Your sleep pattern follows a bio-rhythm. You sleep more soundly when your temperature is lowest and you sleep more soundly in the wee hours of the morning. You are most likely to awaken when your temperature starts to rise around 6 to 8 a.m.
As you age, the “pacemaker“ part of your brain loses cells. Your sleep is more disrupted. You have to go to the bathroom in the middle of the night because you can’t hold it any longer. You awaken early and need to nap more. Sleep deprivation causes a decrease in hormone production.
Biological rhythms also impact hormone production, specifically cortisol. (Figure 6) Here are some examples of how that happens.
Cortisol affects metabolism, regulates your immune system and normally is at its highest between 6 and 8 a.m.. It gradually declines throughout the day and is lowest around midnight, and then slowly begins to increase again throughout the night.
Changing your daily sleep schedule changes your bio-rhythm and causes you to produce the highest cortisol at a different time. If cortisol is too high at the wrong time then bad things happen. If your cortisol is too high at the end of the day you will have trouble falling asleep or staying asleep. If your cortisol is too low in the morning then you will have trouble waking up and getting rolling in the morning.
Sleep triggers night time hormone production when you go to bed and Cortisol secretion peaks between the hours of 6 and 8 am.
If you are stressed out and have a chronically elevated cortisol level, there is an extensive list of things that can go wrong. Your symptoms will suggest a wide variety of developing health-related problems. If your cortisol levels remain high, you need to make changes in your life! Don’t wait! We can help!
Phosphatidylserine (PS) is directly or indirectly implicated in practically every cell membrane from the brain and nervous system to hormone function and the adrenal glands. The following are the primary scientifically backed reasons why children should add PS from CMWC to their health, wellness and recovery regimen.
1. PS supplementation produced significant improvements in short term auditory memory and working memory in ADHD children.
2. Significant improvement in ADHD children’s mental performance to visual stimulation.
3. ADHD children have significant decrease of inattention and impulsivity.
4. PS enhanced mood in a group of young people during mental stress.
5. PS has been proven as an effective therapeutic agent for ADD and ADHD.
6. Children and young adults get benefits in maintaining a sharp mind and controlling stress with PS.
7. Students experience improved learning abilities and performance.
8. PS helps your brain cells to metabolize glucose,to release and bind with neurotransmitters, all of which are important to learning, memory and other cognitive functions.
9. PS helps insomnia and sleep disorders caused by excess cortisol at the end of the day.
10. Young university students experience significantly less stress from tests, stay more clear-headed and composed, and keep a more stable mood when taking PS.
11. Diets are deficient in PS and modern industrial food production decreases all of the natural phospholipids
We’ve all seen people working on laptops in airports, airplanes, coffee shops, on the train, walking down the street…you name it! So how does this affect one’s neck, and does it contribute to headaches?
A 2016 study compared females with posture-induced headaches vs. healthy, age-matched female control subjects to see if there was any significant difference in their head-tilt and forward head position during laptop use.
The research team measured angles for maximum head protraction (chin-poking forwards), head-tilt, and forward head position at baseline (neutral resting) and while using a laptop. Essentially, they measured how “slumped” the participant’s posture was at rest vs. while working on a laptop.
The results showed that the headache group demonstrated an increased head protraction of 22.3% compared to the control group at rest. When comparing the ratio of forward head position during habitual sitting to the maximum head protraction, the researchers found a significant difference, which was also worse in the headache group. Similarly, laptop work head position was worse in the headache group.
The researchers concluded that the headache group showed worse posture at rest in the two measurements as well as more forward head posture during the laptop task than the control group. They recommended that management/therapy for patients with headaches and/or neck pain include posture retraining exercises as an important aspect of obtaining long-term successful outcomes.
This study illustrates the importance of that and the need to include exercises like chin-retractions, conscious head re-positioning, cervical traction (in some cases), deep neck flexor muscle strengthening, managing scapular stability, and more.
When looking at a person from the side, imagine a perpendicular line that passes through the ear canal should pass through the shoulder, hip, and ankle. In cases of forward head posture, that line will pass forwards of these bony landmarks.
Previous research shows that the head weighs an average of 12 pounds (5.44 kg), and for every inch of forward head positioning, the neck and upper back muscles are burdened with an extra 10 pounds (4.53 kg) of load to keep the head upright. That means a five-inch forward head position adds 50 pounds (22.67 kg) of weight to the neck and upper back area. It’s no wonder this faulty posture leads to chronic neck and headache complaints!
