Migraine headache

A.D.A.M. Editorial Team

Introduction:

Migraines are severely painful, recurrent headaches that are sometimes accompanied by other symptoms such as visual disturbances (aura) or nausea. There are two types of migraine – migraine with aura (formerly called common migraines) and migraine without aura (formerly called classic migraines). If you have a migraine with aura, you may experience a visual disturbance (like seeing stars or zigzag lines or a temporary blind spot) about 30 minutes before the headache starts. Even if you don't experience an aura, you may have other warning signs in the period before the headaches starts (called prodrome), such as a craving for sweets, thirst, sleepiness, or depression. Although there is no cure for migraines, you can manage the condition by reducing the frequency of attacks and lessening pain once an attack starts.

Signs and Symptoms:

The headache from a migraine, with or without aura, has the following characteristics:

• Throbbing, pounding, or pulsating pain
• Often begins on one side of your head and may spread to both or stay localized
• Most intense pain is often concentrated around the temple(s) (side of the forehead)
• Can last from 4 to 72 hours

These symptoms may occur at the same time or before the headache:

• Nausea and vomiting
• Dizziness, lightheadedness or even vertigo (feeling like the room is spinning)
• Loss of appetite
• Fatigue
• Visual disturbances, like seeing flashing lights or zigzag lines, temporary blind spots (for example, loss of your peripheral vision), or blurred vision
• Parts of your body may feel numb, weak, or tingly
• Light, noise, and movement – especially bending over – make your head hurt worse; you want to lie down in a dark, quiet room
• Irritability

Symptoms that may linger even after the headache is gone:

• Feeling mentally dull, like your thinking is not clear or sharp
• Sleepiness
• Neck pain

Causes:

Researchers aren't sure what causes a migraine, although they know it involves changes in the blood flow in the brain. Initially, blood vessels constrict (narrow), reducing blood flow and leading to visual disturbances, difficulty speaking, weakness, numbness, or tingling sensation in one area of the body, or other similar symptoms. Later, the blood vessels dilate (enlarge) leading to increased blood flow and a severe headache. Migraine triggers can include the following:

• Alcohol, especially beer and red wine
• Certain foods, such as aged cheeses, chocolate, nuts, peanut butter, some fruits (like avocado, banana, and citrus), foods with monosodium glutamate (MSG), onions, dairy products, meats containing nitrates (bacon, hot dogs, salami, cured meats) fermented or pickled foods
• Skipping meals
• Fluctuations in hormones (for example, during pregnancy, before and during your period, and menopause)
• Certain odors, such as perfume or smoke
• Bright lights
• Loud noises
• Stress, physical or emotional (often, the headache occurs during a period of relaxation after a particularly stressful time)
• Sleeping too little or too much
• Caffeine
• Smoking or exposure to tobacco smoke
• Some medications

Risk Factors:

• Gender (women are more likely to get migraines than men)
• Having other family members with migraine headaches
• Being under age 40; migraines tend to diminish as you age
• Taking birth control pills (if your migraines are affected by fluctuations in estrogen levels)
• Exposure and sensitivity to any of the potential triggers listed above

Diagnosis:

Your doctor will take a detailed medical history in order to distinguish migraine headaches from other types of headaches, such as tension or sinus. He or she will ask questions about when your headaches occur, how long they last, how frequently they come on, the location of the pain, and any symptoms that accompany or precede the headaches. Sometimes it helps to keep a diary about your headaches prior to seeing the doctor, so you'll have an accurate recording of how often they happen. (See Lifestyle section for what information to include in a diary.)

Tests your doctor may order, depending on your symptoms and exam, include:

• Computerized tomography (CT) scan, to look for other problems that could be causing your headache
• Magnetic resonance imaging (MRI), to look for brain abnormalities, and to look closely at the blood vessels in the brain
• Lumbar puncture (spinal tap), if your doctor suspects meningitis or other conditions

You should seek emergency help if you experience the following symptoms:

• You have unusual neurologic symptoms you have not experienced before, such as speech problems, change in vision, loss of balance, or difficulty moving a limb.
• Your headache pattern or intensity is different
• You are experiencing "the worst headache of your life"
• Your headache worsens when you are lying down

These may indicate a stroke, a bleed in the brain, or other serious condition.

Treatment Approach:

Treatment for migraines is aimed at preventing them from occuring and lesseneing pain once an attack starts.

You can control your migraines with a combination of medications, lifestyle changes, and complementary therapies. Biofeedback (see Mind/Body Medicine) may help you control the initial contraction of blood vessels, while relaxation techniques may reduce both the frequency and intensity of attacks.

Lifestyle

Keeping a migraine diary, particularly when you first begin to experience migraines, can help identify the triggers for your headaches so you can avoid them. When a migraine occurs, write down the date and time it began. Note what you ate for the preceding 24 hours, how long you slept the night before, what you were doing just before the headache, any unusual stress in your life, how long the headache lasted, and what you did to make it stop.

Other lifestyle measures that may reduce the number of migraines include:

• Avoiding cigarettes, caffeine, and alcohol
• Exercising regularly
• Getting enough sleep each night
• Relaxing and reducing stress in your life (see Mind/Body Medicine section)

Once a headache or associated migraine symptoms begin, it helps to:

• Rest in a quiet, darkened room
• Drink fluids to avoid dehydration (especially if you have vomited)

Medications

Medications for migraines can be classified in two major categories: those designed to prevent attacks, and those designed to relieve pain.

Drugs for Prevention

Your doctor may prescribe preventive medications if you have two or more migraines per month, use pain relievers more than twice a week, or if your symptoms are especially debilitating. Depending on your condition and medication, your doctor may recommend taking the medication daily or when a known trigger is about to occur (such as having your period).

• Beta-blockers -- also used to treat heart disease; researchers aren't sure why they also work for migraines, although they may help keep blood vessels in the brain from constricting and dilating. Beta-blockers include
  • Atenolol (Tenormin)
  • Metoprolol (Lopressor, Toprol-XL)
  • Propranolol (Inderal, Inderal LA)
• Calcium-channel blockers -- another type of cardiovascular drug that can help prevent migraines, including
  • Verapamil (Calan, Isoptin)
  • Diltiazem (Cardizem, Dilacor)
• Anti-depressants -- Tricyclic antidepressants are helpful in preventing all kinds of headaches, including migraines. Tricyclic antidepressants include:
  • Amitriptyline (Elavil)
  • Nortriptyline (Pamelor)
  • Doxepin (Sinequan)
  • Imipramine (Tofranil)
• Anticonvulsants -- Some anti-seizure drugs help prevent migraines, although researchers aren't sure why:
  • Divalproex sodium (Depakote)
  • Topiramate (Topamax)

Drugs for Treatment

To be effective, these medications should be taken as soon as you feel a migraine coming on.

