care professionals using clinical hypnosis.

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A headache can be as mild as a minor annoyance or as severe as an excruciating, debilitating pain.

While the vast majority of headaches are not signs of a serious condition, the pain is still real and bothersome to people who suffer from chronic headaches.

Randolph Schiffer, a neuropsychiatrist at the Texas Tech Health Sciences Center, and Dr. Fiona Prabhu, a family medicine physician at the HSC, answer common questions about headaches:

Q: What are the most common types of headaches?

A: Schiffer and Prabhu said the most common types of headaches are tension, migraine and cluster.

Tension headaches feel like a tightening sensation around the head and are not specific to one side. Schiffer said tension headaches are a steady, constant pain that are often caused by stress or tension. According to the National Headache Foundation, about 78 percent of people have experienced a tension headache.

A migraine headache is a pulsating, throbbing sensation on one side of the head that tends to be disabling, said Prabhu. Typically, they last from four to 72 hours, she said. A migraine can include nausea, vomiting and sensitivity to light or sound, said Prabhu.

Migraines are more common among women than men, said Prabhu. An estimated 5 to 10 percent of people suffer from migraines, according to Schiffer.

A cluster headache is described as a severe headache that feels like being stabbed with an ice pick, Prabhu said. They are not common - less than one quarter of one percent of people experience cluster headaches - but they are more common among men, said Prabhu.

Q: When should I worry about a headache - that is, when is a headache a sign of something more serious?

A: Rarely is a headache a sign of a serious problem, said Schiffer and Prabhu. However, if it is “the worst headache of your life,” and it comes on suddenly, you should seek immediate medical attention. A headache that is new or changed - that is, you haven’t experienced one quite like it, and the headache changes - also demands immediate medical attention. Major changes in behavior, fever, chills and weight loss that accompany a headache are signs that a person should seek immediate medical attention as well.

“If it’s the first headache you’ve ever had and it is severe enough to where you can’t function, it’s probably a good idea to have it checked,” Prabhu said.

“Anyone whose headaches interfere with work or social life, probably should go to the doctor,” Schiffer said.

Q: Is a headache a sign of a brain tumor?

Probably not, said Schiffer. A brain tumor will not typically cause a headache until the later stages, and other signs will tip off someone that something isn’t right far in advance of a headache, he said. Those signs include seizure, weak hands or a numb leg, Schiffer said. Prabhu said another sign of a brain tumor is vomiting in the morning. Moreover, if a headache were to be a sign of a brain tumor, the headache would become increasingly severe over time - not occur suddenly and severely.

Q: What can be done to treat headaches?

A: Schiffer said we tend to look for a pill to cure our ailments, but no such pill exists for headaches. He cautions against using over-the-counter pain relievers to treat headaches because someone can become habituated to them. Prabhu said when someone becomes habituated to pain relievers, they get rebound headaches that require more and more of the medication to ease his or her pain. She recommended someone with frequent headaches see a physician to explore ways to reduce the frequency of headaches.

Several therapies are available to a migraine sufferer, Schiffer said. Prabhu said that these medications are more effective when taken as soon as a person feels the migraine coming on.

Q: How can I prevent headaches?

A: Schiffer said tension headaches are a sign that something is wrong in someone’s life. He suggests a tension headache sufferer try to reduce the stress in his or her life. Physical exercise is a good way to reduce tension headaches, he said.

To prevent migraines, Prabhu suggests people keep a headache journal - a diary in which people record their headaches and suspected triggers. Once someone identifies possible migraine triggers, she or he knows what to avoid. Some common migraine triggers include red wine, chocolate, smoked meats, aged cheeses, weather changes, MSG and aspartame, Prabhu said.

A person with cluster headaches should seek a physician’s care to begin preventive therapy, according to the headache foundation.

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People who suffer with migraine are more likely to experience exacerbated skin sensitivity or pain after non-painful everyday activities, such as rubbing their head, combing their hair or wearing earrings, the results of a new study indicate.

A team of researchers surveyed over 16,500 people who suffered with headaches. The participants were asked about the type of headaches they suffered from and the frequency of these. They were also asked about their quality of life, depression and other illnesses that can cause pain.

Of the participants, 11,737 were identified as having migraine, 1,491 were deemed to be suffering from probable migraine, while the remainder had some other kind of headache.