Spinal joint manipulation is one of the most patient-satisfying, fast-acting remedies for neck pain and headaches of several types offered by doctors of chiropractic. But when manipulation is combined with exercise training, studies show this combined approach results in the best long-term benefits or outcomes!
Content Courtesy of Chiro-Trust.org. All Rights Reserved.
It’s been said that if you haven’t had back pain, just wait, because (statistically) some day you will! The following list is a list of “causes” that can be easily “fixed” to reduce your risk for a back pain episode.
1. MATTRESS: Which type of mattress is best? The “short answer”: there is no single mattress (style or type) for all people, primarily due to body type, size, gender, and what “feels good.” TRY laying on a variety of mattresses (for several minutes on your back and sides) and check out the difference between coiled, inner springs, foam (of different densities), air, waterbeds, etc. The thickness of a mattress can vary from 7 to 18 inches (~17-45 cm) deep. Avoid mattresses that feel like you’re sleeping in a hammock! A “good” mattress should maintain your natural spinal curves when lying on your sides or back (avoid stomach sleeping in most cases). Try placing a pillow between the knees and “hug” a pillow when side sleeping, as it can act like a “kick stand” and prevent you from rolling onto your stomach. If your budget is tight, you can “cheat” by placing a piece of plywood between the mattress and box spring as a short-term fix.
2. SHOES: Look at the bottom of your favorite pair of shoes and check out the “wear pattern.” If you have worn out soles or heels, you are way overdue for a new pair or a “re-sole” by your local shoe cobbler! If you work on your feet, then it’s even more important for both managing and preventing LBP!
3. DIET: A poor diet leads to obesity, which is a MAJOR cause of LBP. Consider the Paleo or Mediterranean Diet and STAY AWAY from fast food! Identify the two or three “food abuses” you have embraced and eliminate them – things with empty calories like soda, ice cream, chips… you get the picture! Keeping your BMI (Body Mass Index) between 20 and 25 is the goal! Positive “side-effects” include increased longevity, better overall health, and an improved quality of life!
4. EXERCISE: The most effective self-help approach to LBP management is exercise. Studies show those who exercise regularly hurt less, see doctors less, have a higher quality of life, and just feel better! This dovetails with diet in keeping your weight in check as well. Think of hamstring stretches and core strengthening as important LBP managers – USE PROPER TECHNIQUE AND FORM; YOUR DOCTOR OF CHIROPRACTIC CAN GUIDE YOU IN THIS PROCESS!
5. POSTURE: Another important “self-help” trick of the trade is to avoid sitting slumped over with an extreme forward head carriage positions. Remember that every inch your head pokes forwards places an additional ten pounds (~4.5 kg) of load on your upper back muscles to keep your head upright, and sitting slumped increases the load on your entire back!
We have only scratched the surface of some COMMON causes and/or contributors of back pain. Stay tuned next month as we continue this important conversation!
We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for back pain, we would be honored to render our services.
The holiday season is here, which means our daily routines will be disrupted by festive get-togethers, cookies, pies, traveling, and shopping. It can be stressful just thinking about it, but we have some tips to help you stay on top of your healthy habits throughout the season - without feeling overwhelmed.
Practice Healthy Nutrition
Similar to back pain, neck pain affects almost all of us at some point in life, and the severity can range from a mild stiffness to complete incapacitation. Chiropractic care offers a non-drug, non-surgical method of treatment that MANY neck pain sufferers utilize and benefit from. The following is a description of what you can expect when treated with an evidence-based chiropractic approach.
Let’s first discuss the different types of neck pain. One classification system divides neck pain into two main groups: acute and chronic. In the acute group, there is an onset of pain that comes on quickly and resolves in less than three months. Chronic neck pain represents the patients who continue to have neck pain longer than three months.
Studies show that patients experience immediate benefits—including pain reduction and mobility/range of motion (ROM) improvement—following cervical spinal manipulation, especially when administered on the same side as the neck pain. Short and medium-term benefits include pain reduction and ROM improvement when administered bilaterally (on both sides).
Multiple manipulations may be better than unsupervised stretching alone. However, studies show that stretching the neck muscles both before and after manipulation can improve a patient’s outcome. The combination of three-point traction and multiple manipulations can improve pain in the medium and long-term as well.