• Triptans -- This class of medications tends to be the front-line treatment for severe migraines and relieve pain, nausea, and sensitivity to light and sound. They work by constricting the blood vessels in the brain. Triptans include
  • Almotriptan (Axert)
  • Eletriptan (Relpax)
  • Frovatriptan (Frova)
  • Naratriptan (Amerge)
  • Rizatriptan (Maxalt)
  • Sumatriptan (Imitrex)
  • Zolmitriptan (Zomig)
• Ergots -- Ergots also work by constricting blood vessels, but tend to have more side effects than triptans. Ergots include
  • Ergotamine (Ergomar, Cafergot)
  • Dihydroergotamine (Migranal)
• Isometheptene, dichloralphenazone, and acetaminophen (Midrin) -- Midrin combines a pain reliever (acetaminophen) and sedative (dichloralphenazone) with a medication that constricts blood vessels (isometheptene) to prevent migraines.

Other medications used to treat the headache pain or associated symptoms:

• Anti-nausea drugs
• Acetaminophen (Tylenol) for pain
• Ibuprofen (Advil, Motrin) or other nonsteroidal anti-inflammatory drugs (NSAIDs)
• Narcotics, such as codeine, are sometimes used for people who can't take triptans or ergots; however, they can cause dependency and rebound headaches

Nutrition and Dietary Supplements

Diet

Certain foods may trigger migraine headaches. Some of the include:

• Chocolate
• Cheese
• Monosodium glutamate (MSG), a flavor enhancer found often in food from Chinese restaurants
• Foods containing the amino acid tyramine (found in red wine, aged cheese, smoked fish, chicken livers, figs, and some beans)
• Nuts
• Peanut butter
• Some fruits (like avocado, banana, and citrus)
• Onions
• Dairy products
• Meats containing nitrates (bacon, hot dogs, salami, cured meats)
• Fermented or pickled foods

If you suspect that any of these foods cause your migraines, you could follow an elimination diet, eliminating all the items on this list from your diet and then reintroducing them one at a time. Pay close attention to when the number of headaches increases after eating particular foods. Then you know which trigger foods to avoid.

Supplements

• 5-hydroxytryptophan (5-HTP, 400 to 600 mg per day) -- This amino acid is made by the body from tryptophan (another amino acid you get from certain foods) and converted into serotonin, an important brain chemical. Researchers think abnormal serotonin function in blood vessels is related to migraines, and some of the drugs used to treat migraines work by affecting serotonin. Several studies indicate that 5-HTP may be about as effective as some prescription migraine medications, reducing the intensity and frequency of attacks. But not all studies have been so positive – one study found that 5-HTP was less effective than the beta-blocker Inderal. More studies are needed to be sure that 5-HTP is helpful in treating migraines. If you take an antidepressant, or supplements such as St. John's wort or SAMe, you should not take 5-HTP.
• Magnesium (200 to 600 mg per day) -- People with migraines often have lower levels of magnesium compared to people who do not have migraines, and several studies suggest that magnesium may reduce the frequency of migraine attacks. In one study, people who took magnesium reduce the frequency of attacks by 41.6 percent, compared to 15.8 percent in those who took placebo. Some studies also suggest that magnesium may be helpful for women whose migraines are triggered by their periods. Side effects from magnesium can include lower blood pressure and diarrhea.
• Vitamin B2 (riboflavin, 400 mg per day) -- A few studies indicate that riboflavin may reduce the frequency and duration of migraines. In one study, people who took riboflavin had more than a 50 percent decrease in the number of attacks. Not all studies have found riboflavin to be effective, however. More research is needed.

Preliminary research indicates that these supplements may also help prevent migraines, although much more research is needed to say for sure:

• Coenzyme Q10 (100 mg three times per day)
• Melatonin (5 mg per day, taken before bedtime)

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a healthcare practitioner.

• Butterbur (Petasites hybridus, 50 to 75 mg of a standardized extract two times per day) -- A few studies suggest that butterbur may help reduce both the frequency and duration of migraine attacks. The studies used a standardized extract that lowered the amount of alkaloids in the herb, which might potentially be harmful to the liver. If you want to try butterbur for your migraines, ask your doctor about a safe extract and dose. Women who are pregnant or breastfeeding should not take butterbur.
• Feverfew (Tanacetum parthenium, standardized leaf extract to 250 mcg parthenolide per day) -- Feverfew has been used traditionally to treat headaches, and several well-designed studies have found that it may help prevent and treat migraines (not all studies agree, however). In one study of people with migraines, those who took feverfew capsules every day for 4 months saw a substantial drop in the number of attacks as well as far fewer symptoms, such as nausea and vomiting, compared to those who received placebo. Feverfew can increase the risk of bleeding, and should not be taken with anticoagulants (blood-thinners). Women who are pregnant or breastfeeding should not take feverfew.

Although there are no scientific studies showing that these herbs work, they are sometimes suggested to treat migraines and other types of headaches:

• Dong quai (Angelica sinensis)
• Devil's claw (Harpagophytum procumbens)
• Ginger (Zingiber officinale)
• Ginkgo biloba (Ginkgo biloba)
• Willow bark (Salix spp.)

Acupuncture

Acupuncture has been studied as a treatment for migraine headache for more than 20 years. While not all studies have shown benefit with acupuncture, researchers do agree that acupuncture appears safe and that it may be effective for some people. Results from a study published in 2003 suggest that receiving an acupuncture treatment when migraine symptoms first begin is as effective as taking the drug Imitrex; as symptoms continue, however, the medication works better than acupuncture.

In addition to needling treatment, acupuncturists may recommend lifestyle changes, such as suggestions for specific breathing techniques, qi gong exercise, and dietary modifications.

Chiropractic

Several clinical trials indicate that spinal manipulation therapy may help in the treatment of migraine headaches. In one study of people with migraines, 22% of those who received chiropractic manipulation reported more than a 90% reduction of attacks and 49% reported a significant reduction of the intensity of each migraine.

