Dr. Kevin Leach:  11 migraine patients diagnosed by their medical neurologist received NUCCA Chiropractic Care and while secondary outcomes like less pain and a decrease in headache days was observed, there were mixed results with the primary outcome measure. Dr. Evans and I discuss the research and more on this episode of the Upper Cervical Chiropractic research show. Hi there, I’m Dr Kevin Leach here with the Chiropractic Deep Dive Podcast bringing you the most important research and information on conservative primary spine care, upper cervical chiropractic care, and traditional chiropractic care. These research reviews interviews and episodes are made for you whether you’re a medical doctor, patient, or concerned family member or friend. The goal of these shows is to bring awareness of the importance of taking care of our spine and the impact it has on our health and the hundreds of different health conditions it could cause without us realizing it. I’m really trying to bring value with these so I’d appreciate commenting on the videos, hitting the like button, and sharing them with as many people as you can. You never know who might need to see it. And consider subscribing to the channel so you can see all the other episodes and videos coming out. Thank you so so much, I truly appreciate your support. Now onto the show. Okay, Welcome back everyone to the Upper Cervical Chiropractic Research Show this is Episode 14. I’m Dr. Kevin Leach and I’m here once again with my good friend and colleague Dr Tyler Evans, how are you sir? 

Dr. Tyler Evans:  Good to see you. 

Dr. Leach:  Good to see you my friend. All right so this episode’s research review is titled “Effects of Atlas Vertebra Realignment in Subjects with Migraine: An Observational Pilot Study” by H. Charles Woodfield III, D. Gordon Hasick, Werner J. Becker, Marianne S. Rose & James. N. Scott published in Biomed Research International. This is open source so anybody can find it and anybody can read it. Before we go deep into it let me just give the 50,000 ft review of the paper just to kind of give a little overview and then we’ll get into it a little bit more. This study followed 11 patients diagnosed with migraine by their medical neurologist. The patients underwent NUCCA specific upper cervical chiropractic care with follow-up at four and eight weeks. The study was designed after findings from a case study showed decrease in headache symptoms and improvement in ICCI, which is intracranial compliance index, to see if the case study would be repeatable. Migraine specific outcome measures were used to measure patients improvement and the study showed and the study found statistical improvement, statistically significant improvement, with secondary outcome measures which were the symptoms of the migraine and market improvement in quality of life due to decrease in headache days. They did not however find a statistically significant improvement in overall primary outcome measurement of ICCI and that will be most of the discussion that we do probably today. So let’s start with the positive of the paper and talk briefly about the improvement of the secondary measurements which was improvements in the migraine symptoms. This is not new to me or to you Dr. Evans. In upper cervical offices we see a lot of headaches and a lot of migraine stuff improve but it is good to see that we have some research just showing that there’s good secondary outcome measures with these. Which again, we’ll get the word out more so we can help more people. Any thoughts on that Dr. Evans as far as in your practice, headaches/migraine, or other research? 

Dr. Evans:  Yeah. Generally when I’m in my networking circles I always try to stick to one thing that I talk about and as a chiropractor people think chiropractor – low back or neck pain. But in the upper cervical world I think that the upper cervical profession is – if we’re going to pick something that we can work on and do it well I believe that migraine headaches and headaches are a niche in the upper cervical world that a lot of people can get a lot of benefit from. So that’s something I talk about a lot and work on with a lot of different people from just little headaches to migraine headaches that have happened from a child at 4 all the way up to 60, 70, or 80 years old. It’s definitely a big part of our practice and we see a lot of great results with that and I know you do too. 

Dr. Leach:  Absolutely. Cool. All right, let’s go on to the more interesting finding. I imagine they did this obviously because they saw the case study improved with the ICCI the intracranial compliance but they found that there wasn’t a statistical improvement with that. They saw some improved, some got slightly worse, and some didn’t change at all. Before we go into this let’s talk a little bit, if you would, briefly on what is intracranial compliance. What does that mean and also why a misalignment in the upper neck would affect this and obviously why wouldn’t it be good to have a decreased intracranial compliance. 