Other approaches commonly used by chiropractors that immediately improve pain include mobilization, traction, trigger-point therapy (applying pressure over myofascial trigger points for 90 seconds), cervical pillows, and some modalities that include electric stimulation, ultrasound, low-powered laser, and pulsed electromagnetic field.
Active care or care that can be taught to patients includes exercise intended to improve pain and ROM in the medium and long-term. Exercises that emphasize strength and endurance can also be beneficial. Ongoing light and intensive exercise improves pain in the long-term and intensive exercise is favored in the medium-term.
Content Courtesy of Chiro-Trust.org. All Rights Reserved.
The connection between our sinuses and headaches is well established, but what about the relationship between neck pain and our sinuses? Is there a connection?
Sinusitis is very common in the spring when pollen counts are high and times when the cold and flu are rampant. It usually manifests with a clear runny nose and pain over the affected sinuses and other “histamine” related symptoms (watery eyes, sneezing, etc.).
The Mayo Clinic states at least two of four primary symptoms of chronic sinusitis (CS) need to be present to confirm a CS diagnosis: 1) thick, discolored nasal discharge or drainage down the back of the throat (post-nasal drip); 2) nasal obstruction due to congestion that interferes with nasal breathing; 3) pain, tenderness, and swelling in the eyes, face, nose, forehead; 4) a reduced sense of taste and smell in adults and a cough in children.
Other CS symptoms can include: 1) ear pain; 2) jaw or teeth pain; 3) cough—often worse at night; 4) sore throat; 5) bad breath (halitosis); 6) fatigue; 7) irritability; 8) nausea; and 9) neck pain. Acute sinusitis has similar signs and symptoms when compared with CS, but they are short-lived. Symptoms that warrant a primary care consideration include: 1) high fever; 2) severe headache; 3) mental confusion; 4) visual changes—double vision, blurriness, etc.; and 5) profound neck pain and stiffness.
Causation of CS include: 1) Nasal polyps; 2) deviated septum; or 3) other medical conditions (cystic fibrosis complications, gastroesophageal reflux or HIV and other autoimmune system-related diseases) that can block the nasal passage.
Risk factors for CS include: 1) nasal passage conditions (polyps, deviated septum); 2) asthma; 3) aspirin sensitivity (due to respiratory problems); 4) immune system disorder (HIV/AIDS or cystic fibrosis); 5) hay fever/allergies; 6) pollutant exposure (air pollution, cigarette smoke).
Complications of CS: 1) meningitis; 2) infection migration such as to the bones (osteomyelitis) or to the skin (cellulitis); 3) sense of smell loss (partial or complete “anosmia”); 4) vision problems (including blindness).
Many are not aware that neck pain and stiffness and jaw or teeth pain are symptoms of CS. Conditions like this are a reminder that it’s important for both the doctor and patient to be aware of ALL the symptoms present, even if they seem like they aren’t connected. While doctors of chiropractic are trained to look for non-mechanical causes for neck pain when a patient seeks care, it makes it easier if the patient is forthcoming with all their symptoms, even the ones that don’t seem relevant.
The good news is that doctors of chiropractic are trained to manage CS and can offer patients advice on lifestyle changes that may reduce the risk of the infection recurring. Furthermore, chiropractors often work with allied healthcare professionals when antibiotics or other measures are needed.
Content Courtesy of Chiro-Trust.org. All Rights Reserved.
Review the latest news: Which braces and supports work best?
Conservative care for SLAP lesions
The best exercise for tennis elbow
One third of young adults with chronic LBP may have an inflammatory arthropathy
Tips for differentiating myofascial pain syndrome from fibromyalgia
Successful evidence-based chiropractors continually leverage new studies to improve their clinical decision-making. This month, we’ve summarized more than 40 studies and have already updated our protocols with this information. We are showcasing a dozen articles here.
1. American Family Physician recently published a synopsis on the effectiveness of various braces and supports:
2. A systematic review regarding the effects of corrective exercises on individuals with forward head posture (FHP) found that: “therapeutic exercises may result in large changes in (head position) and moderate improvement in neck pain.”
Rahman Sheikhhoseini et al. Effectiveness of Therapeutic Exercise on Forward Head Posture: A Systematic Review and Meta-analysis. JMPT Volume 41, Issue 6, Pages 530–539
Consider these 2 exercises for starters-Cervical Retractions
Deep Neck Flexion
3. For most throwers with SLAP lesions, a rehabilitation program focused on stretching the posterior capsule and correcting scapular posture is more successful than surgery.