In another study, people with migraine headaches were randomly assigned to receive spinal manipulation, a daily medication (Elavil), or a combination of both. Spinal manipulation was as effective as Elavil in reducing migraines and had fewer side effects. There was no added benefit to combining the two therapies.

In addition, researchers reviewed nine studies that tested spinal manipulative therapy for tension or migraine headaches and found that it was as effective as medications in preventing these headaches.

However, not all these studies were of good quality, and they varied in the techniques used. More research is needed to say for sure whether chiropractic is effective for preventing migraines.

Massage and Physical Therapy

Reflexology, a technique that places pressure on specific "reflex points" on the hands and feet that are believed to correspond to areas throughout the body, has been proposed as a treatment for migraines. Some early studies suggest it may relieve pain and allow people with migraines to take less pain medication. However, more research is needed. Practitioners believe reflexology helps you become more aware of you own body signals, which might help you sense the subtle signals that indicate a migraine is about to occur (before pain starts). They also believe reflexology helps improve general well-being and energy level.

Homeopathy

One of the most common reasons people seek homeopathic care is to treat chronic headaches. However, only one out of four studies included in a scientific review found that individually prescribed homeopathic remedies significantly reduced the frequency, severity, and duration of migraines. Some of these effective remedies are listed below. Professional homeopaths may also recommend various treatments based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account the individual's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

The following are some of the remedies found to be effective:

• Belladonna -- for throbbing headaches that come on suddenly; these types of headaches tend to worsen with motion and light, but are partially relieved by pressure, standing, sitting, or leaning backwards
• Bryonia -- for headaches with a steady, sharp pain in the forehead that may radiate to the back of the head; these types of headaches worsen with movement and light touch, but improve with firm pressure; this remedy is most appropriate for individuals who are irritable and may also experience nausea, vomiting, and constipation
• Gelsemium -- for pain that extends around the head and feels like a tight band of constriction; pain usually originates in the back of the head and may be relieved following urination; this remedy is most appropriate for individuals who feel extremely weak and have difficulty keeping their eyes open
• Ignatia -- for pain that may be described as a feeling of something being driven into the skull; these types of headaches tend to be triggered by emotion, including grief or anxiety, and the treatment is appropriate for both children and adults
• Iris versicolor -- for periodic migraines that begin with blurred vision, especially after eating sweets; pain usually occurs on one side of the head and may be partially relieved by gentle movement and/or fresh air
• Kali bichromicum -- for aching and pressing pains on the forehead (particularly between and behind the eyes); may be accompanied by sinus congestion or nausea and vomiting; this remedy is most appropriate for individuals who prefer to lie down in a dark room and who experience relief from warmth and eating
• Lachesis -- for migraines on the left side of the head that are typically worse in the mornings and before menstruation; this type of headache is aggravated by warmth and sunlight and relieved by open air and firm pressure
• Natrum muriaticum -- one of the most common remedies used for migraine headaches, particularly those that are described as "hammers beating the head;" pain is relieved when the individual is lying down, alone, in a quiet dark room; these migraines may be associated with either menstruation or a grieving experience and are worse in the middle of the day; this remedy is most appropriate for children who look pale and feel nauseated, nervous, and emotional
• Nux vomica -- for headaches that are described as a "nail being driving into the head;" often accompanied by nausea and/or dizziness; this remedy is most appropriate for individuals who are constipated and irritable
• Sanguinaria -- for right-sided headaches that begin in the neck and move upwards, recur in a predictable pattern (such as every seven days), and are accompanied by nausea and vomiting; pain is aggravated by motion, light or sun exposure, odors, and noise; this remedy is appropriate for children who may have a craving for spicy or acidic foods, despite having a general aversion to eating due to the headache
• Sepia -- for migraines that are accompanied by nausea and are relieved when the individual is lying down; light and movement tend to worsen symptoms; this remedy is most appropriate for individuals who are moody and don't like being alone, but worry about being with others

Homeopaths may also prescribe the following remedies based on their knowledge and clinical experience:

• Pulsatilla -- for headaches triggered by eating rich, fatty foods, particularly ice cream; pain tends to move but may be concentrated in the forehead or on one side of the head; may be accompanied by digestive problems or occur around the time of menstruation; children for whom this remedy is appropriate often develop these symptoms while at school
• Spigelia -- for migraines described as a stinging, burning, or throbbing pain, often on the left side of the head; symptoms tend to worsen with exposure to cold weather and with motion, but are temporarily relieved by cold compresses and when the individual is lying on the right side with the head propped up

Mind/Body Medicine

Reducing and learning to cope with stress may help reduce the number and intensity of your headaches. Techniques that can help include:

• Self-hypnosis
• Biofeedback
• Joining a support group
• Relaxation techniques such as progressive muscle relaxation (alternately contracting and releasing muscles throughout your body), meditation, and guided imagery

Alternative Names:

Headache - migraine

Migraines and the Chiropractor's Touch

By Katie Gilbert

The pain of a migraine can be so searing you may as well drill a hole through your head. Then again this was the remedy of choice 3,000 years ago when evil spirits were thought to be the culprit behind migraines. While modern-day treatments have changed, the mystery behind the condition remains.

One popular theory: Migraines result from a chemical imbalance in the brain. Often a trigger, such as certain foods or hormones, can cause blood vessels to dilate in the brain. The vessels become inflamed, thus irritating surrounding nerve fibers. The nerve fibers then send messages back to control centers in the brain, which continues vessel dilation, thus kicking off a vicious cycle of violent pain.

There are plenty of drugs that combat migraines, though no magic bullet exists. Some studies, however, show that alternative treatments can complement mainstream medicine. A study from Northwestern College of Chiropractic in Bloomington, Minnesota, compared chiropractic manipulation with amitriptyline, an antidepressant commonly used to treat migraines. The study found that chiropractic healing was about as successful as the drug.

Chiropractors believe that some migraines originate in the spine. Often a misalignment of the vertebrae, or subluxation, can irritate the nerves that travel the length of the spine to the brain. This misalignment makes a person more prone to chemical imbalances in the brain. Some researchers say that realigning the vertebrae—a chiropractor's specialty—relieves the pressure against inflamed nerves and can in turn relieve the headaches.

