Migraines

 

Clinical Experience

Over the decades, our clinical experience has shown that NUCCA care has had a positive impact on a variety of types of headaches, including migraines. Recent research done at The Britannia Clinic has validated our clinical experience in terms of measuring favorable patient reported outcomes. Our research is also helping to reveal the physiological mechanism behind the quality of life changes experienced by many of our patients following NUCCA care.

Prevalence of Migraines

images1Migraine can be a debilitating disorder characterized by pulsating headaches lasting from a few hours to several days, accompanied by nausea, vomiting, and/or sensitivity to light and sound. An estimated 14% of the world’s population have suffered from migraine at some point in their life1. Studies consistently show that women are more likely than men to experience migraine1.

Migraine is recognized as a major cause of disability1.  A global study ranked migraine eighth in years lived with disability, a measure of the burden of disease1. The cost to individuals, their families and the community is high in terms of quality of life, absenteeism from school and work, lost productivity, and medication expenses1.

In 2010/2011, an estimated 8.3% of Canadians (2.7 million) reported that they had been diagnosed with migraine1. This likely underestimates migraine prevalence. Research indicates that some people who experience migraine do not seek professional help, and therefore, would not have a diagnosis to report1.

Phase Contrast Migraine Study

The Phase Contrast Magnetic Resonance Imaging (PCMRI) Migraine study was a multidisciplinary project that created ongoing partnerships between The Upper Cervical Research Foundation (UCRF), The University of Calgary Neurology, The Britannia Clinic and Elliot-Fong-Wallace (EFW) Radiology. It brought to Calgary state-of-the-art, dynamic MRI technology to determine how the brain’s vascular system and brain function respond to an optimal NUCCA correction. While most MRI’s are like a static image of the brain, this MRI technology looks at dynamic flow patterns and changes. Advanced MRI data analysis was completed by Magnetic Resonance Innovations, Inc. in Detroit. This inquiry allowed for exploration of additional hemo-dynamic and hydro-dynamic flow pattern changes including optimized post NUCCA correction bloodflow and cerebrospinal fluid (CSF) flow patterns.

images2The observational clinical study examined eleven neurologist diagnosed migraine subjects to determine if the findings from a prior case study were repeatable and consistent at baseline, week-four, and week-eight, after the NUCCA atlas correction intervention. The twelve-week study’s secondary outcomes consisted of a daily headache diary and several migraine specific, subject reported, quality of life measures. Subjects between the ages of 21 and 65 years, satisfied specific diagnostic criteria for migraine headache and demonstrated through self-report, between 10 and 26 headache days per month for an average of 23 years. The study was unique in that it measured both physiological changes (as measured on MRI) and patient reported quality of life outcomes.

Results and Publication

Whereas many studies have a lot of patients with a few specific outcome measures, this pilot clinical study had a few patients and a lot of data to scrutinize for the linked relationships. The cross references of data from NUCCA x-ray, posture, MRI and Quality of Life measures was very revealing. Subjects reported positive results regarding migraine quality of life with no adverse reactions to care.

From a physiological standpoint, what was looked at was intracranial compliance index (ICCI) or cranial reserve and the hemo-dynamic and hydro-dynamic changes that occur as a result of the NUCCA correction. The highly compliant nature of the intracranial contents can be explained by mechanisms such as cerebrospinal fluid displacement from compressed brain tissue.

Figure 7: Subject Global Assessment of Headache (VAS) (n=11)

Migraine Study Figure 7

 

 

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There was substantial variation in baseline scores across these patients. The lines show individual linear fit for each of eleven patients. The thick dotted black line represents the average linear fit across all eleven patients.

Abbreviations used: VAS: Visual Analog Scale

Table 2: Subject Intracranial Compliance Index (ICCI) data (n=11)

PC-MRI6 acquired ICCIdata reported at Baseline, week-four and week-eight following NUCCAintervention. Bolded rows signify subject with secondary venous drainage route. MVA or mTBI occurred at least 5 years prior to study inclusion, average 10 years.

