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TREATING HEADACHE WITHOUT DRUGS: THE FORMAL RELAXATION METHODS
Include meditation, yoga, and biofeedback. Meditation is a means of achieving relaxation by the repetition of specially chosen words during two twenty-minute sessions each day. Meditations may afford both biological as well as emotional benefits for those who practice the technique regularly, although the therapeutic impact of meditation is not yet fully understood.
Biofeedback training is a means of teaching you to develop a conscious control over various automatic body functions. The tightness of your neck muscles or even the temperature of your fingers can be altered through control over your body. A variety of devices can be used to help you achieve this control, and the proponents of biofeedback training assert that many disorders, including muscle contraction headaches and migraine headaches, can be relieved with the regular use of biofeedback. Evidence is rapidly accumulating that biofeedback, when taught by
competent professionals and used regularly by the patient, may have an impressive impact on many headache sufferers. We advocate its use for selected headache patients. It is our opinion, however, that biofeedback itself should be only a component of a broader therapy program. What appears most important is the scope of the program in which behavior, expression of anger, identification of stress-producing mechanisms, and other related issues are confronted. Simply being put into a room with a machine and being told to “do it yourself” is, in our opinion, an inappropriate way to administer the therapy. When used in conjunction with other therapeutic techniques, biofeedback can be helpful with some patients. Recently the American Association for the Study of Headaches recommended biofeedback as an effective method of treating headaches in appropriate cases.
Acupuncture continues to be a controversial form of therapy, and the many unsubstantiated claims of cures must be greeted with skepticism. Acupuncture is the insertion of special needles into specific predetermined areas of the body. Many of these acupuncture locations have been determined by ancient Chinese medical teachings. There are many theories that attempt to explain how acupuncture relieves pain in some individuals, and final judgment regarding acupuncture’s effectiveness must be reserved until well-controlled studies convincingly demonstrate its benefit beyond the placebo response. As mentioned earlier, preliminary data suggest that acupuncture’s temporary effect may be related to increased levels of endorphins.
Biofeedback and acupuncture seem innocent since they do not carry with them detrimental side effects. But consumer naivete, together with premature and unsubstantiated claims, has created a good deal of exploitation in the field of headache cures. Objective scientific investigation must be carried out before reliable conclusions can be made. It should be of great concern that these new and “revolutionary” therapies are sometimes performed by practitioners who are unqualified. Generally, we advise against using any method except under the supervision of qualified professional personnel.
Many of our headache patients who are joggers suggest that a headache can be aborted by jogging. Some even suggest that they have suffered far fewer headaches since taking up a regular exercise program. Some psychiatrists and psychologists believe that exercise such as this may also play a beneficial role in the treatment of anxiety and depression, as well as other emotional problems. These possible benefits could represent merely placebo responses, and a firm conclusion must await more scientifically designed means of evaluation. However, it is our belief that regular exercise such as jogging, lasting 15 to 20 minutes a day, four times a week, for patients whose doctors say they are physically fit, may be helpful to both mind and body.
The discussion of treatment must address the subject of chiropractic therapies because many people with headaches have tried these in their desperate search for relief of painful symptoms. As neurologists, we feel that we have a responsibility to offer you an opinion on this subject, because the basic theory of the chiropractic approach is that all or most diseases arise because of compression on nerve structures.
We do not believe that chiropractic theory and practice have any convincing basis in modern scientific knowledge. It appears to us that chiropractors ignore the scientific evidence accumulated during years of legitimate medical research. In our opinion, they are not adequately trained to diagnose or treat many of the medical disorders for which often desperate patients seek their help.
The chiropractic theory is based on a belief that disease is due to a displacement (subluxation) of vertebrae. This, chiropractors claim, results in abnormalities of nerve function. Diseases are a consequence. We know of no scientific evidence suggesting that cancer, heart disease, lung disease, or most other disease entities, including most cases of pain about the head, have any convincing or consistent relationship to displaced vertebrae or compressed nerves. With rare exceptions, the X rays of patients diagnosed by chiropractors as showing displaced vertebrae as the cause of their symptoms have, upon review, failed to reveal significant abnormalities.
Chiropractors frequently show patients their X rays, suggesting that certain bones of the spinal column are misaligned. In fact, patients frequently report that they could see that the vertebrae were not in perfect alignment. However, the backbones are not normally in perfect alignment. The curvature of the spine is nature’s way of giving adequate flexibility and support to the vertebral column. One clear example is the “bump” that you can feel in the lower center of your neck. This bump is actually a part of the seventh neck (cervical) vertebra, which is normally “displaced” backwards a few millimeters. This is the normal position for this vertebra. On X ray, the untrained eye would consider this vertebra misaligned or subluxated. Furthermore, the relative position of the vertebrae may change as the position of the head and neck change. In essence, this means that a highly skilled professional is required to accurately interpret X rays in order to determine whether the vertebrae are truly in proper location. Subluxation of vertebrae is a rare phenomenon in medical practice, and if present can pose a serious medical risk. We believe that physicians, such as radiologists, whose careers and training are focused upon interpretation of X-ray abnormalities, are required for accurate assessment of these conditions.
Chiropractors perform their therapeutic intervention by manipulating the spine. A concern of many medical doctors is the potential hazard incurred by this manipulative technique. The spinal cord runs down the center of the backbone and its delicate nerves emerge from between the vertebrae. The spinal cord itself has approximately the same circumference as a carrot, and is extraordinarily fragile. Nature designed the back to be rigid in order to protect fragile nerve tissue from damage that can be expected from excessive movement of the vertebrae. The back muscles participate in the support as do the tendons, which are designed to hold the vertebrae in close approximation. Any effort, beyond simple exercise, massage, or traction, that stretches, twists, or otherwise unnaturally imposes strain on this important system must in our opinion be considered potentially hazardous.
Additionally, it is our opinion that chiropractors are not trained to diagnose the many medical symptoms for which people often seek their help. It is of great concern to us that any delay in establishing an accurate diagnosis of serious and possibly life-threatening conditions for even a few weeks can prove fatal.
Finally, we recognize that many patients, particularly those with muscle spasm as part of their headache problem, do benefit from any measure that relieves spasm; a firm, gentle massage of neck muscles or traction will do this. But chiropractic treatment frequently goes beyond this, and we cannot recommend it.
Your trust and respect must be earned, not only through competence but also by the manner in which your physician relates to you. Your doctor must be willing to try to relieve your discomfort by the most effective and safest means possible. For your part, you must recognize that human illnesses, particularly pain, are very difficult to treat, and trying to do so safely is a time-consuming and sometimes frustrating challenge. If your doctor is committed to helping you and does so in a medically qualified way, you must be as patient with your physician as he or she must be with you. Patience, trust, and respect must be mutually earned and extended.
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