For migraines caused by subluxation, chiropractors recommend gently stretching the neck—rolling and sudden movements should be avoided. To prevent subluxations, pay attention to your posture. For example, if you sit for long periods in front of a computer, move your body around frequently. Also, sleep on your side or back, and use a firm pillow that supports your neck.

For migraine pain that makes you want to put a hole in your head, put down that drill—and find a chiropractor.

Chiropractic and Headaches

Headaches are common pain events for many people, and they are often recurring. A variety of prescription and over-the-counter medications may control headache pain, but they only mask the pain without addressing the cause. Headache medications may also have side effects, especially with long use. Hoping to find a more natural and holistic solution to chronic headaches, many people turn to chiropractic.

What is a Headache?

A headache may arise from muscular tension, vascular changes, sinus congestion, eyestrain and many other underlying causes. They can start over the eyes, in the back of the head, on the sides or top of the head, or feel centered behind the eyes. The one thing all these headaches have in common is that they hurt, and sometimes they hurt a great deal. The amount of pain associated with a headache may range from a mild ache to a throbbing, nauseating, relentless pain.

It is a common misconception that some types of headaches hurt more than others. It is often said that, for example, migraine headaches are more painful than other headaches. It is also common to call any kind of severe headache a "migraine." In fact, almost any kind of headache can cause a great deal of pain. Three types of headaches are commonly seen in chiropractic offices: tension headaches, migraine headaches, and cervicogenic headaches. Cervicogenic headaches are caused by pain referred to the head from the bony or soft tissues of the neck.

Headaches can be either primary, those that start independently, or secondary, those that begin as a side effect of another disease process. Headaches arising from muscular tension (generally arising from stress) and migraine headaches (vascular headaches) are two of the most common types of headache; both of these headache types are considered primary headaches. A large body of research suggests that chiropractic can effectively treat primary headaches, and many patients have found lasting relief from headache pain through chiropractic care.

Chiropractic and Tension Headaches

Tension headaches are caused by muscular tension and contraction involving the muscles of the shoulders, neck and head. Often this tension is a result of emotional stress, though injuries can also set a pattern of muscle contraction into play. It is normal for muscles to contract when we are threatened, irritated or angry, a reaction known as the fight or flight response. Over time, though, if work or home life creates a constant source of stress from which we can neither fight nor flee, the muscular tension can become chronic. This, in turn, leads to uneven stresses on the skeletal structure of the body, and changes in normal posture and movement to compensate. These misalignments lead to more muscular tension and contraction. This can become a vicious cycle that eventually results in pain, often as headache pain.

Chiropractic adjustments, combined with other therapies such as trigger point therapy and massage, can release muscular tension and realign the skeleton to break the cycle of pain. Often patients with chronic headaches will find relief through chiropractic in just a few treatments, as muscles relax and nerve irritation is reduced.

Chiropractic and Migraine Headaches

Migraine headaches are vascular headaches, arising from sudden dilation of the blood vessels of the head. No one knows exactly what causes migraine headaches, though the basic mechanism, involving both the nervous and vascular systems, is well studied. Migraines can be triggered by hormonal changes, foods, smells, weather changes, stress, and many other triggers. The headaches often begin with symptoms other than pain, such as visual auras, nausea or sensitivity to light and sound. The headache that follows can vary in intensity, but is often severe. Many migraine sufferers have found over-the-counter pain medications to be ineffective, and resign themselves to wait out the migraine event in a dark, quiet room. A variety of pharmaceutical drugs have been developed to treat migraines, but none of them work for everyone, and many have unwanted side effects.

Chiropractic can play an important role in treating migraines. Clinical studies, though still preliminary, suggest that chiropractic may have a measurable role in the prevention of migraines. Through manipulation and adjustments of the spine and neck, migraines can often be reduced or prevented. Nerves control vascular system tension, and chiropractic adjustments reduce irritation of the nervous system beginning with its roots in the spine, also improving vascular flow.

How Will a Doctor of Chiropractic Treat Headaches?

The fundamental technique of chiropractic, spinal manipulation, is used improve spinal alignment, reduce nerve irritation, relax muscle tension and improve vascular flow. Trigger point therapy, massage and other adjunct therapies may also be employed to broaden the treatment plan. Finally, the chiropractor will often recommend exercise, stretching and changes in posture, or teach relaxation techniques.

Forpreventive care, most chiropractors will also provide advice on nutritionalsupplements, vitamins, herbs, and diet toward the development of a long-termwellness plan to prevent future headaches.

Chiropractic care can provide a holistic, comprehensive treatment plan for chronic headaches, giving patients an opportunity to put an end to what can be a very stubborn type of pain and a considerable improvement in quality of life.

(as posted on altmed.com)

A Drug-free Way to Ease Pain Associated with Chronic Headaches

by Maryellen Cicione

"I wish I had seen a chiropractor sooner." The declaration comes unsolicited from Brett Cimino, a plumber who, for 10 years, has suffered from headaches nearly every day and debilitating migraines two to four times a month. "As soon as I began getting adjusted, I noticed a difference. A year later, I am on a maintenance plan now and to say I have had six headaches (of any kind) in the last year would be an overstatement."

According to Dr. Jeffrey Robitaille of Robitaille Family Chiropractic in Rhode Island, 1 in 6 Americans suffers from chronic headaches. But like Cimino, many people overlook seeing a chiropractor for headache pain. "I waited more than a year before I made an appointment with a chiropractor. I guess I had some misconceptions about what a chiropractor does," says Cimino. "But after seeing the results, I don't know why I waited so long."

Every day, chiropractors hear similar stories from hundreds of people like Cimino who have been suffering for years with pain and are at their wits end because the only thing offered to them by their physicians and specialists are more drugs. As Dr. Robitaille explains, many people think headaches are normal and take over-the-counter or prescription drugs to relieve the pain. "But these drugs only dull the pain," he says, "they don't treat the cause, which is why the headache returns."

In addition to chronic headaches, chiropractic care is also effective in treating tension headaches. A recent study released by the Foundation for Chiropractic Education and Research finds that individuals undergoing chiropractic therapy showed sustained reduction in headache frequency and severity compared with patients who took the drug amitriptyline, a commonly prescribed medication for tension headaches.

"The conclusion of the study shows that chiropractic is not actually a therapy or treatment, but rather gets to the cause of the problem, thus allowing the body to effect a correction that lasts beyond actual care," says Dr. Robitaille.

