Stephen Milligan, DC, BCAO, is a chiropractor in San Ramon who specializes in treating patients with the Atlas Orthogonal Chiropractic Technique. We asked Dr. Milligan to speak to the headache support group about this technique and explain how it can relieve head and neck pain.

According to Dr. Milligan, “AO” works well to reduce pressure on the second cervical nerve root, the brain stem, and the occipital artery, vein and nerve.

Dr. Milligan graduated from Life West Chiropractic College in 1995, and then earned post graduate board certification in Atlas Orthogonal Upper Cervical Chiropractic from Sherman Chiropractic College. Besides being one of a very few board certified chiropractors worldwide in the Atlas Orthogonal Technique, Dr. Milligan is also a certified instructor in “AO.”

But what is Atlas Orthogonal Chiropractic Technique? In reviewing Dr. Milligan’s Web site, www.drmilligan.com, and another he recommended, www.beyondheadaches.com, I learned that the Atlas Orthogonist is a doctor in the field of chiropractic with training in the structure, function and bio-mechanics of the upper cervical spine (neck). The spinal vertebrae, if out of proper alignment (known as subluxation), are often the underlying cause of pain. The Atlas Orthogonist utilizes a stationary “AO” percussion adjusting instrument to adjust the cervical spine. The technique is described as being a painless procedure that gently adjusts the cervical vertebrae back toward normal alignment, thus helping the entire body.

Dr. Milligan’s presentation will be in the Ball Auditorium, downstairs at John Muir Medical Center, from 7:30 to 9:00 p.m. on Tuesday, November 12. For more information, call 925-228-1084. Come with your questions!

Cervicogenic headache is headache associated with nerve, muscle or bony structures of the neck (including the cervical spine) or the back of the head (the occipital region). It is diagnosed when there is pain localized to the neck and occipital region, which may project to the forehead, eyes, temples, top of the head, or ears. Pain is triggered or aggravated by specific neck movements or sustained neck posture. At least one of the following are present: (1) resistance to or limitation of passive neck movements; (2) changes in neck muscles, contour, texture, tone, or response to active and passive stretching and contraction; (3) abnormal tenderness of neck muscles. Neck discomfort alone is not diagnostic, since the neck may be painful during migraine or tension-type headache. X-rays may help identify specific underlying problems, such as abnormal neck posture or movement, fractures, bone tumors, or rheumatoid arthritis. Cervicogenic headache may result from trauma such as motor vehicle accidents, chronic postural irregularities, as well as normal aging, the latter due to arthritic changes in the neck.

The term cervicogenic headache was coined some 20 years ago, but the idea that headache may be caused by disease of the cervical spine dates way back to the 1800s. The idea of head-ache related to the cervical spine remains somewhat controversial among many physicians. More controversial yet is the possible role of neck abnormalities in other headaches such as migraine. There have been a number of theories proposed as to how cervical spine disorders and/or dysfunction can cause headache. Cervicogenic head-ache may occur due to irritation or stimulation of pain-sensitive structures in the neck adjacent to nerve pathways that run from the cervical spine to the head. The pain thus originates in the neck but is referred along the nerve pathways to the head.

Manual therapy is typically utilized to treat myofascial restrictions (abnormalities in muscle and its associated connective tissue) as well as joint dysfunctions. Muscle energy techniques (manipulation without thrust) can be quite beneficial in treating joint dysfunctions of the cervical spine, additionally providing the benefit of being less traumatic to the patient and less risky than thrust manipulation. Thrust manipulation, when performed correctly, generally is a safe technique and is used by chiropractors and appropriately trained physicians.

Post-isometric muscle relaxation (PIMR) is very useful for treatment of shortened muscles and can be used to treat myofascial pain as well. Treatment involves active isometric contraction against the comfortable stretch barrier for a few seconds, followed by stretching of the muscle to its new barrier, and then repeating the process till full or optimal range of motion is achieved. PIMR is an excellent technique that can be taught to patients for self-treatment.

Occipital nerve block may be helpful when there is irritation and dysfunction in specific branches of the occipital nerve on one or both sides of the neck. The occipital nerve provides sensation to the scalp in the back of the head. The nerve root found at the juncture of the head and neck will occasionally be damaged by direct trauma or entrapped in structures of the upper neck following whiplash type injuries. When irritation is more severe, shooting or stabbing pain can be referred to the same side of the head behind the eye or in the forehead. A nerve block is performed by carefully injecting a local anesthetic, or anesthetic in conjunction with a corticosteroid, for diagnostic and treatment purposes, respectively.

Occipital rhizotomy is a more invasive procedure that generally is not necessary except in cases of treatment-resistant occipital nerve pain. It may be performed either surgically or with a cryoprobe (a technique involving freezing of the nerve).

C2-C3 facet joint blockade is a procedure that is typically done by an interventional pain management specialist, either an anesthesiologist or a physiatrist or other appropriately trained clinician. The facet joint at a specific segment of the cervical spine (C2-C3) seems to be particularly vulnerable to neck trauma. The blockade is done using x-ray fluoroscopy with injection of local anesthetic.

Cervical epidural steroid injections are also performed by interventional pain management specialists. They may be considered when the pain is unresponsive to conservative treatment but is believed to be responsive to steroids. Studies have confirmed the safety of this technique with symptomatic relief of a variety of painful conditions in the cervical spine.

Cervical traction applies a stretch to muscles, ligaments, and tissue components of the cervical spine. It may provide relief by promoting separation of the space between the vertebrae which contains the disc and may thereby reduce a disc “bulge” or nerve impingement. Cervical traction is not indicated for use in conditions of cervical instability. Traction is optimal when the patient’s neck is placed at 20-30 degrees of flexion (forward tilt).

More invasive interventions requiring true surgical intervention include surgical fusion of the joints at the juncture of the head and neck in patients with arthritis producing cervicogenic headache.

The East Bay Headache Support Group is a nonprofit organization dependent on both monetary donations and volunteer labor. A small group of volunteers organizes the meetings and publishes this newsletter, and our speakers volunteer their time and expertise.

Dr. Michael Stein is a neurologist in Walnut Creek who specializes in the treatment of headaches. In addition to his private practice and his volunteer duties as medical advisor to the East Bay Headache Support Group, Dr. Stein is also conducting research studies on headaches. He is currently seeking participants for two studies, as follows:

One study is on treating “migrainous headaches” using Imitrex. In order to qualify you must be 18 to 65 years old, have 1-6 moderate or severe headaches per month for the last 6 months, have at least a one-year history of headaches that interfere with the ability to work or enjoy life, and have never been diagnosed with migraine.

The other is a study using a nasal spray formulation of an already available headache medicine. To qualify for this study you must have at least 2 but not more than 6 migraine headaches per month. You must also not have any abnormalities of the nasal passages, nor have a history of uncontrolled hypertension, heart disease or stroke. You also must be 18 to 65 years old.