Headaches After the Adjustment: Clinical Pearls

In my experience, although rare, sometimes patients complain of headaches after cervical adjustment. I have found several reasons for this and would like to share a few of these clinical pearls:

1. Too aggressive force or technique applied for that patient. Not that the doctor did anything wrong, just beyond that patient’s tolerance.
2. Pro-inflammatory chemistry of patient or just a lot of inflammation released with adjustment.
3. Patient dehydration.
4. Alar ligament laxity.
5. Connective-tissue disorders such as Ehlers-Danlos syndrome, but can be lower on the spectrum and undiagnosed by classic criteria.
6. Undiagnosed counterrotation of vertebra above or below segment adjusted. Often see this at C0-1, C1-2 or C1-3. Sometimes fixing one makes the other tighter. Also, sometimes it matters which order they are released, similar to locknuts, but I have yet to determine a way of differentiating the order other than trial and error by feel for the tightest or lower segment first. Sometimes it’s the top one.
7. Rebound fixation of segment above or below segment adjusted. Same levels as listed above are often involved. See this in situations in which there is a lot of bilateral spasm in area or compensating spasm on opposite side adjusted. This pulls the involved segment or one above or below into fixation in opposite direction after the primary fixation is released.
8. Rebound spasm. Similar to above, but only the compensating opposing muscle spasms and does not actually fixate attached segment, but does cause tension headache.
9. C2 fixated in extension, rather than rotation. Often palpates as body left. Common in cases involving dizziness.
10. Occiput fixation not found and adjusted.
11. Sacral fixation not found and corrected, especially sacral base anterior or posterior.
12. Undiagnosed or untreated trigger points.
13. Stress or other emotional underlying component.
14. Learned behavior linked to neural circuit pain.
15. Other things you may know and could teach me, or I cannot recall at the moment.

The above came from a discussion with a chiropractic intern and medical resident shadowing me at our FQHC. I love situations in which DC and medical residents/interns/students get to share and explore together. I hope you find this useful.