Moving to Higher Ground

How many times have you been subject to this medical pontification:

"Chiropractic can't possibly have any effect on headaches, it's simply anatomically impossible."

Even now, when the anatomical link is clearly presented in the 1998 edition of the Medical and Health Annual¹ (please see "Missing Anatomical Link Supports Chiropractic for Headaches" beginning on the front page of this issue), it will probably take another five years before most of the medical profession wakes up to the news.

The latest study published in the American Journal of Public Health² (please see the graph on the front page of this issue) clearly shows that on average over 68% of our patients come in for low-back pain. The discovery of a link between spinal musculature and spinal cord dura is a great opportunity for chiropractic to make an impact beyond low-back care. Among our chiropractic patients, only 2.3% come to us for headache relief.

True, the prevalence of low-back pain is quite high. Some studies suggest that during any given year "38% of adults reported a significant episode of low-back pain."³ But the prevalence of headache is also high. And according to another recent study, 15-20% of all recurrent headaches are cervicogenic.⁴ When you consider that approximately 16% of the population has a headache at any given moment,⁵ this translates to one out of every 32 people in your community has a headache that you can effectively treat.

If you know the population of your area, it's easy to calculate the number of headache patients you should have right now!

But there are two obstacles standing between you are those headache patients:

Credibility: Thus far, the chiropractic profession has not conducted a sufficient number of studies to demonstrate, with little doubt, that the chiropractic adjustment can be used to effectively address cervicogenic headache. The paper by Nilsson et al⁴ goes a long way towards making this point, but it appeared in a chiropractic research journal read predominantly by doctors of chiropractic. Credibility will only come when we have a larger, well-designed, randomized controlled trial published in a major medical journal.

Publicity: While the world marvels at the popularity of a drug for male impotence, we have an effective means of addressing up to 20% of the world's headaches, but are totally ignored. The difference is publicity.

Without credibility and publicity, DCs will continue seeing mostly low-back pain patients, and almost exclusively musculoskeletal. Current figures show that on average, all but three percent of chiropractic patients are for musculoskeletal ailments.² This is not a reflection of what you can do for your patients, it is a reflection of what your patients THINK you can do for them.

It's time to move from our beachhead of low-back pain onto the high ground of cervicogenic headache. A group of Maryland researchers lead by a dentist have opened the way for us. Now it's our job to take it for ourselves.

References

1. The anatomist's new tools. 1998 Medical and Health Annual, Encyclopedia Britannica, 1997.
2. Source: Hurwitz EL, Coulter ID, Adams AH, Genovese BJ, Shekelle PG. Use of chiropractic services from 1985 through 1991 in the U.S. and Canada. Am J Public Health, 1998;88:771-776.
3. Croft PR, Macfarlane GJ, Papageorgiou AC, Thomas E, Silman AJ. Outcome of low-back pain in general practice: a prospective study. BMJ 1998;316:1356-9.
4. Nilsson N, Christensen HW, Hartvigsen J. The effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther 1997; 20:326-30.
5. Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population: a prevalence study. J Clin Epidemiol 1991;44:1147-57.