509- Cervical MRI Findings Linked to Less Severe Headaches

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 are back with more brand new research, another great one. This one's gonna be all about cervical MRI findings and reports of headaches. Where do they intersect? What are the differences? We'll dive into that and much more on today's episode. Before we get started, I wanna give a special shout out to Necare. Neccare is the best cervical assessment tool out there. So if this episode interests you, Talking about cervical MRI findings, check out neckcare.com as a listener. They're gonna hook you up with 10% off the best assessment tool. That's a combination of hardware and software. Neckcare.com connect with your team or and I'll drop the link down in the show notes. But as I said at the top on today's episode, all about research, title of the study is the association between cervical MRI findings and patient reported severity of headache in patients with persistent neck pain. And this is a cross sectional study. Link will be down in the show notes of course and we'll kick it off with what I'll say is the most surprising twist of this to begin with, which is you'd probably think that more degenerative changes in the cervical spine means worse headaches. This says, well, not so fast. This is a brand new study and it's flipped that idea totally on its head. And today we're going to dive into this research we which really is meant to uncover the link between cervical MRI findings and headache severity, specifically in patients with neck pain. This one may challenge how you think about imaging headaches and ultimately patient communication. So we know headaches are one of the top three reasons people come into your practice, right? The top three reasons people report visiting a chiropractor for the first time are low back pain, neck pain and headaches, in that order. And this study ties together two of those items, neck pain and headaches. Not only are they one of the most common reasons people initially visit a chiropractor, they're just common in general. Two thirds of people will experience headaches in their lifetime and up to a third of people have them at any given moment. That's that point prevalence we discuss. You put 10 people in a room that up to three people might have had a headache within the last 24 hours. And then when you add neck pain into that mix, you've got a combination that's very likely something that you see literally every single day in your practice. And you have to always consider for all the people you see every day who have these challenges, think about how many people are left out in your community struggling that didn't make it into your practice. This is a massive opportunity to teach, to educate, and to be an expert so that you can drive more people into your practice and help more people live the lives they want to, which is functionally as good as they can be without drugs and surgery, which is ultimately the goal. So the big question this study attempted to answer was, do structural changes that we see on MRIs, things like disc degeneration, stenosis, endplate changes, modic changes, actually relate to how bad somebody's headaches are? They looked back at the past research, and we didn't really have a clear answer. Some of the studies said yes, others said probably not. And most of them were not focused on headache severity, just whether the headache was there or not. And that's where this new study from Denmark comes into play. The researchers looked at over 570 patients with persistent neck pain and coexisting headaches. And they wanted to answer two key questions that relate to that. One, do single cervical MRI findings correlate with headache severity? Does a single finding on the MRI correlate with severity? And what happens when you aggregate. Second question. What happens when you aggregate multiple findings and into a combined score? And what they found is probably gonna surprise you a little bit. Again, sample size, over 270 patients, all of them, again, chronic neck pain and headaches. Demographics. The headache severity was slightly higher in women and in younger patients. And the most common MRI findings, this is just go on for a whole episode on this alone. But the most common MRI finding, 76% of people headed had foraminal stenosis noted on their MRI, 68% of them had disc degeneration and 50% had a disc protrusion. I probably would have maybe inversed those. I would not have thought foraminal stenosis would have been the leader. I would have thought it would have been generative changes or disc protrusion. So a little bit interesting there. Now, the main takeaway was the more this is wild, the more degenerative MRI findings a patient had, the less severe their headaches tended to be. So that's the startling aspect of this study. We're going to dive into why some thoughts, some theories and how this matters. So, you know, for example, patients with no MRI findings actually had the highest odds of severe headaches. Having just one finding on their MRI lowered the odds of severe headaches by almost 40%. That's substantial. And having two or three different findings dropped those odds by about 60%. So it was like the total inverse of what I would have guessed, and I think maybe what the researchers thought as well. So instead of a positive correlation, which seems that it would make sense at a surface level, the relationship was actually totally inverse. And so if we start to unpack this a little bit, we'll start with the single findings, right? Those who had a single finding on their MRI, foraminal stenosis and vertebral end plate changes, type 2, emotic changes, type 2, showed the clearest association with lower headache severity. Now, nerve root compromise was too rare in this sample to draw real conclusions. So remember, there's foraminal stenosis narrowing, and then there's compression. There's always a little bit of extra space, right? So foraminal stenosis does not intrinsically mean that it's causing symptomatology, whereas true nerve root compression would. So when they built this into an aggregate score, basically like tallying up all the findings, like stenosis, herniation, endplate changes, the relationship actually got even stronger. Patients with more findings consistently had less severe headaches, which is totally counterintuitive. We probably would expect degenerative changes to equal pain, but in this case, it didn't. Now, the question is why? And there are three aspects that the researchers pointed out out that may be affecting things. The first is age. Older patients had more degeneration on their MRIs, but they also had fewer reported headaches. Now, that fits with what we know from an epidemiological perspective. Headache prevalence drops with age. So that's one aspect. Let's talk about the symptom focus, so to speak. So these patients, again, were referred primarily for neck pain. So it is possible that they underreported or actually kind of deprioritized their headaches compared to their neck symptoms, because the neck pain was really the primary thing that they were dealing with. Right. So just a comparative effect, so to speak. And