Dr. Evans: Yeah. What I’ll just kind of preface with is in the paper in the third paragraph it says intracranial compliance, ICCI, appears to be a more sensitive assessment of changes made in craniospinal biomechanical properties in symptomatic patients than the local hydrodynamic parameters of CSF flow velocities and core displacement measurements. What that means is that in the past and we’ve actually done I think most of the studies by the upright MRI groups, Dr. Scott Rosa and Dr. Ray Damadian, because that’s amazing stuff and that all came out kind of at the turn of the millennium 2000 and on to about 2010. I know we’ve reviewed most of those papers so you guys can go back and look at those if you like them or if you’d like to. The reason we did that is because those were ground-breaking studies in this new world of fluid flow in and out of the brain. If we are talking about chiropractic historically we talked about nervous system, nervous system, nervous system, nervous system, bone pushing on nerve – cutting off nerve flow – causes problems because the brain can’t communicate the messages from the body from the brain to the body and then body back to the brain. What this new direction has kind of enlightened upon is that we’re not just talking about bone on nerve. We’re talking about literal cutting off or slowly cutting down or you sometimes literally choking off some of the fluid flow in and out of the brain, which is brain health. So when I get up every morning when I go to work every day, I’m sure this is the same with you, but I’m very passionate about what I do because I know that it changes the entire body’s function and physiology via brain health. So this is just another way that they’re trying to get to the bottom of what we’re doing in chiropractic. Dr. Rosa and Dr. Damadian they were talking about CSF flow and then they started to get into blood flow in and out of the skull. But this is talking about a little different take on that where we’re just not measuring CSF or blood flow we’re actually measuring compliance. Which is the ability of the tissue to absorb those changes in fluid flow in and out of the brain and the skull is a pressure cooker. It really is and these are things that I’ve taken from Dr. Rosa’s work and Dr. Damadian’s work is that it’s timed and pressurized perfectly to the blood coming in the cerebrospinal fluid coming in and then that cerebrospinal fluid getting pushed out and going down into the spinal cord and then back up through the venous system. The same thing with the blood and this balance, this ballet, is going on all the time which keeps us upright, breathing, digesting and functioning all day long but we never think about it. So it’s just a beautiful system, this is a little more nuanced way of measuring brain changes with compliance rather than just cerebrospinal fluid flow in and out of the brain or arterial blood flow in and out of the brain. So anyway, long story short, intracranial compliance represents the change in volume per unit change in pressure and is exactly the inverse of elastance – in other words ICCI determines the ability of the intracranial compartment to accommodate an increase in volume without a large increase in intracranial pressure. So meaning the fluid can come in and it doesn’t change the shape/form or it doesn’t change the function of the tissue in the skull. We might have a rush of blood because we either see a tiger chasing us from behind and we have sympathetic burst or what have you but your body’s more able to adapt and that’s what chiropractic does. That’s what we’re doing in chiropractic is we’re trying to help the body adapt better. So anyway, long story short, that’s where we’re going with this. We want to see intracranial compliance increase and clearly we didn’t get exactly what we were looking for in this paper but we’re going to discuss that a little bit more. 

Dr. Leach:  Well exactly. What are your thoughts? Some improved. Some didn’t. The case study did. Some didn’t change. I have my thoughts on why, we can see kind of through the spectrum here but what are your thoughts on just what happened and why they got these results? 

Dr. Evans:  Yeah. Clearly if there’s a misalignment at C1/C2 underneath the skull it’s going to change that fluid flow in and out of the skull. It’s going to change that ability of the skull to be able to adapt and if there’s a misalignment and we correct it we’re going to see a good change. If there’s not a misalign or if there were misalignments but if the misalignment wasn’t affecting the compliance initially then you’re not going to see a change in compliance. Maybe in some cases too, most of these people if they have migraine headaches – I can tell you if I took 5 of my migraine patients when they first came in they were probably on blood pressure medication and abortive medication for their migraine. Meaning I think it’s either topamax or imitrex, a preventative which is topamax or imitrex, or one of the type gabapentin, all the amitriptyline, and all these other medications that change brain physiology. Right? So we’re talking about a lot of variables here especially if somebody’s putting chemicals in their body that it changes brain function. So that would be my take on it. If things change in the neck and you’ve got more fluid coming up and then the brain tissue isn’t elastic enough to absorb that change. That may be either a problem that already existed or something that’s being exacerbated by medication that now we’ve changed one of the root causes and you’re still on that medication. Right? So anyway. Those are my thoughts. What do you think?

