301- Migraine Headache Improvements with Chiropractic Care

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. On today's episode we're talking about migraine headaches. This is one of the top three reasons people come in to visit chiropractors. There's a pretty new study just a couple years old that has a really interesting take. A lot of great nuggets to be able to utilize in patient conversations and clinical care. We'll dive into that and much more on today's episode. Before we get started, I'll just, I want to say a few words about Novopulse. It is where recovery meets performance. You can learn more about this technology that reduces pain and inflammation while improving function to get your patients back to the activities that they love. @novopulse.com, novo Pulse.com I'll drop that link down in the show notes. This is a really, really cool technology that I'm talking more about as time goes on. So check out that link in the show notes. Also, for our 300th episode last week I teased some giveaways and I want to give a shout out to the feedback user, Dr. Vest. He is a realtor by day and student by night. Hit me up Jeff, the evidence based chiropractor.com shoot me over your address and I will send you some evidence based chiropractor swag. I cannot believe we are beyond now the 300th episode of this podcast. So thank you so much everybody for, for tuning in. And Dr. Vest, shoot me an email. Jeff, the evidencebasedchiropractor.com we will get you hooked up with some pretty cool evidence based chiropractor schwag. But as I said at the top, today's episode we are focused on a study that came out in 2019 and it's titled Integrating Chiropractic Care into the Treatment of Migraine Headaches in a Tertiary Care Hospital. A case study series. And there's some really, really good stuff in this. So we know that migraine headaches affect over 38 million people in the United States alone. It's probably over 10% of the population and while they're managed, there really is no cure and many medications have supremely terrible side effects. It's, you know, we talk about this with the smart chiropractor some of the when we have a headache month, we talk about the fact that one of the number one side effects of many common migraine and headache medication is microbiome, more headaches and more migraines, which is completely insane to say and the truth. So what do people do? Hopefully chiropractic, but not enough. That's why studies like this are so important. So we know that migraine headaches also, you know, they really, they vary by patient, they're pretty wide in terms of what's classified as a migraine. But over 75% of migraine headache sufferers report neck pain in many, no neck stiffness, muscle tension and problems with jaw function. So this was a stat that took me a little bit by surprise. I did not know that over 75% think about that. And 75% of those people struggling with migraines have associated neck pain. Do you think that they are intertwined? I think so many, many times. So, you know, typical allopathic treatments, muscle relaxants, NSAIDs, physical therapy, and quite often these just don't get it done. We see people continue to struggle and sort of going on. Correlative to this, not causative, but correlative to this have been new opportunities to take care of people in a tertiary care setting. And in 2007, Harvard Medical School, Osher center for Integrative Medicine established their Osher Clinical center for Complementary and Integrative Therapies, which is located at Brigham and Women's Hospital. I know Ren Burton, who's part of our smart chiropractor team, is there on a fellowship right now, which is super, super co cool. But people are taking note. And one of the central focuses of care at that clinical center is chiropractic, delivered by two chiropractors with over 40 years of clinical experience. So that is pretty cool to think about chiropractic being in Brigham and Women's Hospital, associated with Harvard, in an Osher center for Integrative Care. And really being one of those primary modalities is really, really cool. So in this study they looked at chiropractic care as the whole, not necessarily just the adjustment or the manipulation, but really everything within a chiropractic tool belt. So it really was taken from that 20,000, 30,000 foot view because as we know, chiropractors, yes, we can do adjustments or spinal manipulation, but we also can have experience and have great experience in soft tissue therapies, myofascial release, massage, trigger point rehab and exercises, ergonomic advice, lifestyle management, nutritional counseling. All of these fall into the bucket of what we do as chiropractors and what we can do. However, the hallmark still remains to be the adjustment in spinal manipulation. How does it work? Well, current theory is activating descending pain inhibitory pathways and that basically is responsible for pain modulation. A lot of stuff that goes on, we touch on it week in and week out, I should say on this podcast. But the gist of it is that an adjustment is essentially altering, influencing what's going on with pain pathways and really modulating pain. So this study really had three different cases. Case number one was a patient who is 40 years old and has daily headaches. And I think we've all had patients that have come into our practice like this. You know, they start and you know, you get their history and this, the story remains the same often and in this there's multiple of these three patients that the headaches got worse after pregnancy. Probably a study for another day, but you know, headaches came on, little bit of headaches here and there. Next thing they know, daily headaches. So after they received the integrative care, which included chiropractic, this patient had a nearly immediate reduction in headache and neck pain in a reduced frequency of one per month. So to go from daily headaches to one per month, absolutely. You know, that is life changing for somebody. So that was case number one. Case number two was an individual who's 34 years old and she had pounding constant pain that was rated basically a 7 or 8 out of 10 on any given day. This took a little longer, but after nine months of treatment, the patient's headaches reduced to 10 per month, which is a significant reduction from 30 per month. And the pain was reduced to 3 out of 10. 8, 8 out of 10. Pain that is supremely going to impact just about anybody's lifestyle. Three out of 10, that's livable. These are changes that totally impact flip upside down in a positive way. These individuals lives. And at 10 months she experienced her first headache free month in years and years and years. Super powerful. Case number three, this was an individual, 27 years old, decade long history of nearly daily migraines and disabling, interfered with life. And she was really only able to take one to two college classes per semester. She just couldn't. The headaches were that bad. And after care, with 50% reduction in headache intensity, the average pain intensity dropped to a 3.5 out of 10. With a range of 2 out of 10 to 4 out of 10. And previously, again, this had been to the point of 7, 8, 9 out of 10 day in and day out. So powerful cases that are happening in really, really respectable, you know, college institutions and learned institutions. And these sort of studies are exactly what we utilize with the evidence based chiropractor to build relationships with other healthcare providers. So if you're interested in building relationships, we've done it. We have a proven system. Check out the evidence based chiropractor if