Matthew CJ et al. Superior Labral Anterior to Posterior Tear Management in Athletes. Open Orthop J. 2018 Jul 31;12:303-313. doi: 10.2174/1874325001812010303. eCollection 2018.
4. For most throwers with SLAP lesions, a rehabilitation program focused on stretching the posterior capsule and correcting scapular posture is more successful than surgery.
Matthew CJ et al. Superior Labral Anterior to Posterior Tear Management in Athletes. Open Orthop J. 2018 Jul 31;12:303-313. doi: 10.2174/1874325001812010303. eCollection 2018.
5. “Shockwave therapy significantly reduced the pain that accompanies tendinopathies and improves functionality and quality of life. It might be first choice (for treating tendinopathies) because of its effectiveness and safety.”
Dedes V et al. Effectiveness and Safety of Shockwave Therapy in Tendinopathies. Mater Sociomed. 2018 Jun;30(2):131-146. doi: 10.5455/msm.2018.30.141-146.
6. An expert panel for the Danish Health Authority performed a comprehensive review of published recommendations to establish National Clinical Guidelines for the treatment of neck pain (NP) and cervical radiculopathy (CR). The recommendations include:
7. A study of 231 young adults (mean age 32) with LBP for greater than 3 months found that 39% “had axial-Spondyloarthropathy (axSpA) as per ASAS Criteria”
Rasool T et al. Axial Spondyloarthritis In Patients With Chronic Backache Using Assessment Of Spondyloarthritis International Society Criteria For Axial Spondyloarthritis. J Ayub Med Coll Abbottabad. 2018 Apr-Jun;30(2):253-257.
8. A BMJ scoping review of 84 prior systematic reviews endorsed treatments with moderate/good quality evidence for the following conditions:
9. A study of 183 senior adults with back and neck related disability compared short-term treatment (12 weeks) versus long-term management (36 weeks) using spinal manipulative therapy combined with supervised rehabilitative exercises The authors conclusion: “For older adults with chronic back and neck disability, extending management from 12 to 36 weeks did not result in any additional important reduction in disability.”
Maiers M et al. Short or long-term treatment of spinal disability in older adults with manipulation and exercise. Arthritis Care Res (Hoboken). 2018 Oct 24. doi: 10.1002/acr.23798. [Epub ahead of print]
10. A study of nearly 70,000 adults found “a higher frequency of organic food consumption was associated with a reduced risk of cancer.”
Baudry J, Assmann KE, Touvier M, et al. Association of Frequency of Organic Food Consumption With Cancer RiskFindings From the NutriNet-Santé Prospective Cohort Study. JAMA Intern Med. Published online October 22, 2018. doi:10.1001/jamainternmed.2018.4357
11. European Spine Journal: “To evaluate the anatomical integrity of the cervical spine in adults with neck pain, we found preliminary evidence to support the use of:
12. Differentiating myofascial pain syndrome from fibromyalgia
“Migraine” is a complex, chronic neurologic disorder characterized by recurrent debilitating headaches. Over 30 million Americans suffer at least one migraine headache each year. (1) The condition affects 18% of females and 6% of males and is the leading cause of “severe” headaches. (1) Over 80% of migraineurs miss work as a result of their headaches, with an average of 4-6 absences per year. (2)
Early explanations for the genesis of migraine focused on cerebrovascular vasoconstriction with subsequent vasodilation. (3) Migraine is now recognized as a more complex series of neurologic and vascular events wherein vasodilation may or may not be present. (4-8) Evidence suggests that a migraineur’s brain is hyperexcitable and uniquely predisposed migraine headaches in much the same way that an epileptic is susceptible to seizures. (8,9) The hyperexcitable migraineur brain is susceptible to various “triggers”. Migraines develop when the number of triggers exceeds a critical threshold for a given patient.
Migraine treatment is subdivided into “abortive” therapies that seek to stop or reverse the progression of an existing headache and “prophylactic” treatments, which seek to prevent or reduce the frequency of future attacks. Abortive treatments are most effective when given within the first minutes of an attack. (10) Unfortunately, once the migraine brain has been “triggered”, conservative therapy may not always abort that particular episode. However, prophylactic management directed at controlling migraine triggers is often helpful.