While many people associate chiropractic care as a treatment for bad backs, there is growing documentation that chiropractic is also effective in the treatment of cervicogenic headaches, migraines and cluster headaches. In fact, the American Chiropractic Association reports that 14 percent of the public who see chiropractors presently go for headaches.

However, much of the general public continues to use the traditional medical practitioner route for headache treatment, with little success. The problem, says Dr. Robitaille, rests in the six misconceptions about headache relief. They are listed below, followed by his explanation:

1. Over-The-Counter Medication Treat The Cause Of Your Headache.
"Drugs only numb the pain. If these drugs treated the real cause, your headaches would go away permanently. None of us were born with too few Advil in our blood. A lack of drugs is not the cause."

2. Headache Medication Can't Harm You.
"On the contrary, drugs can cause side effects that can be far worse than the headache pain you're trying to relieve."

3. Stress Causes Headaches.
"Although stress is a part of life, it is not the cause of headaches. Rather, it's how your body adapts to stress that affects your health. Chiropractic care can provide ways to help you increase your body's ability to adapt to stress of any kind."

4. Headaches Go Away On Their Own.
"Without treating the cause, or root of the problem, they won't."

5. All Doctors Know How To Treat Headaches.
"If this were true, no one would suffer from headaches. Chiropractors offer natural alternatives that do not involve drugs or invasive treatments."

6. Your Problem Is Always Where Your Pain Is.
"In fact, not all headaches originate in the head. For instance, a person who suffered a neck injury at some point in their life, whether from a car accident, playing sports, or a fall as a child, could suffer head pain later on. These are called cervicogenic headaches because they result from tension of the neck and head muscles."

Can Cayenne Peppers Really Cure a Headache?

Cayenne pepper, also known as chili pepper, is definitely one of your more multi-functional spices, so if you’re a lover of hot and spicy food, that’s great news. Some of the research into the health benefits of capsaicin (its active ingredient) has found that it may:

• Reverse Type 1 diabetes in mice, when injected into the pancreas
• Relieve stomach aches, and gas
• Help fight cancer, by binding to proteins in cancer cell mitochondria, triggering cellular death without harming healthy cells

When it comes down to it, all this research into the benefits of food products really points out the importance that your diet plays in your overall health – even though they are narrow-mindedly focusing on picking out the active ingredients to be able to patent it and put it in a pill.

Other Natural Treatment Options for Your Headaches

Headaches can generally be divided into two types, tension and migraine. Migraine can be extremely debilitating, and many of the drugs used to treat migraines are effective in relieving this severe pain, offering welcome relief. Unfortunately, they do absolutely nothing to treat the cause and in fact actually contribute to your problem as after a short while they might cause rebound headaches themselves.

Fortunately, many natural treatment options exist that can help treat migraines. These should always be considered first, as drugs to treat migraines can make your problem worse, and often come with other serious side effects.

Natural Solutions Are Your BEST Option

Following my eating plan, which is designed to take your personal biochemistry into account, so that you’re eating the right foods for your nutritional type, seems to reduce headaches and migraines by about 80 percent.

Avoiding wheat, grains, sugar, artificial preservatives, and all fluids but water seem to be particularly effective.

However, your customized eating plan does take some time to work. In the past, I have used intravenous magnesium to relieve the headache pain, but now I find that the Emotional Freedom Technique is incredibly effective. Oftentimes it can remove your pain in as little as a few minutes.

I am sure it won’t work for everyone, but I have yet to find that person. I have found it to be truly amazing. And, as time goes on, more and more people (including some more open-minded medical professionals) will begin to accept the truth about energy medicine, as the facts about the “New Biology” becomes more widespread.

The New Biology is based on the science of epigenetics, which literally means that your mind is in control over your genes – nothing in your medical history is preordained. In essence, your mind is in total control over your physical body, and the ailments you develop. This is not a very popular truth as of yet, as most people are not willing to accept that they carry the responsibility for their health.

But, it may very well explain why energy psychology tools, such as EFT, are so effective, and can be used for such a wide variety of ailments. EFT can also be used to eliminate food cravings, which can help you stick to your eating plan.

One final, simple tip to free yourself from migraine pain -- start an exercise program. This will help to improve your response to stress along with the underlying inflammatory conditions that can trigger migraines.

Remember, your pain typically serves a very useful purpose, signaling that something is not right -- prompting you to resolve your problem at its root level.

Unfortunately, most are brainwashed and resort to a drug model to cover the problem up. So I take the position of embracing and loving pain for the important warning signal it can provide. Once you understand what is causing your pain you can start using natural therapies to address the underlying cause.

as posted on Dr. Mercola

Alternative Treatments for Headaches That Really Work

By Dr. Leila Marsha Peterson

A headache, like a fever or cold hands or feet is one of the many ways that your body is letting you know that something is wrong with it.

Let's imagine for a moment that your body is a house with a smoke detector. Upon sign of smoke it sounds an alarm giving you a chance to do something before you are engulfed in a full-blown fire.

Removing the batteries from a smoke detector because it alarms when what you are cooking starts to burn is like taking a pain reliever for your headache. It is similar to putting a band-aid on the headache and is not solving the cause of the problem. In time, the causes of the problem get worse and so does the headache.

Headaches may be a result of stress from a chemical, environmental, emotional or physical source or any combination thereof. For instance, headaches that may be due to hormonal fluctuations and changes could be checked out with a saliva test.

A shortage of oxygen or blood to the head, which can be due to poor vertebral alignment, could possibly be another reason and a visit to a chiropractor that had special training in Applied Kinesiology and Cranio-Sacral Therapy may be the answer to your prayers.

Another probable but unlikely cause that needs to be ruled out is a head tumor or any growth inside the head.

One very common reason for headache is tired eyes. "Exercising" your eye muscles by squeezing your eyelids tightly closed for a few seconds, or doing some quick, soft blinks every so often will help relax -stressed-out eyelids according to Jacob Liberman, O.D., Ph.D. author of "Take Off Your Glasses And See". An annual check-up with your eye doctor would also be a wise thing to do.

Some of the possibilities that we need to explore are:

• When does the headache come?
• Does it coincide with your monthly menstrual cycle?
• Or is it always at a regular set time during the day or night?
• Do you need to wear dark glasses every time you go out in the sun or else your head would start throbbing?
• Could your jaw muscles be the cause of your headaches?
• Does eating certain foods like chocolate, red wine, citrus fruits, or monosodium glutamate (MSG) elicit your headache?