you're interested in getting more people in your community to build trust and rapport and ultimately get more patients in with direct to patient, direct to consumer messaging. That's where the smart chiropractor comes in. All of our automations, email, social posts, et cetera, this is the kind of stuff we love to dive into. Part of the reasons why I have this podcast is it stimulates me to check out the research week in and week out, understand what's going on and then we get to put it, we get to action it into the tools that you can utilize automated to communicate your message. Total win, win, win. So what, what really is the discussion points? What's the end point of this study? Well, they observed improvements in pain scores, pain free days, decreased medication usage, which is huge and patient anxiety with patients with those individuals who receive the integrative care and specifically when they added on chiropractic. And I want to pause for a moment and just showcase decreased medication usage is a really, really big deal. Many of these medications are not designed, most medications are not designed to be on for a lifetime. Yes, there's exceptions to that rule. But specifically when we refer to pain medications or medications that are involved in neurological function, these are typically not medications designed to be on for a long period of time. The side effects can be pretty detrimental. And also we see sensitization, which is expected. More medication, less result, more medication, less result. New medication, more medication, less result, new medication. That is not a cycle people need to be on. And wow, when we take a Look at these three cases, people dropping from 8 and 9 out of 10 to 2 out of 10 pain everyday headaches to once a month headaches. This is super, super powerful and a story that needs to be told in your community to other healthcare providers and definitely a story that needs to be told to other people. We know 10 to 15% of individuals suffer from migraines. You know, our practices should be full right there. We know our total utilization as chiropractors, 10 to 15% and we're not taking care of every person with migraines. That would be zero low back cases, zero sports cases, zero anything else. So the Bottom line is we are underutilized and under serving these individuals with migraines. So there were three reasons that they identified. Hey, hey. When would a patient be appropriate for integrative care? One was those seeking non pharmaceutical approaches or wanting to reduce their medication uses. Really good reason. Number two, non responsive in their current care. And then number three, patients who have reached a therapeutic plateau. So all three are great reasons. I'm gonna say, you know, this is not in the study, but mine would be. The number one would be that they want something new and different and they want something effective. I mean, we've seen time and time again how effective chiropractic care can be. It really shouldn't be only after they fail something else or only if they don't want pharmaceuticals. We need to be at the top of that list. There's no question about it. This paper is a great start towards that. And as they cite here, you know, many medical practitioners are unaware of the treatment approaches within chiropractic profession and the efficacy of these approaches because chiropractors have practiced as a separate healthcare system for over 100 years. So this is really again, dives into the point of getting out there, bridging the gap and building relationships is critically important. And it's the basis on which you're gonna get referrals. Yes, getting your results with your patients is one way to do it. But if you're expecting that just to do all the work for you, you're gonna be sorely missing the opportunity. You have to be proactive in relationship building and get out there, tell the story of who you are, what you do. And studies like this, you make it really easy. Now having systems and process is another thing. That's why evidence based chiropractor exists. But man, these studies should support the messaging that you're getting out month after month to all of these other physicians in your community. So they tidy things up by saying, quote. A common discussion within neurology and the general medical community is the concern that some chiropractic procedures, namely cervical spine manipulation, may be associated with an increased risk of adverse events, including a cervical artery dissection. That's the bad news. The good news, a recent review article by the American Heart association and American Stroke association noted that the association between cervical manipulation and CAD is not well established and is probably low, if it even exists. So again, these articles, as far as cads and vertebral artery dissection, these things keep coming up in the research. I'm torn on it. I think it's great that, you know, anything. That's a question should come up and it should be analyzed and addressed. I also look at this and say there is, you know, over the course of how many years, I mean, you know, 126 years at this point of chiropractic, there's never been causation or really any correlation really established yet. It keeps coming up. While medications with very, very poor track records with high side effects, you know, they're really just normal standard of care. It blows my mind. But even more reason to get out there, tell your chiropractic story, let people know about studies like this. You know, the fact that most people, 99% of people are completely unaware that chiropractic is in the Osher center, that is affiliated with Harvard, that it's at Brigham and Women's Hospital. I mean, there's just credibility right there that is true credibility that's been built on the hard work of chiropractors over the last 125 years getting fantastic results. Now we're seeing the, you know, the benefits of that as we see studies come out, as we see these chiropractors integrated into care. And hopefully I'm gonna say not only if somebody doesn't want medication eventually and not only if somebody plateaus or doesn't receive the results that they want, but really as a first line treatment. And this study is from 2019. I think in the last two years we have seen those guidelines updated where it says before any medications, you need to have a chiropractic evaluation. Now, the practice of that is totally different in terms of is it happening in your community? Quite frankly, probably not, which is why you need to get out there, build those relationships. But more great research being produced each and every day, each and every week, each and every month, each and every year, supporting who we are and what we do. If you have any questions about this, you can hit me up. Jeffeevidencebasedchiropractor.com I want to just thank you so much for tuning into this podcast. Over 300 episodes. I'd love your review, your feedback, that would be super, super cool. Helps more and more docs find out about it. And before we wrap, I want to say just a word or two about Echiro ehr. Every EHR sells features. If you have Echiro's expertise, they can help you create a better lifestyle and improve your practice health. Check them out. Echiroehr.com echiroehr.com and again, I've said it before, I'll say it again. This was co founded by Dr. Scott Munsterman, a compliance and documentation expert. So if you're serious about compliance, if you're serious about documentation, check out Echiro Ehr. Have a fantastic weekend practice and I will talk to you soon.

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