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Dynamic Chiropractic – February 10, 1997, Vol. 15, Issue 04
Dynamic Chiropractic
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Chiropractic's Role in Treating Headaches

Cervicogenic Headache Model Gives Credence to Chiropractic

By Editorial Staff

Until recently, the medical understanding of headaches has not taken into account the chiropractic model. The concept that headache pain can emanate from cervical dysfunction is still completely foreign to most of the medical profession. Noted researcher Nikolai Bogduk, MD, PhD, professor of anatomy at Newcastle, Australia, commented:
"The people in control of the headache field seemingly have not, cannot, or will not, recognize this paradox ... that the model for cervicogenic headache is not only the best evolved of all headaches but is testable in vivo, in patients with headache complaints. No other form of headache has that facility."
Several years ago, a Canadian anesthesiologist, Peter Rothbart, MD, FRCPC, came to the same conclusions about cervicogenic headache. Dr. Rothbart made many observations in his own pain management practice which subsequently led to an article in the Toronto Star, the most widely read newspaper in Canada. The Toronto Star article, "A Pain in the Neck," was subtitled: "Chiropractors were right.

Many headaches are caused by damaged structures in the neck -- and scientific evidence proves it." The article explained that years ago, French medical professor Robert Maigne "came to believe that many headaches originated with a structural problem in the neck." He was "thought to be a lunatic," said Dr. Rothbart. But others took up Dr. Maigne's work, including Dr. Nik Bogduk.

In 1995, a team of MDs at Syracuse University established neck problems as the cause of many headaches "with scientific, anatomical proof." Dr. Rothbart termed the Syracuse results "a minor miracle." In the Toronto Star article, Dr. Rothbart made several insightful comments:

"Some brilliant people have put their hearts, souls and minds to this (headache) problem and haven't come up with anything. All we've been able to do is treat people with an array of medicines, one after the other, and hope the side effects won't be too bad."

"We couldn't believe it at first. We've been able to put together a scientific explanation for how neck structure causes headaches -- not all headaches, but a significant number of them."

"It's true that chiropractors have been saying this for years. Unfortunately, many (medical) doctors tend to have a jaundiced view of chiropractors, but they were right about headaches."

Dr. Rothbart's clinical experience and findings have led him to become a founder and president of the North American Cervicogenic Headache Society (NACHS). The NACHS is dedicated to establishing the place of cervicogenic headache in the minds and practices of those health care provider who treat headaches. At the first North American Cervicogenic Headache Conference, held last year, Dr. Rothbart remarked:
"So far as the International Headache Society and the American Association for the Study of Headaches have defined this entity (cervicogenic headache) -- it simply doesn't exist. I'm pleased to say that thanks to the works of Drs. Merskey and Bogduk, cervicogenic headache is recognized in the IASP (International Association for the Study of Pain) taxonomy. This situation creates an enormous problem in addressing the diagnosis and treatment of headaches. Since most of the physicians and headachologists are unfamiliar with the IASP taxonomy, they are unaware of this entity, so diagnosis of cervicogenic headache is rarely made. Thus, there are a large number of chronic headache sufferers who go through life with the wrong diagnosis and hence the wrong treatment for their headache. It was the ongoing ignorance about this clinical entity that motivated the founders of this society to establish a formal organization. One of our goals is for this entity to be accepted into the general headache classification, and until this happens, large numbers of patients will continue to suffer unnecessarily."
The second North American Cervicogenic Headache Conference will be held in Las Vegas, March 22-23. Dr. Rothbart with be the conference moderator. Conference speakers include Dr. Bogduk and Howard Vernon, DC, associate dean of research at the Canadian Memorial Chiropractic College in Toronto. The conference is designed for MDs, DCs and all other providers who deal with headaches. One of the sessions will specifically address the use of "manipulative therapy" for cervicogenic headaches.

The development of the concept of cervicogenic headache has opened a new door for chiropractic. As this concept is developed and adopted, it is expected that a large percentage of headache sufferers will fall into this category. Chiropractic has much to offer as the first line care for cervicogenic headache. Dr. Rothbart notes the importance of this conference for DCs:

"This conference will demonstrate the anatomy and physiology of cervicogenic headache and will show the importance of manipulation as a method of treatment. This will be the first conference bringing together chiropractors and neurologists. It will help to validate chiropractic practice to some of the most skeptical medical practitioners and so benefit all practitioners involved in treatment of chronic headaches."
Editor's note: For information regarding the North American Cervicogenic Headache (NACH) Conference, please contact Bev Hann at 1-800-663-2858. The NACH fax number is: 1-905-882-8412.

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