Pinpointing the location, character and duration of the headache could offer some insight to the organ system or emotion involved. To check if the jaw muscles are involved, put your little finger inside each ear. Now open and close your mouth slowly.

Next, observe or feel if your jaw (that ends by your ear) both open and closes at the same time, and do so without any clicking or popping sound. Myofascial release combined with polarity therapy might be able to release those tight muscles. It is also a good idea to have your dentist check your "bite" and while you're there, make sure that you do not have amalgam (mercury) fillings.

Did you know that the cells in your body could be in an acidic environment and that could be a playing a huge role in how you feel? Adding Green Plus from Alternative Care Products or alkaline ash producing foods and thoughts may help maintain alkalinity inside your body.

It is also helpful to know your saliva and urine ph. before and after a "threat" to your body. Gargling frequently with warm salt water and massaging your gums and tongue gently with fine sea salt using your fingertips would boost the circulation and change acidity in your mouth according to the Book of Wellbeing published by the Bulfinch Press. (I modify this tip a bit by combining Himalayan sea salt, Epsom salt, and baking soda with a twist of lemon.)

Sometimes, the very candles that we use for meditation and relaxation may trigger a headache. Therefore, it is advisable to use lead free wicks and candles that are made of either soy or bees wax only.

Dr. Cox, an occupational physician suggest that many people using mobile phones have symptoms which may include dizziness, disorientation, nausea, headaches, and transient confusion. These symptoms may be due to the unilateral stimulation of the portion of the nervous system that assists in balance and coordination.

The best thing to do is limit the use of your mobile phones to times of emergency. I can hear you laughing but this is not a joking matter. If you are like me who uses the mobile phone for convenience, then at least use a RF 4 headset and keep the actual phone as far from your head as possible.

Another factor to consider is if the sufferer is "rewarded" for the headache? For example, the "reward" could be any possibilities like being able to get out of a job or responsibility, or getting extra or special attention. Self-hypnosis or hypnotherapy with lights and sounds might be able to help create harmony from within and release the healing powers of the mind. Hypnotherapy is usually very beneficial in "rewarded" cases because it is known to encourage rather than compel change.

According to some metaphysical beliefs, suffering from a headache might indicate an inability to express or receive unconditional love and acceptance, or their opposite, which are hate, anger and rejection. However, Daniel R. Condron, author of Permanent Healing suggests that headaches or migraines could be that the sufferer is feeling pressured by factors that seem out of her control or that there is a pressure on one's self between "right" or "wrong".

Dr. Earl Mindell author of several nutritional and herb "bibles" recommends a cup of peppermint tea or feverfew to ward off a headache. Including digestive enzymes with your meals (if you need them) is often a surprisingly effective antidote for a headache. Squeezing the web between the thumb and the index finger with the thumb and index finger of the other hand to bring instant headache relief for some is an ancient acupressure maneuver.

Another way to ward off an incoming headache is to press the philtrum, (the indented area between the bottom of your nose and your up per lip) with the knuckle of your index finger tenderly and stop when you feel a sense of warmth, perspiration, or clamminess in any part of your body which means that you have "restarted" the energy flow in your body.

According to the World Health Organization (WHO), headaches are one of the many conditions that have been shown through controlled trials to be treated effectively by acupuncture. Doing slow, deep-breathing exercises may help liberate the emotion, physical condition, or resistance associated with some tension headaches.

Therapeutic essential oils from Young Living like Idaho Tansy, Roman Chamomile may help enhance the oxygen carrying capacity of the blood and oxygen infusion into the cell according to the Essential Oils Desk Reference as compiled by Essential Science Publishing. In the homeopathic world, headaches from over exposure to the sun may perhaps be helped with Belladonna, while headaches with constipation might be relieved with Bryonia.

There are anecdotal stories that assert that Energy Work like the Hawaiian Healing Technique or Reiki is excellent for migraine.

Remember that maintaining balance and restoring harmony to the body, mind and spirit is the main goal. There are a lot of gentle remedies and time-tested strategies that are available to you.

You are a unique individual. Your fingerprints are yours alone. Wouldn't it make sense to see someone who will treat you as such?

Have you thought of acupuncture to treat your headaches?

Tension Headaches Cut In Half With Acupuncture

by: Dr. Mercola

A study in the British Medical Journal showed that acupuncture is an effective technique for treating tension headaches. What’s more, “minimal” acupuncture techniques -- needles inserted superficially into the skin at nontraditional points -- work almost as well as the full, traditional version used in China.

Eight-Week Trial

Researchers in Germany divided 270 patients with similar symptoms into three groups for a randomized, controlled trial. Over an eight-week period, one group was treated with full traditional acupuncture, one with minimal acupuncture, and one with neither method.

Headache Rates Cut In Half

Headache rates dropped by almost half among those in the “traditional acupuncture” group. On average, they experienced 7 fewer days of headaches in the four weeks following the trial than they did in the four weeks preceding it.

Those in the “minimal acupuncture group” fared almost as well, with an average drop of 6.6 days with headaches. The third group only saw an average drop of 1.5 days -- just a tenth less than what they had experienced prior to the study.

The researchers concluded that acupuncture works as well or better for tension headaches than treatments already accepted.

Still looking for headache relief?

Before looking for a headache remedy, one should understand the origin of the headache. Spinal manipulations have shown to decrease the severity and frequency of headaches, because they usually are due to a misaligned spine. Poor posture or injury can force your vertebrae out of place and pressure the nerves. These nerves can send painful signals to the muscles surrounding the neck and cause a headache. The spinal manipulations straighten your spine and relax the muscles.

There are several types of headaches; including tension, migraine and cervicogenic. Most people experience the tension headache, which includes moderate pain on both sides of the head. It is often described as a pressure that is squeezing your head causing the pain. Migraines are more severe and are usually described as a throbbing pain. Sometimes a migraine can cause nausea, loss of appetite, and in some cases vision difficulties. If you get migraine headaches regularly, keep a record of the foods you eat. You might notice that your headaches are caused by specific foods. The cervicogenic headache is related to the spine and causes most tension type headaches.