Spinal manipulation is a useful tool in migraine prophylaxis. One study demonstrated a “significant reduction” of migraine intensity in almost half of those patients receiving spinal manipulation. Nearly ¼ of migraine patients reported greater than 90% fewer attacks. (11) Spinal manipulation has demonstrated similar effectiveness but longer lasting benefit with fewer side effects when compared to a well-known and efficacious medical treatment (amitriptyline). (11,12,13,14)
Conservative care should also include evidence-based dietary and nutraceutical recommendations. An excellent literature review by Orr, provides the following recommendations for migraine prophylaxis (15):
1. Lose Weight
Weight loss may decrease the frequency of migraine and other primary headaches (tension, cluster). (16-18) “Migraine has a specific association with obesity. Furthermore, obese individuals appear to be more likely to suffer from chronic migraine as compared to their peers. There is increasing evidence to suggest that migraine and obesity may be linked through inflammatory mediators released by adipose tissue.” (15)
2. Limit Fats
Dietary fats trigger synthesis of prostoglandins which are known migraine triggers (19). Low fat diets have been shown to play a role in migraine prophylaxix. (20,21)
3. Drink Water
Increased hydration may produce subjective improvement in headache disability and intensity, however no difference in frequency. (22)
4. Decrease Sodium
Patients on a low sodium (DASH) diet report a decrease in headache frequency vs those on a high sodium diet. (23)
5. Feverfew (125mg)
Feverfew may be a useful tool for preventing migraines. (24,25,26) Dosage recommendations vary, however the average dose used in the studies was 125mg/day.
Adding ginger to feverfew may provide relief for acute migraine. (27,28) The proprietary ginger preparation used was (LipiGesic™ M)
7. Riboflavin (400mg)
Riboflavin (Vit B2) may help prevent migraines. (26, 29-38) Dosage recommendations vary, however the average dose used in the studies was 400mg/day.
8. Magnesium (400-600mg)
Magnesium may provide migraine prophylaxis. (26, 39-42) Dosage recommendations vary, however the average dose used in the studies is
400-600mg/ day for the prevention of migraine in non-pregnant patients.
9. CoEnzyme Q10 (100mg TID)
CoEnzyme Q10 may be effective in migraine prophylaxis. (26, 43-46) Dosage recommendations vary, however the average dose used in the studies was 100mg TID.
1. Lipton RB, Scher AI, Kolodner K, Liberman J, Steiner TJ, Stewart WF. Migraine in the United States: epidemiology and patterns of health care use. Neurology. Mar 26 2002;58(6):885-94.
2. Burton WN, Landy SH, Downs KE, Runken MC. The impact of migraine and the effect of migraine treatment on workplace productivity in the United States and suggestions for future research. Mayo Clin Proc. May 2009;84(5):436-45.
3. Wolff, HG. Headache and other head pain. New York: Oxford University Press: 1948.
4. May A, Goadsby PJ. The trigeminovascular system in humans: pathophysiologic implications for primary headache syndromes of the neural influences on the cerebral circulation. J Cereb Blood Flow Metab. Feb 1999;19(2):115-27.
5. Dodick DW, Gargus JJ (August 2008). “Why migraines strike”. Sci. Am. 299 (2): 56–63
6. Waeber C, Moskowitz MA. Therapeutic implications of central and peripheral neurologic mechanisms in migraine. Neurology. Oct 28 2003;61(8 Suppl 4):S9-20.
7. Moskowitz MA. The visceral organ brain: implications for the pathophysiology of vascular head pain. Neurology. 1991;41(2(Pt 1)):182–186.
8. Chawla J. Migraine Headache. Medscape. http://emedicine.medscape.com/article/1142556-overviewAccessed 2/1/14
9. Welch KM. Contemporary concepts of migraine pathogenesis. Neurology. Oct 28 2003;61(8 Suppl 4):S2-8.
10. Kelman L. Women’s issues of migraine in tertiary care. Headache. Jan 2004;44(1):2-7.
11. Nelson CF, Bronfort G, Evans R, Boline P, Goldsmith C, Anderson AV: The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headaches. J Manipulative Physiol Ther 1998, 21 :511-519
52. Biondi DM. Physical treatments for headache: a structured review. Headache. 2005;45(6):738–746.
53. Bronfort G, Assendelft WJ, Evans R, et al. Efficacy of spinal manipulation for chronic headache: a systematic review. J Manipulative Physiol Ther. 2001;24(7):457–466.