The study found that 68% of those with chronic migraine (headaches occurring daily or almost daily) and 63% of those with episodic migraine reported having allodynia, a condition in which ordinarily non-painful stimuli evoke pain.

A further 42% of those with probable migraine had the condition, compared to 37% of those with daily or tension headaches.

“This condition causes discomfort or pain during everyday activities like touching one’s hair or putting on clothes. More importantly, this condition may be a risk factor for migraine progression, where individuals have migraines on more days than not”, explained study author, Dr Marcelo Bigal of the Albert Einstein College of Medicine in New York.

He pointed out that identifying risk factors for migraine progression is a very important public health priority.

“For example, it may be that individuals with allodynia should be more aggressively treated in order to prevent migraine progression, as well as to decrease this sensitivity on the skin”, Dr Bigal said.

The study also found that this type of skin pain was more common in women with migraine and people with migraine who were obese or had depression.

Details of these findings are published in the medical journal, Neurology.

Migraine currently affects around 400,000 people in Ireland. It is characterised by a severe, one-sided headache that can last up to three days. It can be accompanied by symptoms such as nausea, vomiting and sensitivity to light and/or noise.

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Keep a headache diary to help identify the source or trigger of your symptoms. Then modify your environment or habits to avoid future headaches. When a headache occurs, write down the date and time the headache began, what you ate for the past 24 hours, how long you slept the night before, what you were doing and thinking about just before the headache started, any stress in your life, how long the headache lasts, and what you did to make it stop. After a period of time, you may begin to see a pattern. A headache may be relieved by resting with your eyes closed and head supported. Relaxation techniques can help. A massage or heat applied to the back of the upper neck can be effective in relieving tension headaches. Try acetaminophen, aspirin, or ibuprofen for tension headaches. DO NOT give aspirin to children because of the risk of Reye syndrome. Migraine headaches may respond to aspirin, naproxen, or combination migraine medications. If over-the-counter remedies do not control your pain, talk to your doctor about possible prescription medications. If you get headaches often, your doctor may prescribe medication to prevent headaches before they occur. All types of pain pills (including over-the-counter drugs), muscle relaxants, some decongestants, and caffeine can cause this pattern. If you think this may be a problem for you, talk to your health care provider.

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Last week, I was suffering from a ragin’ headache. Not only was it painful. It was like the Energizer bunny…it kept going and going and going.

I asked you, my marvelous readers, if you had any advice to cure the 3 day headache and you really came through! With so many tips, I recovered from my headache and went on to feeling energetic and breathing clear. Since it is springtime, breathing clear is a tough one. But you did it and I thank you.

Since there were twenty tips, I couldn’t do them all - I picked a couple and tried them.

So here are the Top 20 DIY Headache Cures That Bring Quick Relief:

1. You might want to have your eyes checked (if you haven’t done so already). I had a new pair of prescription contact lenses made for me about 4 years ago. But they always gave me problems. I stopped wearing them and I noticed that when I was working (and staring at a computer screen) I got headaches. But the headaches would last and last. I thought there was something else wrong with me. Long story short (too late), I had PRK laser correction surgery done and I’ve been headache free since. I’m fortunate not to have allergies so I don’t have to deal with that possibility.

2. Peppermint oil applied under your nose. (Be careful with application and wash hands!!) Rice packs heated in the microwave for four minutes applied over eyes / back of neck. Also take a hot shower with Peppermint Soap (the liquid version) Oh it makes you tingle.

3. During allergy season I would suggest you use a sinus rinse like Neilmed. Once I started using it regularly, it cut down on my headaches.

4. Tiger balm on your temples, rub tendons in back of neck to release tension.

5. Snort this twice a day:
* Sinus Rinse
* 16 oz. H2O
* 1 tablespoon kosher salt
* 1/2 teaspoon baking soda
* Mix.
Pour some into palm of hand and snort.

6. Brush teeth with flossing and mouthwash. Something about swishing, gargling, changing teeth positions, spitting, etc., makes it so you can clear your head a little.

7. Gargle with salt water periodically to clear head/get rid of drip.

8. Take a bath in fairly warm water. Submerge your head so your ears are covered. Even allow them to fill with water to put pressure on the inside of your head and help it drain. Then — KEY — sit up in the tub so that your wet hair gets cold. This is supposed to help shrink the nasal/sinus membranes and gives some relief. I imagine using a cold wet towel on the head might also help, but I think the bath steam helps and that’s why this is good.