Not all headaches are cause by spinal misalignments but you should consult your chiropractor before you begin any treatments. Sometimes caffeine, lack of nutrients, stress, allergies, menstruation, or poor sleep habits can cause headaches. In some cases of reoccurring headaches the location of the pain can clue you into a more severe problem. A headache located above the right eye may indicate a liver problem. Pain at the top of your head could indicate a kidney problem or high blood pressure. If you experience pain at the back of the neck, high stress levels probably cause the headache.

Your chiropractor will conduct physical, orthopedic and neurological tests to reveal the condition of your spine. A palpation test can check for irregularities in the spine that may be the cause of your headaches. Sometimes and x-ray is necessary. Your chiropractor may consult with other medical specialists if the test results dictate further exams.

Looking for a Headache Remedy?

Chiropractors do not prescribe medications or recommend surgery (rarely a treatment for headaches), but instead have had success relieving the pain associated with headaches. Taking aspirin every day as a headache remedy can lead to increased doses and even more severe headaches in the long run. The medicine taken for today's headache may give you one tomorrow or the days after. Chiropractic has been extremely successful in dealing with cervicogenic headaches. A chiropractor's ability to adjust spinal abnormalities lessens the forces contributing to headache pain. Other manual techniques such as massage and heat therapy can be a useful headache remedy.

(as posted at ChiroCommunity)

What are you putting in your body?

The thing I hate about going to the doctor for anything now days, is that they seem to just throw some pills at me, and send me on my way. I'm never sure exactly what the pills are for, and what they will do to me, except that they will help my pain go away. Will they make me itchy, or make my hair fall out? Most of the time, the side effects are worse than the reason I am taking the pills in the first place.
If you are like me, then you may be interested in the following article, posted at Healthy New Age, in which you will find many natural ways to relieve your pain.......... and keep your hair.


Natural Arthritis Treatments for Pain Relief and Joint Protection

The true test of an arthritis pain relief formula goes beyond pain relief.

If it's to be a health formula worth taking, it will also assist the body in repairing the damage to joints and bone and also to providing nutrients the body can use to maintain healthy joint function and protect against further cartilage degeneration.

So, don't settle for temporary pain relief when you can utilize this special combination of ingredients to help your body repair. Learn about natural arthritis treatments that have research behind them.

12 Ingredients That Can End Your Arthritis Pain and Joint Pain

Glucosamine is a natural sugar produced by the body and found in certain foods. It plays an important role in the production, maintenance, and repair of cartilage. It stimulates the production of glycosaminoglycans and proteoglycans, two essential building blocks of cartilage.

Shark Cartilage is a source of Chondroitin Sulfate. It drives the Glucosamine and provide maximum absorption. Also, in many trials it has reduced the possibility of developing cancer. Bovine Trachea can also be used as a source of Chondroitin, however, there is a risk of BSE (Mad Cow Disease).

Chondroitin Sulfate reduces inflammation and assists the Glucosamine in protecting against future cartilage degeneration.

Bromelaine cleans away the debris in the joints restores proper fluid balance. In addition, it helps to inhibit inflammatory compounds and reduces pain and swelling.

Ascorbate (Manganese and ascorbic acid) assists your body with processing the glucosamine. This is a very important ingredient and one that is missing in nearly every glucosamine product on the market today.

Yucca has a long history in treating arthritis and rheumatism. The root is rich in sponins that elevate your body's ability to produce cortisone naturally.

The Omega 3 and 6 fatty acids (eicosapentaenoic acid) and DHA (docasahexaenoic acid) are constituents of fish oils that act as anti-inflammatory agents. Usually, these products are sold separately in health food stores as salmon or fish oil.

Boswellin has been used for centuries in the Indian Ayurvedic system of medicine to maintain healthy joints. Boswellic acids improve blood supply to the joints and maintain the integrity of blood vessels. At least one study has indicated that they may open up collateral blood circulation to provide adequate blood supply to the joints. Boswellin has been known to reduce joint swelling, maintain blood supply to inflamed joints and mobility as well as reduce pain due to stiffness in the joints.

Vitamin A (Beta carotene) is essential for growth and repair of body tissues and it aids in bone formation.

Vitamin C (ascorbic acid) produces a mobilization of your body's self-defense mechanisms, which assists your immune system to overcome disease.

And finally, Vitamin E (Tocopheral) is an antioxidant, which acts to protect red blood cells and unsaturated fatty acids from oxidation damage. It also assists your body in maintaining healthy membrane tissue.

Vitamin A, C, and E all promote general health and protect against the harmful effect of free radicals.

Afraid that Chiropractic medicine isn't safe?

In my field, I meet a lot of people who are in pain, and many who have been in pain for many years. I find myself asking them why they would wait so long before coming in to see us, and their answer is almost always the same, " I was afraid it would hurt", or "I was afraid it would make it worse". In the following article posted on the American Chiropractic Association website, the safety of the practice is made very clear.

Is chiropractic treatment safe?

Chiropractic is widely recognized as one of the safest drug-free, non-invasive therapies available for the treatment of neuromusculoskeletal complaints. Although chiropractic has an excellent safety record, no health treatment is completely free of potential adverse effects.

The risks associated with chiropractic, however, are very small. Many patients feel immediate relief following chiropractic treatment, but some may experience mild soreness or aching, just as they do after some forms of exercise. Current literature shows that minor discomfort or soreness following spinal manipulation typically fades within 24 hours.

Neck pain and some types of headaches are treated through precise cervical manipulation. Cervical manipulation, often called a neck adjustment, works to improve joint mobility in the neck, restoring range of motion and reducing muscle spasm, which helps relieve pressure and tension.

Neck manipulation is a remarkably safe procedure. While some reports have associated upper high-velocity neck manipulation with a certain kind of stroke, or vertebral artery dissection, there is not yet a clear understanding of the connection. The occurrence appears to be very rare—1 in 5.85 million manipulations— based on the clinical reports and scientific studies to date. If you are visiting your doctor of chiropractic with upper-neck pain or headache, be very specific about your symptoms. This will help your doctor of chiropractic offer the safest and most effective treatment, even if it involves referral to another health care provider.

It is important for patients to understand the risks associated with some of the most common treatments for musculoskeletal pain -- prescription and over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDS) -- as these treatments may carry risks significantly greater than those of chiropractic manipulation. According to a study from the American Journal of Gastroenterology, approximately one-third of all hospitalizations and deaths related to gastrointestinal bleeding can be attributed to the use of aspirin or NSAID painkillers like ibuprofen.