then there's other factors that are. There's a plethora of hormones, stress, mental health, social context. All of these, we know, play a massive role in headache frequency and severity. And none of those, of course, show up on imaging and specifically in mri. So there's a lot of factors at play. I'll go one step further here. Where when we go back to the degenerative changes and modic changes, which is we know as degeneration advances, we actually see pain tally off right when it's inflammatory changes early on, that's often when the most pain is present. But, but as calcification takes place, we often see pain kind of fall off and we see this a lot. Also. If you see older patients, you might look at their spine, they might have minimal symptomatology, but their imaging looks wildly insane. They have bone spurs all over the place. Now if they don't have nerve compression, chances are that was painful 20, 30 years ago when the remodeling was taking place. But over time, as calcification and the remodeling process ends and the inflammatory aspect ends, often things might not look good on an image, but it might not actually be causing any pain in the moment. And that kind of ties in, I'm going to say indirectly with the age effect. And I think it's really important to highlight. So what does this mean for you in practice? Number one, don't over interpret imaging and MRIs specifically when it comes to headaches. Just because you see degenerative changes doesn't mean that's what's driving the headache severity in your patients. So make sure again you're using a 360, a holistic approach when you're analyzing what is the case history, what are they dealing with specifically and then of course, what are my exam findings. Imaging plays a role in that, but it shouldn't dominate that thought process and decision making process number two is this reinforces, I'm gonna say the disconnect we know exists between imaging and symptomatology. Patients think all the time, if my MRI looks bad, I must feel bad. And this study is a great reminder that structural change in symptoms do not always align. And I was just speaking last night at an AI healthcare conference here at a startup incubator in Tampa. And one of the things I spoke about was specifically the doctor, physician, chiropractor's job to say, my job is to separate the not perfects from the problems. Your image is gonna show and discuss everything that's not perfect in your spine. And that's why you might have a five page MRI report. But there might only be one or two things on that that matter. Right. The report is gonna highlight everything that's not perfect. My job is to be able to delineate and decide what are the actual problems. It is totally great. You don't need to be perfect, not perfect is normal. But But a problem is something that should be addressed in helping patients understand that. And framing it like that, I've found to be a very successful way where people are like, oh, I get it. And it also is just a massive trust builder. So this goes into number three, which is communication is key. You know, helping your patients understand that degenerative findings are super common and sometimes actually totally unrelated to their pain can help reduce fear, improve compliance, and help your patients stay engaged in their care plan. Now, that's not to say if you're seeing degenerative change that's, I'm gonna say abnormal, it's advanced, it's happening early, it's causing the. It is the problem, by all means, bring it up. But degenerative changes, as you've probably heard me say hundreds of times on this podcast, time and gravity are undefeated. And with that, the aging and degenerative process take place. It's when that's beyond the scope of what we expect, or when it's the driver of pain, that, that it's important, so just important to keep that in mind and keep that communication open. So if you're trying to put this into patient friendly language, I think there's a few key ways to discuss this with your patients. One is just highlighting the fact that many people with changes on their MRI actually have fewer headaches. So your MRI scan doesn't automatically predict your pain. Also letting them know that headaches are influenced by a lot of factors, so stress, posture, sleep, even hormones, not just what's on your image. And that also just reinforcing the benefits of what you do. So letting them know that you have safe, natural, holistic ways to help reduce both their neck pain and their headaches. And just because there's a finding on their MRI that doesn't predetermine their future, changes can be made. So just letting people know whether this in report of findings or, or whatever it might be, these simple and clear and reassuring statements can go a long way. And this type of thing is not, I'm gonna say, just saying something nice. It's been shown time and time again, the communication you have day in, day in and day out with your patients actually drives the outcome in some cases nearly as much as the care that you deliver. So be cognizant of that. So using this, where can you use it? We, we highlighted one report of findings. If a patient's like fixated on their imaging and MRI reference this study to show that degeneration doesn't necessarily mean they're gonna have worse headaches again, marketing patient education. Use this as a positive message. Use this across your social media channels. Use this as education out to your community reactivation campaigns. This is awesome. If you're reaching out to patients who have had headaches in the past, highlight that imaging findings don't need to dictate their future. They don't need to write off I'm quote unquote too far gone for a chiropractor nonsense. Help them understand you might be the best place they can be. And of course for referral relationships MD connection Evidence based chiropractor Best way to do it Sharing research like this for and with other healthcare providers, MDs, DOs, midwives, doulas, whoever it might be in your community is a great way to show that what you do plays a really important role even when imaging doesn't neatly line up with their symptoms. So in short, this study, over 500 patients imagine it showed more cervical MRI findings were actually associated with less severe headaches. And it's a super powerful reminder that we cannot rely on imaging alone to tell our story. So as we wrap today, I wanna highlight one of our partners, Leander Tables. Leander Tables is hooking you up with $1,000 off their series 950. Fantastic table, fantastic company. Check em out, get the discount just for being a listener of this podcast. And on that note, thank you so much for tuning in. Whether it's your first episode, whether it's your 509th episode, thank you so much for tuning in. Love it. If you take a moment and leave a rating or review that helps more and more people find this podcast massively important. Big shout out to everybody that has done so so far. And if you haven't, I will just make the subtle ask to please take a moment and do so. Other than that, I hope you have a fantastic week in practice and I will talk to you soon.

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