9. Eat hot stuff like chili peppers, salsa. Again, this helps drainage. Even a little bit of heat helps break things up.

10. Cold compress over eyes to help the eyes stop swelling and bring some comfort.

11. Lie down and let head drain. Try with and without a pillow, side to side, head nose pointed up toward wall, and head pointed down toward feet, and rolling from one side to another.

12. Sleep, lots of fluids, and perhaps a walk. (I know this sounds lame,) but it helps the lack of blood flow, which is the initial cause of most headaches.

13. My daughter has used peppermint and lavender essential oils in a rollerball applicator. You apply a small amount to your temples and she said that she felt relief almost immediately. She recommended it to a friend of mine who gets migraines quite often, and she said that, although her headache didn’t go away immediately, it only lasted about 1/10 as long as usual.

14. I suffered from a headache for several days earlier in the year. I went to a regular chiropractor appointment for my back and she adjusted my jaw and the headache went instantly. Apparently my jaw was slightly misaligned (apparently due to stress causing me to tense my teeth) and this was leading in uneven pressure in my head when I moved my jaw. If the other suggestions don’t work I would recommend going to have a check up a chiropractor.

15. I usually find headaches are due to dehydration, stress or tiredness. So upping my fluid intake, getting plenty of sleep or having some time-out (maybe a walk in the fresh air) will usually sort it out. But if my sinuses are at all involved, steam inhalation helps (put your head over a basin filled with hot water and cover your head with a towel for 10-15 minutes. You can add aromatherapy oil or some herbs or a spoonful of vicks if you like. A little lavender oil on your temples, the bridge and sides of your nose and across your forehead will help to relieve sinusitis and stress headaches.

16. If your headaches are allergy related, I have started using a neti pot on a regular basis and found it to be very helpful for relieving sinus congestion. The result is similar to the nasal rinse suggested above, but I’ve done both and much prefer the neti pot. I mix a little sea salt with warm water in the pot and rinse out my sinuses during my morning shower.

17. My worst headaches from barometric pressure. When I feel one coming on, I’ll typically check the weather to see if a front is moving in. If it appears the weather is causing it, I’ll take an Excedrin migraine early on. I hate taking pills, so acting early really does the trick in my case. I’ve wanted to purchase a barometer for some time now so that I can get used to seeing the measurement every day. This way I’d intuitively know what my “feel good” vs. “feel bad” ranges are. Was there some poor weather in your area while you were in pain? If so, a barometer may be a wise investment so you can start using your peppermint oil early on. =)

18. (1) Chlorpheniramine Maleate 4 mg tablet (Walgreens Wal-finate Allergy 4 Hour Tablets) (2) Ibuprofen 200mg each, esgic plus an ice pack. Usually he find that it starts to go away in 20 minutes, but he gets a little sleepy. Try it next time. I also use this for tension headaches.

19. I found that when I reduced my wheat and milk intake my headaches disappeared.

20. Make sure you are hydrated. You can get migraines triggered from dehydration.

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101 Headache Prevention Tips:

* Understand that headaches are largely PREVENTABLE.
* Discover a super vegetable that can possibly save you from headache pain.
* Understand how to use meditation to “de-stress” yourself.
* Understand the effect of alcohol on your headaches.
* Understand how to protect yourself from headaches while spending time in the sun.
* Discover how certain colors can actually cause you headaches.
* Discover the three types of headache pain.
* Understand why rain, especially the first rain of the season, can cause you a lot of headache pain.
* Learn exactly what migraines are and why they hurt.
* Learn 4 critical criteria for choosing your next pair of sunglasses.
* Understand what reading in a car is doing to cause you pain.
* Realize that your computer screen could be giving you headaches and what to do about it.
* Learn how to create your own soothing face pack to release tension.
* Learn 7 tips for dealing with hangover headaches.
* Find out what air-pollutants to stay away from.  They may already be causing your headaches.
* Understand what proper ventilation can to do help your headaches.
* Discover how your pillow may be causing you undue pain.
* Understand that your posture may be causing you headaches and how to change that.
* Learn 4 key factors to consider while watching television in order to reduce headaches.
* Learn which breathing exercise can help to reduce your headaches.
* Discover what the effects of hair gel may be having on your headache pain.
* Find out if you should stay away from aerosol.
* Learn to avoid shaking your head - and what it means if you experience pain when doing so.
* Learn the truth about hair dryers and why you should be cautious with them if you have frequent headaches.
* Learn to cool your head correctly - the wrong way can cause you more pain!
* Realize that your computer is giving off radiation and how this can affect you.
* Learn the best way to relax your eyes. Hint: Your eyes should not be closed.
* Learn the proper way to massage your eyes and relieve tension.
* Learn three simple techniques that can help you relax and ease your tension.
* Learn the 2 different types of migraine headaches and how they can effect you.
* Understand the importance of sleep on your headache pain.
* Understand what massages and “touch therapy” can do for your headache pain.
* Learn the 13 easy steps to a powerful exercise that will help relieve tension in your neck and head.
* Discover why hot water is not the best for your head and what you should do about it.
* Understand how organic foods can help you steer clear of unwanted pesticides and hormones.
* Realize that there is such a thing as sound pollution and how this may be affecting you in a negative way.
* Learn 2 simple and effective ways for clearing your sinuses and relieving your pain.
* Discover which ingredients in food and beverages can cause you headache pain.
* Learn which styles of dress may be causing you headache pain.
* Understand the affect that cigarettes and coffee may be having on your headache pain.
* Learn 5 essential factors that need adjusting while reading to avoid headaches.
* Understand the relationship between water and your headache pain.
* Understand that unknown allergies may be causing you headache pain.
* Girls - understand that the way you do your hair may be causing you unnecessary headache pain.
* Learn a great way to exercise your eyes and relieve tension.
* Learn an effective way to “rinse” your sinus pain away.
* Understand that some headache pain is actually heredity.
* Realize the effects of jetlag on your headaches.
* Discover another great tension reliever for your eyes that will leave you feeling very refreshed and headache free.
* Discover tension headaches - any why they are so common yet preventable.
* Learn to use Accupressure to treat and rid yourself of sinus pain. My simple 17 step plan will show you how.
* Learn 4 of the most common triggers for migraine headaches and how to avoid them.
* Understand the effects of exercise and how you can use it to stop your headache pain.
* Discover that the position you read in may be causing you headache pain.
* Realize that too much sleep may be the cause of your headaches.
* Understand why pills may not be helping you at all -and when you should stay away from them.
* Discover that much of your headache pain may be due to your failing eyesight and what you should do about it.
* Understand sinus pain, it’s causes, and the headaches it can cause.
* Learn how to use your time in the shower to relax tension with a simple exercise.

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I’ve searched through as many memories as I could. I am currently in the beginning stages of yet another bout of migraines. About 7 years ago I started getting terrible migraines around my period and for awhile it was just all the time. (I think it was really a combination of stress/tension headaches and migraines at some point). I was in so much pain I was getting desperate. I eventually agreed to hormonal birth control. It was a monophasic pill and it stopped my migraines. I’ve been on several pills and they each have had their own undesirable side- effects. The last few months I have been getting migraine headaches again. I’m concerned about this because now I wonder if my pill is not as effective? I can’t get in to see the OB/GYN for a month since this isn’t an emergency. My ultimate concern is this: Is there anything I can take (herbal or an otherwise natural product) to avoid these migraines? Is there something that will regulate my hormones so this doesn’t happen? I know these headaches are hormone related. I thought Evening Primrose Oil would help, but I’m not sure how much to take. And will that effect the “culprit”. I’m not even sure what causes Menstrual Migraines. Does anybody? Anyone have any good reference sites? I would be so grateful. I am nauseous and heading my way to miserable. I have 4 more days ahead before my new pill pack. I workout daily and do yoga several times a week. I try to avoid trigger foods (though I haven’t really had any foods trigger any headaches thus far). I just don’t want to be miserable and I’d like to use more natural methods if possible.

Answered:
Magnesium helps mine. My neurologist has me taking 1000 mg a day, combined with a prescriptive medication such as Esgic Plus. She also recommends taking two Aleve when I’m in a situation that may trigger a migraine. With menstrual migraines, for example, it may be worth taking something in the days leading up to when you get a migraine. Aleve isn’t natural, but it works for me.

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Headaches. Just about everybody has them occasionally - and some unfortunate people experience them often. The term “migraine” often is used to describe a particularly severe and long-lasting headache, but it’s not always used accurately. You can have a horrible headache that is not a migraine - it could be a tension-type headache, a cluster headache, a sinus headache, a rebound headache or a symptom of another problem, such as meningitis.