14. Boline P et al. Spinal Manipulation vs. Amitriptyline for the Treatment of Chronic Tension-type Headaches: A Randomized Clinical Trial J Manipulative Physiol Ther 1995 (Mar); 18 (3): 148–154
15. Orr SL. Diet and nutraceutical interventions for headache management: A review of the evidence. Cephalalgia. 2015 Jun 11.
16. Hershey AD, Powers SW, Nelson TD, et al. Obesity in the pediatric headache population: A multicenter study. Headache 2009; 49: 170–177.
17. Di Lorenzo C, Coppola G, Sirianni G, et al. Migraine improvement during short lasting ketogenesis: A proofof-concept study. Eur J Neurol 2015; 22: 170–177.
18. Verrotti A, Agostinelli S, Dinelli SD, et al. Impact of a weight loss program on migraine in obese adolescents. Eur J Neurol 2013; 20: 394–397.
19. Antonova M, Wienecke T, Olesen J, et al. Prostaglandins in migraine: Update. Curr Opin Neurol 2013; 26: 269–275.
20. Bic Z, Blix G, Hopp H, et al. The influence of a low-fat diet on incidence and severity of migraine headaches. J Womens Health Gend Based Med 1999; 8: 623–630. 3
21. Bunner AE, Agarwal U, Gonzales JF, et al. Nutrition intervention for migraine: A randomized crossover trial. J Headache Pain 2014; 15: 1–9.
22. Spigt M, Weerkamp N, Troost J, et al. A randomized trial on the effects of regular water intake in patients with recurrent headaches. Fam Pract 2012; 29: 370–375.
23. Amer M, Woodward M and Appel LJ. Effects of dietary sodium and the DASH diet on the occurrence of headaches: Results from randomised multicentre DASHSodium clinical trial. BMJ Open 2014; 4: 1–7.
24. Pittler M and Ernst E. Feverfew for preventing migraine. Cochrane Database Syst Rev 2004; CD002286.
25. Diener HC, Pfaffenrath V, Schnitker J, et al. Efficacy and safety of 6.25 mg t.i.d. feverfew CO2-extract (MIG-99) in migraine prevention—a randomized, double-blind, multicentre, placebo-controlled study. Cephalalgia 2005; 25: 1031–1041.
26. Holland S, Silberstein SD, Freitag F, et al. Evidencebased guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology 2012; 78: 1346–1353.
27. Cady RK, Schreiber CP, Beach ME, et al. Gelstat Migraine (sublingually administered feverfew and ginger compound) for acute treatment of migraine when administered during the mild pain phase. Med Sci Monit 2005; 11: 65–70.
28. Cady RK, Goldstein J, Nett R, et al. A double-blind placebo-controlled pilot study of sublingual feverfew and ginger (LipiGesicTM M) in the treatment of migraine. Headache 2011; 51: 1078–1086.
29. Maizels M, Blumenfeld A and Burchette R. A combination of riboflavin, magnesium, and feverfew for migraine prophylaxis: A randomized trial. Headache 2004; 44: 885–890.
30. Smith C. The role of riboflavin in migraine. Can Med Assoc J 1946; 54: 589–591.
31. Boehnke C, Reuter U, Flach U, et al. High-dose riboflavin treatment is efficacious in migraine prophylaxis: An open study in a tertiary care centre. Eur J Neurol 2004; 11: 4750477.
32. Schoenen J, Lenaerts M and Bastings E. High-dose riboflavin as a prophylactic treatment of migraine: Results of an open pilot study. Cephalalgia 1994; 14: 328–329.
33. Di Lorenzo C, Pierelli F, Coppola G, et al. Mitochondrial DNA haplogroups influence the therapeutic response to riboflavin in migraineurs. Neurology 2009; 72: 158891594.
34. Sa´ndor PS, Afra J, Ambrosini A, et al. Prophylactic treatment of migraine with beta-blockers and riboflavin: Differential effects on the intensity dependence of auditory evoked cortical potentials. Headache 2000; 40: 30–35.
35. Schoenen J, Jacquy J and Lenaerts M. Effectiveness of high-dose riboflavin in migraine prophylaxis: A randomized controlled trial. Neurology 1998; 50: 466–470.