Dr. Leach:  Yeah. I think that’s a really important point to just emphasize that the upper cervical treatment, the upper cervical correction, to restore biomechanical function, CSF blood flow, etc. It’s not a treatment to increase ICCI. Right? That’s not the end goal. Just because we didn’t see that happen it doesn’t mean “Oh it didn’t work,” because I don’t think that that’s what their goal was but they just made the assumption that higher ICCI, higher compliance, is healthier so they were thinking if they had these misalignments then maybe it was affecting the ICCI and thus improving the biomechanical alignment function that those would improve. However, again if that misalignment only had a neurological effect and that’s why it helped with symptoms of the migraine but it didn’t increase intracranial compliance, like you just said, it probably wasn’t affecting the intracranial compliance. The intracranial compliance could have been low due to some other factor. Maybe the tissues weren’t as elastic, like you said, they weren’t as elastic as they should have been or other medications that could have been affecting that. I think it’s important to understand and this is why we do research. We do research not to just prove “Oh. Hey, this is it,” but it’s to answer questions and to ask questions and to do further research in the future. I wouldn’t see this as a failure whatsoever. I see this as an eye opening, “Hey. Okay, this is information. What can we do now?” I know they said also that just with the MRI acquisition and again even with medications there’s a lot of variables involved in this. They didn’t do a controlled study just because of the financial stuff or whatever because these were not the NIH with multi-million dollars to just kind of do research on. Anything else in regards to just those findings for the ICCI? Any other touch points as far as the research here? 

Dr. Evans:  I think that’s, without going crazy on it, I think that’s probably the high points.

Dr. Leach:  Pretty good high points. Cool. All right. Well there’s a ton more information and they did an amazing job on this paper. It’ll be interesting to see once we put this on maybe the NUCCA facebook page to see what kind of feedback we get as far as, “Hey, you should have said this.” or “Hey that’s not true.” 

Dr. Evans:  This is a high level study right. So something we didn’t say is Chuck Woodfield is the first name on the paper. So usually the first name on the paper is the heaviest researcher and then Gordon Hasick. I don’t know how long he’s been in practice but I know he’s done a ton of research and he’s been in practice for a while. I don’t know the other three docs on there but I can vouch Chuck Woodfield’s probably the greatest researcher that we’ve had for a long time in the upper cervical community. Gordon Hasick is probably one of the better docs too and this goes in a lineage of papers that the NUCCA organization has produced with Dr. Dickholtz. So this was done in 2015. This was released in 2015 I believe and Dickholtz’s backers study came out in 2007 or 2008 and this is just a jump off from… What’s that? 

Dr. Leach:  The blood pressure study. 

Dr. Evans:  Yeah, the blood pressure study. Sorry. The Dr. Dickholtz’s blood pressure study. This is trying to take that to another level and the statistical analysis in this paper is fantastic. You know when you shine a light or you look at a puddle of water with a microscope you see things that you may have never thought you would see and so this is a great paper. It just goes to show that yes, migraine headaches do respond to upper cervical chiropractic care. Intracranial compliance did increase in some people, some people it didn’t change, and some people it went down but that’s a who knows why. 

Dr. Leach:  Right. But that’s a good question of “Why?.” It’s a really good question because the takeaway for me is that it affected it and it could potentially affect it. 

Dr. Evans:  Right.

Dr. Leach:  Which is huge. Right it’s absolutely huge being a factor in something that can affect it. The idea is if it can affect it how can we best utilize upper cervical care as it means to optimize ICCI while potentially looking at other factors that could be affecting ICCI in any given patient. 

Dr. Evans:  Right. We’re talking about brain function. This is big stuff. So again this is another study that puts chiropractic on the map for things other than neck pain and back pain. That’s a good thing. 

Dr. Leach:  Absolutely. I might try to reach out to Woodfield to see if he’ll do a podcast and just give us the background or give us some other information on the study and his thoughts and whatnot on the study. I think that would be cool to get him on here. 

Dr. Evans:  Oh yeah. 

Dr. Leach:  Interesting guy. 

Dr. Evans:  That’d be cool learned a lot from that gentleman over the years he’s a wealth of knowledge.

Dr. Leach:  Yes. Cool. All right. Anything else before we end? 

Dr. Evans:  No, I think that’s it man.

Dr. Leach:  Awesome all right well good to see you again and we’ll see you on the next one

Dr. Evans:  Okay, take care. 

Dr. Leach:  Yep. Thanks. Okay, that’s it for this episode. So what did you learn that fascinated you or surprised you about the research today? Join or start the conversation in the comments below. Hey, thanks so much for watching. To watch more of our research shows click or tap the screen right there(on the video) to subscribe to the channel click or tap the screen right there(on the video). Until next time, I’m Dr. Kevin Leach with The Upper Cervical Chiropractic Research Show bringing awareness to conservative primary spine care, upper cervical chiropractic care, and traditional chiropractic. Until next time, take care and take care of your spine. It’s the only one you’ll ever have.

 

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