Migraine headaches are considered one of the most disabling chronic medical conditions and about 12 percent of adults in the U.S. are “migraineurs” - that is, nearly 30 million people suffer from migraines. Recently, some researchers have come to believe migraine headaches are caused by an inherited genetic abnormality.

Three times more women are diagnosed with migraines than men; the female hormone estrogen is thought to play a role. Often, girls and young women will experience their first migraine headache around the time of their first menstrual period. For some women, migraines stop around menopause. For others, the onset of migraines coincides with menopause.

In men, migraines can start at any time from childhood on. Some headache specialists think men are underdiagnosed with migraines because they are less likely than women to seek medical attention for headaches. Also, men are more likely to medicate themselves with over-the-counter or illegal drugs.

Everyone who experiences migraines will describe their pain and symptoms in a different way. Some migraneurs have “classic migraines” that start with symptoms such as mood changes, loss of appetite, sensitivity to sight, sound and smells, and fatigue beginning hours or days before the actual headache.

Then, in the hour before the headache, an “aura” can occur. Auras usually are described as visual distortions similar to bright flashing lights. However, not everyone with migraines experience these symptoms.

Once a migraine headache starts, most people feel pain on just one side of the head, but 40 percent have pain on both sides. The pain often is described as pounding or throbbing and sufferers may feel nauseated, irritable, depressed, confused, dizzy and weak. The headache can last for many hours or even days. Usually, people with migraines want to rest in a dark, quiet place.

For those of us who have never experienced a truly severe and long-lasting headache, it can be hard to understand how debilitating migraines can be. Even after the pain of a migraine has subsided, its effects can linger in the form of fatigue, irritability and lack of concentration.

People with severe migraines may have headaches many times each week or month.

Some migraineurs know exactly what triggers their headaches - things such as lack of sleep, weather changes, missed meals, emotional stress, certain foods or exposure to strong perfume. If triggers are identified, avoiding them can minimize the number of migraines. But, for many, migraines seem to come randomly.

There are two approaches to treating migraines. One way is to get treatment when the symptoms begin. Most people with migraines treat their pain with a variety of medications - over-the-counter drugs such as ibuprofen or acetaminophen in maximum doses may work for some people; others depend on prescription medications. Some medications, such as Imitrex, are effective if taken as a self-administered injection at the first sign of a migraine.

The second approach to the treatment of migraines is preventative medication that is taken daily in an attempt to decrease the frequency and severity of migraines - drugs such as propanolol, amitriptyline, divalproex sodium and topiramate. Some of these medications also are used for the treatment of depression or seizures.

Some people with migraines have found relief with acupuncture or biofeedback.

It’s my hope everyone who suffers from migraines or any type of severe headache can educate themselves and find a health care provider who will listen carefully and help them find ways to prevent and treat their pain. The challenge is that everyone who suffers from headaches will have different triggers and will find relief in different ways. The trick is to learn about all the treatment options that exist and try them in a rational way until you find what’s best for you.

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Postural and Symptomatic Improvement After Physiotherapy in Patients With Dizziness of Suspected Cervical Origin.

Patients with dizziness of suspected cervical origin are characterized by impaired postural performance. Physiotherapy reduces neck pain and dizziness and improves postural performance. Neck disorders should be considered when assessing patients complaining of dizziness, but alternative diagnoses are common.

Vertigo and dizziness are common complaints accompanying neck pain. The combination of neck disorders with vertigo or dizziness was termed “cervical vertigo” by Ryan and Cope, a designation that may be misleading as most patients suspected of suffering from it report dizziness or dysequilibrium. Owing to its poor definition and the lack of reliable clinical tests, the entity has been the subject of much debate.

There is evidence of a substantial contribution of cervical proprioceptive input to ocular motor control and postural control in both animals and humans, and vestibular and neck proprioceptive information interact linearly in subjective body orientation and mental representation of space. Consequently, disturbed cervical proprioceptive input has been suggested as a probable cause of cervical vertigo, s Information on the orientation of the head in relation to the trunk is necessary for the execution of appropriate postural responses based on vestibulospinal neural output.