Think Chiropractic medicine is only for backpain?

If you are like much of the world, you have the occasional headache. However, maybe you are like the smaller group of people who have intensely painful headaches, that make it difficult to get out of bed. You will find, in the article posted on the American Chiropractic Association site, that you may very well find relief from your local Chiropractor, yes that's right, we aren't only for back pain! If you are suffering, check us out, we can help. Bratcher Chiropractic


Headaches & Chiropractic

If you have a headache, you’re not alone. Nine out of ten Americans suffer from headaches. Some are occasional, some frequent, some are dull and throbbing, and some cause debilitating pain and nausea.

What do you do when you suffer from a pounding headache? Do you grit your teeth and carry on? Lie down? Pop a pill and hope the pain goes away? There is a better alternative.

Research shows that spinal manipulation – the primary form of care provided by doctors of chiropractic – may be an effective treatment option for tension headaches and headaches that originate in the neck.

A report released in 2001 by researchers at the Duke University Evidence-Based Practice Center in Durham, NC, found that spinal manipulation resulted in almost immediate improvement for those headaches that originate in the neck, and had significantly fewer side effects and longer-lasting relief of tension-type headache than a commonly prescribed medication.

Also, a 1995 study in the Journal of Manipulative and Physiological Therapeutics found that spinal manipulative therapy is an effective treatment for tension headaches and that those who ceased chiropractic treatment after four weeks experienced a sustained therapeutic benefit in contrast with those patients who received a commonly prescribed medication.

Headache Triggers

Headaches have many causes, or “triggers.” These may include foods, environmental stimuli (noises, lights, stress, etc.) and/or behaviors (insomnia, excessive exercise, blood sugar changes, etc.). About 5 percent of all headaches are warning signals caused by physical problems.

Ninety-five percent of headaches are primary headaches, such as tension, migraine, or cluster headaches. These types of headaches are not caused by disease. The headache itself is the primary concern.

“The greatest majority of primary headaches are associated with muscle tension in the neck,” says Dr. George B. McClelland, a doctor of chiropractic from Christiansburg, VA. “Today, Americans engage in more sedentary activities than they used to, and more hours are spent in one fixed position or posture. This can increase joint irritation and muscle tension in the neck, upper back and scalp, causing your head to ache.”

What Can You Do?

The ACA suggests the following:

• If you spend a large amount of time in one fixed position, such as in front of a computer, on a sewing machine, typing or reading, take a break and stretch every 30 minutes to one hour. The stretches should take your head and neck through a comfortable range of motion.
• Low-impact exercise may help relieve the pain associated with primary headaches. However, if you are prone to dull, throbbing headaches, avoid heavy exercise. Engage in such activities as walking and low-impact aerobics.
• Avoid teeth clenching. The upper teeth should never touch the lowers, except when swallowing. This results in stress at the temporomandibular joints (TMJ) – the two joints that connect your jaw to your skull – leading to TMJ irritation and a form of tension headaches.
• Drink at least eight 8-ounce glasses of water a day to help avoid dehydration, which can lead to headaches.

What Can a Doctor of Chiropractic Do?

Dr. McClelland says your doctor of chiropractic may do one or more of the following if you suffer from a primary headache:

• Perform spinal manipulation or chiropractic adjustments to improve spinal function and alleviate the stress on your system.
• Provide nutritional advice, recommending a change in diet and perhaps the addition of B complex vitamins.
• Offer advice on posture, ergonomics (work postures), exercises and relaxation techniques. This advice should help to relieve the recurring joint irritation and tension in the muscles of the neck and upper back.

“Doctors of chiropractic undergo extensive training to help their patients in many ways – not just back pain,” says Dr. McClelland. “They know how tension in the spine relates to problems in other parts of the body, and they can take steps to relieve those problems.”

Autism and Chiropractic medicine.

There seems to be an alarming increase in children who have Autism, and we in the Chiropractic community think that we have found a link between the care that we provide, and Autism. In the following article by Dr. Ashley Ochsner, I think you will come to agree with me.


WELCOME TO THE WONDERFUL CONNECTION OF CHIROPRACTIC AND AUTISM


Many people in search of help with a neurodevelopmental disorder find themselves here in this group. In order to get the help you need and deserve, it’s important to understand the processes and procedures involved in seeking treatment.

Phase I: Structural Spinal Neurological Evaluation

This is the starting point for all of our Autistic patients. Why? Because the central nerve system is the controller of all function and healing in the body. This pathway (the spine) must be checked first and foremost. Testing should include digital thermographic imaging, digital posture analysis, as

well as digital structural x-rays (if necessary). If there’s a problem detected, it must be corrected or reduced. Correcting the spine is not a simple procedure. It also isn’t something every chiropractor is qualified to do. Only chiropractors specializing in corrective care can truly correct the spine. Depending upon the age of the patient, their condition, and past similar cases, an appropriate course of care will be recommended. This process must be implemented successfully before moving to Phase II.

Phase II: Nutrient and Toxicity Evaluation (Biomedical Evaluation)

This is the step many of you are very familiar with and can’t wait to get started moving. It is a very important part of the recovery process. It’s vital that this be done AFTER the nerve system is functioning at it’s best from the work done in Phase II. This assures the best results every time. Most of the Chiropractors in this group network are trained and integrate the Defeat Autism Now! approaches. If they don't do this in their offices, they will refer you to the proper professional for help in this phase. A detailed history is always taken as our first step. Once the history is complete, appropriate lab testing will be ordered. Testing options include but aren’t limited to:

• Urine Organic Acids
• Lyme Disease Testing
• Biotoxic Illness
• Toxic Metals Testing
• Vitamin Panel (Metabolic Profile)
• Essential Fatty Acids Test
• Food Allergy Panel
• Thyroid Study
• And many others…

Treatment for each patient is extremely individual and unique, based upon the case. However, one of the foundational parts of this phase of care is diet. Most, if not all patients, will be given dietary guidelines and a program that goes way beyond just gluten and casein free. It is customized for the individual.

Phase III: Referral for Specialized Therapies

If at any time a referral to another professional is indicated, you can be assured that we will get you to the right professional. The Chiropractors in this group work with dozens of professionals in the arena of neurodevelopmental disorders.