36. Nambiar N, Aiyappa C and Srinivasa R. Oral riboflavin versus oral propranolol in migraine prophylaxis: An open label randomized controlled trial. Neurol Asia 2011; 16: 223–229.
37. Condo` M, Posar A, Arbizzani A, et al. Riboflavin prophylaxis in pediatric and adolescent migraine. J Headache Pain 2009; 10: 361–365.
38. Markley HG. Prophylactic treatment of headaches in adolescents with riboflavin. Cephalalgia 2009; 29(Suppl 1): 100.
39. Facchinetti F, Sances G, Borella P, et al. Magnesium prophylaxis of menstrual migraine: Effects on intracellular magnesium. Headache 1991; 31: 298–301.
40. Ko¨seoglu E, Talaslioglu A, Go¨nu¨l AS, et al. The effects of magnesium prophylaxis in migraine without aura. Magnes Res 2008; 21: 101–108.
41. Esfanjani A, Mahdavi R, Ebrahimi Mameghani M, et al. The effects of magnesium, L-carnitine, and concurrent magnesium-L-carnitine supplementation in migraine prophylaxis. Biol Trace Elem Res 2012; 150: 42048.
42. Peikert A, Wilimzig C and Ko¨hne-Volland R. Prophylaxis of migraine with oral magnesium: Results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia 1996; 16: 257–263.
44. Rozen TD, Oshinsky ML, Gebeline CA, et al. Open label trial of coenzyme Q10 as a migraine preventive. Cephalalgia 2002; 22: 1370141.
45. Sa´ndor PS, DiClemente L, Coppola G, et al. Efficacy of coenzyme Q10 in migraine prophylaxis: A randomized controlled trial. Neurology 2005; 64: 713–715.
46. Hershey AD, Powers SW, Vockell AL, et al. Coenzyme Q10 deficiency and response to supplementation in pediatric and adolescent migraine. Headache 2007; 47: 73–80.
Wouldn’t it be nice if we could assess three common types of treatment for neck and back pain to determine which is the most effective? Here is a look at three studies that compared three popular forms of care for chronic spinal pain to determine the short-term and more importantly, the LONG-TERM benefits of chiropractic manipulation, acupuncture, and non-steroid anti-inflammatory drugs (NSAIDs, like Advil).
The FIRST published study included a pilot group of 77 patients complaining of chronic spinal pain (neck, mid-back, or low-back pain). These patients were separated into one of the three treatment groups and received either NSAIDs, acupuncture, or chiropractic manipulation. Patients received care for four weeks with outcome measures (questionnaires) used to assess changes in pain and disability. After a 30-day time frame, only patients who received chiropractic manipulation (CM) reached a level of statistically significant improvement, supporting CM to offer the best SHORT-TERM BENEFITS for those with chronic back/neck pain.
The SECOND study included 115 patients, again randomized, to receive either one of the same three treatments, but this time the outcome data was gathered two, five, and nine weeks after the start of treatment. Again, those who received chiropractic manipulation (CM) experienced the best overall improvement at nine weeks.
The THIRD study involved follow-up from the same patient group from the SECOND study two years later. Once again, participants completed outcome assessments that measure pain and disability. This time, the results showed that only patients in the chiropractic manipulation group maintained long-term improvements in pain and disability.
There have been other studies looking at the efficacy and benefits of SMT (spinal manipulative therapy) both in comparison with other forms of care (as presented here) as well as with different conditions or diagnoses. Perhaps the most exciting results were published in 2008 by the International Bone and Joint Decade 2000-2010 Task Force on Neck Pain.
They divided patients into four groups (Group 1: Neck pain with little to no interference with activities of daily living – ADLs; Group 2: Neck pain that limits ADLs; Group 3: Neck pain with radiculopathy or radiating arm pain from a pinched nerve; Group 4: Neck pain with serious pathology such as cancer, fracture, infection, and/or systemic disease.)
The researchers concluded that chiropractic care was highly recommended especially in Grades 1 and 2 (which includes the majority of neck pain sufferers). Interestingly, many multidisciplinary physician groups now incorporate chiropractic care as part of their “team” approach, which also offer pain management in the form of medications, injections, PT, and when necessary, surgery. They have seen the value of spinal manipulation for neck pain and often seek out chiropractic because it’s safe, beneficial, and cost effective.
Cliff Atwell, B.S., D.C.