Table2

 

 

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(*mean of two values provided)

1-ICCI-intracranial compliance index
2-ID-subject identification
3-mTBI-mild traumatic brain injury
4-MVA-motor vehicle accident
5-NUCCA-National Upper Cervical Chiropractic Association
6-Phase Contrast Magnetic Resonance Imaging

Table 3: Descriptive statistics [mean, standard deviation, median and Interquartile Range (IQR2)] of NUCCA1 assessments Before-After Initial Intervention (n = 11)

Table 3

 

 

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(* – as derived from radiographic measurement)

Table footnotes:
* – as derived from radiograph measurement
1 – NUCCA: National Upper Cervical Chiropractic Association
2 – IQR: Interquartile Range
3 – GSA: Gravity Stress Analyzer

The study manuscript has been published by BioMed Research International.

Further Areas Of Study:

Glymphatics: 

Improved venous outflow as a result of the NUCCA intervention may also contribute to a reduction in the inflammatory response and the detoxification of the brain through a system known as glymphatics. The glymphatic system is a functional waste clearance pathway for the mammalian central nervous system (CNS). An intercellular “glymphatic” pathway clears cell waste from the brain and may reveal new targets for treating neurodegenerative diseases2.

New research shows the restorative function of sleep may be a consequence of the enhanced removal of potentially neurotoxic waste products that accumulate in the awake central nervous system.3  Some neurodegenerative diseases are thought to be associated with the accumulation of cellular waste products from lack of proper sleep.

We know from our migraine headache research4 that the proper alignment of the upper neck with a NUCCA correction helps the flow patterns of cerebro-spinal fluid (CSF) optimize. This may help in the cleansing of our brains with more efficient flow at night when we sleep.

Concussion: 

There has been a recent increase in awareness of the potential health impact of concussions and mild traumatic brain injuries. Our research indicates that the correction of the upper cervical spine with the NUCCA treatment protocol provides an important component in the treatment of migraines, head injuries and concussion. 

Accumulating scientific evidence suggests that “mild traumatic brain injuries, such as concussion, produce neuroinflammatory and excitotoxic responses in the brain.  When stimulated by trauma, immune protective cells in the brain are activated which normally clean up debris from the injury and secrete substances to repair the damage.  Repeated trauma to the brain may prevent these cells from switching from a neurodestructive mode to a reparative mode”2.

“Multiple disturbances of brain homeostasis, including mild traumatic brain injury are known to prime or activate these cells. Priming causes the cells to become hyperactive, releasing much higher concentrations of inflammatory substances than are normally released.  When the cells remain primed, a second concussion, even a mild one, would trigger a second round of hyperactive neurodestructive cell activation.  With each successive concussion, the process would be repeated.”2.  Multiple brain injures can have a cumulative effect.   ”People who have had multiple concussive brain injuries over the course of their lives may acquire lasting, and even progressive, impairment that limits their ability to function”5.

As a side note; in the migraine study, there was a history of head and neck injury in 85% of the study participants. This is prompting further study into this important correlation.

References:

1. Ramage-Morin, P. and Gilmour, H (2014, June) Prevalence of Migraine in the Canadian household population.  Retrieved from: http://www.statcan.gc.ca/pub/82-003-x/2014006/article/14033-eng.htm

2. Blaylock, Russell; Maroon, Joseph. Immunoexcitotoxicity as a central mechanism in chronic traumatic encephalopathy – A unifying hypothesis. 2011.

3. Nedergaard, M; (2013, June) Garbage Truck of the Brain. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3749839/

4. Woodfield, H. Charles; Hasick, D. Gordon; Becker, Werner J; Rose, M. Sarah; Scott, James N.; Effect of atlas vertebrae realignment in subjects with migraine – an observational pilot study, BioMed Research International. 2015.

5. Mayo Clinic Staff (n.d.) Diseases and Conditions – Concussion – Complications.  Retrieved from: http://www.mayoclinic.org/diseases-conditions/concussion/basics/complications/con-20019272