The vestibular receptors cannot provide this information, but it has been suggested that it is provided by the cervical proprioceptors. Furthermore, infiltration of local anesthetics into the deep tissues of the neck causes ataxia and nystagmus in animals, but ataxia without nystagmus in humans. Thus, it is reasonable to assume that disturbed cervical proprioception primarily affects postural control in humans, and patients with neck pain and concomitant dizziness have been reported to manifest impaired postural performance, as compared to healthy subjects.

Postural performance can be assessed objectively by posturography, recording the forces actuated by the subject’s feet on the supporting surface. To enhance the sensitivity of posturography in assessing balance disorders, recordings should preferably be made during or after a postural perturbation, This can be accomplished in various ways: by moving the support surface; by the application of erroneous sensory input, eg, by exposing the proprioceptive receptors to a vibratory stimulus; by exposing the vestibular nerves to a galvanic stimulus; or by exposing the subject to visual disturbance in the form of moving surroundings.

Physiotherapy, traction of the neck, injection of local anesthetics at tender points, or immobilization of the neck with a collar have been suggested as treatments for vertigo or dizziness of cervical origin. Among others, deJong and Bles described recovery of postural stability after treatment directed at the neck in occasional patients with dizziness of suspected cervical origin, but to our knowledge there have been no prospective, controlled studies.

In this study, consecutive patients were examined who had recent onset of neck pain and simultaneous complaints of dizziness or vertigo. Extracervical causes of their complaints were excluded when possible, and no medico-legal issues were known to be involved. The aim was to ascertain whether, as compared with healthy subjects, the selected patients have disturbed postural control as objectively analyzed by posturography, and to investigate in a randomized, controlled setting the effects of physiotherapy on postural performance and subjective symptoms of neck pain and dizziness/vertigo.

The performance of patients with dizziness of suspected cervical origin was significantly poorer than that of the healthy controls in the objective tests of postural performance. This indicates that postural control is impaired in these patients and suggests that cervical disorders may affect human balance function. Physiotherapy, aimed to decrease cervical discomfort, objectively improved the disturbed postural performance and reduced subjective symptoms of dizziness and neck pain. Despite the restricted number of patients, the differences between the Treatment group and the Delayed Treatment group, as well as findings within the Delayed Treatment group, suggest that the improvement was a result of the physiotherapy and not merely an effect of general care or reassuring information as to the cause of the symptoms.

Of the 65 patients considered for inclusion in the study, a majority were excluded because extracervical causes were suspected, eg, owing to histories of head or neck trauma with the possibility of traumatic otolith damage or damage to the brainstem, or neck problems secondary to a vestibular lesion. Thus, the mere combination of neck pain and dizziness should not be called cervical dizziness. These findings are in accord with Brandt’s suggestion that well-established signs and tests can yield a convincing alternative diagnosis in many of these patients? It also stresses the necessity of careful history taking and clinical examination, as well as of electronystagmography, before suspecting cervical dizziness. The patients’ subjective complaints of dizziness were classified according to type, and 10 of the patients reported dysequilibrium alone or in combination with vertigo. This is in accord with Brandt’s suggestion that cervical vertigo manifests itself as a feeling of unsteadiness.

The neck muscles were tender on palpation in all included patients, and 13 of the 17 patients also complained of headaches that were of the tension headache type. These cases may belong to a subcategory of the tension headache or tension neck syndrome, and dizziness is reported to be common in these conditions. None of the patients had had extended periods of sick leave, none was retired or opted for early retirement because of neck problems or vertigo, and none stood to gain medicolegal benefit from the outcome of the testing. Thus, malingering is an unlikely cause of the differences between patients and controls in this study, though it cannot be excluded as a possible source of error. If a patient tries to perform poorly in the postnrographic tests, this usually gives rise to a pattern of high-frequency body sway unaffected by the vibratory stimulus. None of the patients manifested such a pattern.

Vibratory stimulus of muscles produces changes in the signalling of the muscle spindles, interpreted by the CNS as indicating a lengthening of the vibrated muscle. This may induce limb, as well as shifts in body posture (vibration-induced body sway). Vibratory stimulus can thus be used as a tool to perturb human stance in a reproducible manner, and has been used in posturographic testing to reveal the effects on postural performance of different factors such as age, drugs, and vestibular or CNS disorders. Repeated posturographic testing may introduce a source of error due to learning effects. However, both Ishizaki and associates and Uimonen and colleagues reported that vibratory-induced body sway in healthy subjects yielded excellent reproducibility without significant learning effects in repeated posturographic testing, both in shortand long-term use.

