Structural problems cause headaches: A case history

The obvious is only ob­vious when you look for it. With each passing year, I find that the more I look to the obvious, the faster my patients get well. I often feel like Dorothy in the Wizard of Oz: If only I had searched in my own backyard, I would have found the answer. In chiropractic school, we were taught palpation, the art of using our hands and our sense of sight to evaluate structural problems. For me, the confidence injust using my hands was a difficult concept to grasp. During the fust several years that I was in prac­tice, I referred patients for X-rays, MRTs, CAT scans, and every other imaginable test. After all. I rationalized, an MRI has to be better than my hands. What I have discovered since then is that, while ad­vanced diagnostic tests have their uses, your hands are the most powerful tools you have. What I hope to impart to you in this article is to look at the obvious first; use your hands, and have faith in YOUR diagnostic capabilities, not a machine's. Let me tell you, right here and now, nowhere else in the world can a patient get what we can offer in our chiropractic offices. Restoration of normal biome-chanics is paramount to any other cor­rective action we can do to help patients regain their health. To illustrate the im­portance of looking at the obvious, let's take a look at the case history of an 8-year-old boy, whom I will call "Tommy." Case History Tommy, complaining of chronic headaches, was brought into the office by his mother. The headaches were intense in nature and were coming at a frequency of 3-4 times per week, hav­ing begun just after Christ­mas. Nausea and, some­times, vomiting accompa­nied the headaches. There was no prodrome noted, and there was no history of trauma. The pain would start in the suboccipital re­gion and then radiate into the eyes. The pain would be a pressured, squeezing feel­ing, followed by a deep throbbing pain. His past history was, essentially, non-contributory. Tommy had been taken first to his pe­diatrician, who prescribed a course of ac­etaminophen. When this did not help, the pediatrician prescribed children's ibuprofen. The ibuprofen gave him mild relief, but Tommy's mother was interested in finding the cause of the problem, so she then took Tommy to a pediatric neu­rologist. The neurologist ran a CAT scan of his brain, as well as an MRI. Both tests re­vealed normal results. A complete blood count (CBC), Chem-20 and urinalysis were also run—all came back normal. The neu­rologist diagnosed Migraine Syndrome and put Tommy on naproxen. The head­aches became transitory in nature, but Tommy began to experience stomach pains, so the neurologist advised discon­tinuing the naproxen and going back to the ibuprofen. Frustrated, the mother came to my office, because she had heard from a friend that I have treated head­aches very successfully. I took down a complete case history. There were two points that stuck out: 1. Tommy's past history revealed he had had colic as a newborn, digestive prob­lems that existed to this day, and that he moved his bowels every 2-3 days; and 2. Tommy had fractured his right ankle. which had required surgical interven­tion. When the mother was further ques­tioned about Tommy's bowel habits, she stated that the pediatrician told her that bowel movements every 2-3 days was "normal for her son" and she should not worry about it. She described his diges­tive complaints as frequent bouts of gas and abdominal pains after eating. She was unable to pinpoint what foods caused him distress, but she noted that the complaints were worsening. I asked the mother if physical therapy, orthotics, or strengthening exercises had been per­formed on the ankle after surgery and cast­ing. The answer was, "No." Physical Exam Findings Preprandial: The standing postural exam revealed a right head tilt with the right side being high. A low right hip was present. The right arch was fallen. The seated exam revealed a hemipelvis on the left. Cervical right rotation was restricted at 65/80. All DTR's were grade 2 and symmetrical. Foraminal compres­sion, Jackson's compression and maxi­mum cervical compression were all nega­tive. His blood pressure was 110/75. There were palpable trigger points in the right Trapezius muscle and the right sub-occipital muscles. The supine exam re­vealed internal rotation fixation of the right foot, right foot eversion, muscle contraction of the masseter muscle on the right, the left costal arch, and the inguinal region. George's test for vertebrobasilar insufficiency was negative. Tommy was then fed a powdered drink consisting of adequate amounts of pro­tein, carbohydrate, fiber, and fat. The in­tention was to make demands on his di­gestive system in order to evaluate what he could and could not digest. Forty-five minutes after Tommy drank the "meal," I re-examined him so that I could compare pre- and postprandial results. Postprandial: Results revealed no head tilt, low right hip, and fallen right arch. Cervical rotation was 65/80, and trig­ger points were still present in Trapezius" muscle and suboccipital muscles on the right. Also noted was internal rotation tlxation ol the right foot, right foot ever-sion, muscle contraction ofthe masseter muscle on the right, suboccipital muscles on the right, the left costal arch, and the inguinal region. George's Test for vertebrobasilar insufficiency was still negative. Subluxation was palpated at C1, T6-T8 on the left, the right sacroiliac joint, and the right ankle. Results on Tommy's 24-hour