East Bay Headache Support Group
DECEMBER  1999 MEETING
TOPIC:  “CHIROPRACTIC CARE FOR HEADACHES”

The December 14th meeting of the East Bay Headache Support Group featured Bruce Presnick, D.C., who spoke to the group about chiropractic treatment for headaches.  The meeting was held in the Aspen I Room at John Muir Medical Center, with 20 people in attendance.  Dr. Presnick graduated from the Palmer College of Chiropractic and has had a private practice in Pleasant Hill with his wife, Laura, for the past twenty years.

Dr. Presnick began his talk by stating that chiropractors in general are a very inspired group—they feel strongly and are impassioned about helping people.  He was asked how he became interested in chiropractic, and answered that back in 1968 he wanted to improve on his own good health, and so took up yoga, and then meditation.  He also became a vegetarian and began eating health foods.  And he took up running for exercise, and tried acupuncture and massage therapy.  Then a massage therapist told him about chiropractic and the importance of nerve flow.  He learned how the spine and nervous system interrelate.  Basically, he found that chiropractic fit into his natural healthcare philosophy.

Dr. Presnick asked the group, “What is health?”  He told us that health is a balance of physical, spiritual, mental attributes.   He said one can have a health problem and still be in balance.  Health is also the absence of disease.  The definition of health from a medical dictionary is, “Health is an optimal state of physical, mental and social well-being.”  He added that this is not merely the absence of disease or infirmity.

He asked, “What do you have to do to achieve this optimal state?” and answered that you have to do things to keep it balanced.  Many of us go on until something breaks down, they go to the doctor, get it fixed, and then go on.  Generally, we don’t work at staying balanced (functioning optimally).

Dr. Presnick drew the Health --- Disease Continuum on the whiteboard and explained that health is a goal.  There is a process toward disease.  He put “dysfunction” and then “symptoms” on the continuum and said there is a process back towards health.  Be patient with yourself and your doctors as you go back towards health.  He said that something in the body can be dysfunctional for awhile before you experience symptoms.

Dr. Presnick said we must look at the structure of the spine for optimal state.  The chiropractor looks at the curves of the spine, and the muscles and balance of muscles.

He also looks at the alignment of the spine and its relationship to the nervous system and muscles.

Dr. Presnick made the statement that a body aligned properly moves through space using less energy than a body that is not aligned.  This is the concept of being physically balanced.  He stressed, “You should attempt to be aligned as optimally as possible throughout your whole life.”

A triangle was then drawn on the whiteboard showing the interrelationship between biochemical, mental, and physical aspects of health.

He said, “Your physical workout needs to be balanced—don’t do just token stretching prior to a workout.”

Besides manipulating spines, a big part of Dr. Presnick’s practice is to educate patients.  He always explains the biochemical, mental, and physical aspects to his patients.

Dr. Presnick said it is good to have a doctor/coach to help you with your headaches.  There are so many different aspects of headaches:  biochemical/mental/physical.  A chiropractic evaluation for structural alignment should be included in doing a workup for a headache sufferer.

He mentioned “ART,” or Active Release Technique.  And said that chiropractic isn’t only aligning the spine, it is also analyzing and working with the muscles to achieve balance between one side of the body and the other.

Dr. Presnick drew a picture on the whiteboard which included the “dura mater” (covering for the brain), and the “atlas vertebrae” (first cervical atlas), sub-occipital muscles, and then a new muscle discovered by two dentists.  This new muscle is located between the dura mater and sub-occipital muscles and it takes tension off the dura mater, which may help to relieve tension headaches.

He gave a case history of a patient who begrudgingly came in to see him for low back pain.  Then the patient asked for help with his headaches and Dr. Presnick said he was able to better his headache condition by 50%.  Dr. Presnick also told the support group that magnesium supplements helped this patient a little more.   He said that although medical physicians help many people with their headaches, so do chiropractic physicians help their headache patients.

Dr. Presnick concluded his talk with the statement that a multidisciplinary approach is important, and then he asked for questions from the audience.

Q. One audience member told Dr. Presnick that she has received the Palmer method of
    chiropractic (where there is audible crunching) and also the activator method.  She said she
    likes the Palmer method the best, and asked him about the two techniques.