Posturography has also been used to objectivize positive effects of habituation and balance retraining physical therapy on postural performance in patients with different vestibular disorders but has hitherto only been used in isolated cases to determine the effects of different treatments on dizziness/vertigo of suspected cervical origin. The physical therapy in the present study was aimed at reducing cervical discomfort and did not include vestibular rehabilitation exercises. Thus, the positive findings cannot be attributed solely to habituation of vestibular or postural reflexes. Because there is no gold standard treatment of cervical dizziness, the choice of physiotherapeutic methods was pragmatic and individualized according to signs and findings, and was aimed at reducing cervical discomfort and pain. Thus, the results do not permit meaningful discussion of the choice of physiotherapeutic regimens.

Carlsson and Rosenhal described oculomotor disturbances in patients with tension headache, as compared with healthy subjects, and reported that treatment with physiotherapy or acupuncture, reducing headaches and neck pain, also improved the disturbed oculomotor function. They also found a significant correlation between the degree of tenderness in the trapezius muscle and the severity of oculomotor disturbances. These authors suggested that the improvement in oculomotor function was a consequence of the reduction of neck muscle tension, secondary to reduction of neck muscle pain. Revel and coworkers reported that patients with chronic cervical pain of unspecified origin, as compared to healthy subjects, had poorer ability to reassume the original position of the head after a voluntary active maximal rotation of the head. This was taken as an indication of altered cervicocephalic kinesthesia and neck proprioception in these patients. In a later study, Revel and colleagues also found that a rehabilitation program, based on eye-neck coordination exercises and aimed to improve neck proprioception, significantly improved cervicocephalic kinesthesia and horizontal rotational active range of neck motion, and significantly reduced neck pain in patients with chronic cervical pain syndromes. Similar findings have been reported by Persson and coworkers in patients with cervical root compression due to disc hernias or spondylosis but without medullary compression. After surgical treatment of the root compression, patients manifested significantly improved postural performance and significantly reduced cervical pain. These reports, together with the findings of the present study, suggest that neck disorders per se can in fact cause dizziness.

Women comprised 80% of the referrals and 88% of the final study population. This female preponderance is consistent with that commonly found in different disorders of the neck, such as tension neck syndrome, cervicogenic headache, and tension headache. A similar preponderance of women was found among subjects with vertiginous complaints in a normal population, where approximately 25% to 30% of women complained of vertigo, as compared with only about 5% of men of comparable age. Similarly, the incidence of motion sickness is higher in women. As motion sickness is considered to be caused by mismatch between conflicting vestibular, visual, and proprioceptive stimuli, the skewed sex distribution might reflect greater susceptibility in women also to sensory mismatch involving cervical proprioception.

In the present study the improvement in postural performance was obvious in the posturographic tests in which vibratory stimulus was applied to the calf muscles, but not in the tests in which it was applied to the neck muscles. The patients were improved with regard to neck pain after physiotherapy, but none was completely free from pain. Thus, the muscle spindles of the neck muscles may still be sensitized. As vihration-induced body sway is believed to be induced via stimulation of the muscle spindles, the patients may still have enhanced sensitivity to vibratory stimulation of the neck. Furthermore, Abrahams and Falchetto have reported that electrical stimulation of nerves from the biventer cervicis muscle in cats facilitated the monosynaptic reflexes in the hindlimbs over supratentorial pathways. Hypothetically, the physiotherapy might have resulted in a reduction of sensitivity of the cervical proprioceptors great enough to normalize the gain of the postural reflexes of the lower extremities, thus normalizing the responses to calf muscle vibration, but not sufficiently reduced to normalize the responses to neck muscle vibration.

In the present study, comparison of the patients after physiotherapy to the group of healthy subjects showed the patients’ posmral performance still to be poorer but not in all tests, and the differences between the groups had diminished. Thus physiotherapy improved but did not normalize the patients’ postural performance. Before physiotherapy the patients manifested significantly greater velocity of body sway than did healthy subjects in three of the four stimulus-free periods of quiet stance. After physiotherapy there were no significant differences between the patients and the healthy subjects in any of the stimulus-free periods. Similarily there were no significant differences in any of the four stimulus-free periods between pretreatment and posttreatment values for the patients. These findings emphasize the importance of using perturbation stimuli in posturography to reduce stochastic variations of unperturbed stance if differences between normal subjects and patients with various lesions are to be found.

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