urinaly-sis were obtained and revealed that he did not digest simple carbohydrate and that he was deficient in calcium. Treatment I adjusted the right foot and taped the arch with athletic tape. I also fitted Tommy for a size "C" ischial lift to place under his left Gluteus muscle whenever he sat down. I advised him to eat a diet that was low in carbohydrate and rich in lean pro­tein. I also advised him to take an en­zyme supplement to aid in the digestion of his carbohydrates, and another supple­ment rich in calcium and synergists to restore nutritional homeostasis. I ad­justed the subluxations I had found us­ing an osseous diversified technique, then advised him to take his supplements, eat lunch, and return after lunch. After lunch, the exam revealed no hemipclvis when he was sitting on the lift, and there was normal foot flair of 45 degrees, with no eversion of the right foot. The trigger points were no longer active, but latent, and were elicited only upon applying deep pressure. The muscle contraction ofthe left costal arch, inguinal region and sub-occipital region were gone. Cervical range of motion in right rotation was now normal at 80/80. Tommy was discharged for the day and advised to return 2 days later. He was advised to wear the tape as long as he could, but if he had to remove it or if it fell off, to make a note if his symptoms changed. The morning of the day Tommy was to return to the office, the tape fell off in the shower. Until then, he had been head­ache-free and he had noticed that his neck felt different, that it hadn't been as tight. However, within an hour of the tape com-j ing off, he had tightness in his neck, and two hours later, he had a headache. He was given some ibuprofen and the head­ache abated. Upon re-examination, there existed right foot eversion and subluxations of the right ankle, C1, T6 and the right sacroiliac joint. Cervical rota­tion was restricted at 65/80 and, this time, he noted pain. I adjusted those areas and re-taped the arch. Cervical rotation was normalized at 80/80 and was pain-free. The tape stayed on for the following 2 days, and Tommy was headache-free once again. As soon as I took the tape off, the right hip be­came low, palpable trigger points returned, the right inguinal ligament was contracted and the foot returned to eversion. I fit the child for orthotics and Tommy has been stable ever since. Discussion This is chiropractic in its purist form. Yes, structural problems can and do cause headaches. The mechanism of Tommy's problem, from my assessment, was that he had sustained an injury to the right ankle. The medical doctor did his job of "piecing" Tommy back together, but he failed to take into account that the body would need to be checked for aberration of biomechanical function due to his in­jury or the surgery performed. The faulty ankle mechanics caused subluxation in the ankle proper that impaired Tommy's gait. The aberration of gait caused sublux­ation of the sacroiliac joint. The sacro­iliac joint is one of the largest joints in the body. In order for Tommy to maintain homeostasis against gravity, his body was sucking up calcium much faster than he was replenishing it. Once the body be­comes depleted of calcium, the inguinal ligaments go into contraction and have a very difficult time keeping the pelvis level against gravity. This prolonged stress caused a hemipelvis that the body could not compensate for. Because these muscles are interconnected and because the attachment of the spinal muscles is in the suboccipital region, Tommy experi­enced constant pressure which caused subluxation of Cl, thereby manifesting the symptom of headaches. Always look at the entire biomechani-cal presentation of the patient. I am con­fident in stating that, if I had only ad­justed him without supporting the feet or pelvis, he would never have gotten bet­ter. If I had just given him nutritional sup­port, he would not have gotten well ei­ther. I anticipate that, over time, he will no longer need the ischial pad. because his muscles, I am hopeful, will be strength­ened enough to do their job without extra support. Additionally, it is vitally important to look at the patient's diet to evaluate how much nutritional stress is being placed upon the body. This child had consumed large quantities of carbohydrate, which he was unable to digest. Eating too much carbohydrate forces the body to use up phosphorus in order to digest the carbo­hydrate. Remember that calcium and phosphorus must be in a constant ratio of 2.5 calcium to phosphorus. So, as the body is using up its phosphorus to me­tabolize the carbohydrate, the calcium is being dropped to the urine to maintain that ratio. This is why he was deficient in calcium on the 24-hour urinalysis—not because he was not getting enough, but rather, he was eating too much sugar, which caused the calcium to be passed to the urine. Since calcium is a vital min­eral fora healthy musculoskeletal system, this process should be recognized. My last point is, where in the world can anyone get this kind of health care, the kind that restores health safely and natu­rally without drugs and their potential side effects? That's right, in a chiropractor's office. The solution for health is not in a bottle of pain medica­tion. Look at the obvious and watch your practice grow with satisfied healthy pa­tients. Dr. Paul S. Insehnan has been in pri­vate practice since I9H6 and is located in Coimmick and Mineola, New York. He can be reached by calling 631-462-0801, or you may visit him on the web at wwn:.dri]iselwan.cxmi.