 A.  Dr. Presnick said there are many different techniques used in chiropractic (he mentioned “57 Heinz variety”) and that they work differently for different people.  He said he will use seven to eight different techniques on a new patient who hasn’t seen a chiropractor before.  He starts out easy and then may work up to the audible technique.

 Q.  Another participant said she has bone spurs in her neck and goes to a neurological      chiropractor every other week, if a good week, or more often if she’s having a bad week.  She asked Dr. Presnick what she could do to stay more in alignment.

A.  Dr. Presnick said that it all comes back to balance.  He would look at the whole picture (relaxation, meditation, stretching, exercise).  Our goal is to decrease the need to be manipulated.  Dr. Presnick said that food allergies can even trigger muscle contraction.

Q.  Dr. Stein (co-founder and medical advisor to the East Bay Headache Support Group)                   asked why is it that the American Medical Association is so against chiropractic?

A.  Dr. Presnick answered that this is changing, but very slowly.  He has some medical doctors refer patients to him.  He said it’s partly chiropractic’s fault from the past: 

Chiropractic was discovered in 1895 in Davenport, IA.  Exaggerated claims of its healing powers were made, and chiropractors didn’t communicate well with the medical profession.  Then in 1910 the Flexner Report turned medical education around.

He went on to say that it is also partly organized medicine’s fault:  They wanted to be the only game in town—didn’t want competition.  They tried to get rid of homeopaths and naturopaths (which were more common than medical doctors in the early 1900’s). 

In the 1970’s chiropractic sued the American Medical Assocation, based on anti-trust laws.  The AMA was found guilty after eleven years. Dr. Presnick stated that chiropractic is a grass roots organization (from the patient up).

Q.  Dr. Presnick was asked if chiropractic helps everybody.

A.  “No.”

Q.  He was then asked, “How does manipulation work to relieve headaches?” and, “How many weeks does it take for results?”

A. Dr. Presnick has set up criteria.  He takes a complete history of the patient, and then does a trial period (four to eight weeks) of manipulation to see if there is a significant decrease (25-50%) in severity and/or frequency of the headaches.  Maybe something else needs to be tried, like ART (Active Release Techniques).  He made the statement that it is unfortunate that chiropractors and medical doctors don’t communicate.

Q.  What is the difference between having manipulation done by a physical therapist and a    chiropractor?

A.  Dr. Presnick answered that training and experience were the differences.  He said anybody can get your neck to pop, but it is important that it’s done with skill.  Virginia Paoli, Dr. Presnick’s assistant, added that people are becoming more educated and insurance companies are starting to recognize chiropractic as a legitimate treatment option.

Q.  Dr. Stein asked Dr. Presnick about the dangers of chiropractic.

A.  Dr. Presnick answered that nothing is absolutely safe, but chiropractic is very, very safe.  The main drawback from cervical manipulation is the possibility of triggering a cerebral vascular accident (CVA, or stroke).  He went on to say, however, that the worst odds of stroke being caused by cervical manipulation are one in one million.  And of this one accident in one million, some were done by a Doctor of Chiropractic, some were done by a Medical Doctor, or Physical Therapist, or Doctor of Osteopathy.

A careful screening of the patient is always done first: 

      1)   Case history
      2)   Physical exam
      3)   X-ray

Dr. Presnick said he needs to be careful in working with patients with spurring and arthritis in the neck.  He completed his answer by stating that, “The odds of side effects are much greater with drugs than with chiropractic.”

Q.  Dr. Stein asked Dr. Presnick if he had had any disasters in his chiropractic practice.

A.  Dr. Presnick answered that he and his wife have been in practice for twenty years and they haven’t had a disaster yet.  He did mention, though, that one time one of his patients experienced an epileptic seizure during a manipulation, which thoroughly scared the doctor and his staff, but the patient’s wife said it was no big deal, that her husband frequently had such seizures.  Dr. Presnick said we should look at his malpractice insurance—it’s only $1,700 per year.  If it’s so low, then there must not be many accidents.

Dr. Presnick added that medical doctors are protecting you so they don’t refer to chiropractors.

The intention of the East Bay Headache Support Group is to provide information and resources.  It does not provide medical advice, which should be obtained directly from a physician.