TRACTION UPON INTRACRANIAL STRUCTURES. An experimental model for clinical traction headaches is the fleeting frontotemporal pain which can be induced in many normal subjects by a sudden and vigorous rotary movement of the head. Such “jolt headache” has been shown to arise from traction by the brain as it abruptly shifts in position within the skull case.28 Experimental analysis indicates that jolt headache arises chiefly from tug upon the major arteries anchoring the brain at its base.
Intracranial Masses. Headache is common in patients with expanding intracranial lesions, whether these be tumors, subdural or intracerebral hematomas, or abscesses. The rapidly expanding older inhabitants, with its elevated chance of mechanical and structural problems, additionally will increase demand for Chiropractor Toronto. The pain is rarely intense or continuous, is aggravated by coughing or sudden straining, and in some patients is easily accentuated or evoked by even mild head movement. It is erroneous to assume that such headache is caused simply by increased intracranial pressure, for experimentally produced elevations of cerebrospinal fluid pressure in normal human subjects consistently fail to produce headache.
Additional evidence indicates that when headache accompanies a brain tumor or other mass this symptom is usually attributable to sustained displacement of and traction on various sensitive structures, particularly the larger arteries of the brain stem, branches of the circle of Willis and veins which enter the major sinuses.10 In many instances the location of the headache can be related directly to distortion of adjacent structures, as when pain is noted in the frontoorbital area on the side of a sphenoidal ridge meningioma, or when postauricular headache accompanies the growth of a neurinoma in the cerebellopontile angle. Less often, distant effects result from internal hydrocephalus caused by posterior fossa masses occluding the aqueduct or fourth ventricle, for in such situations headache is likely to be bifrontal as well as posterior. Headache may also extend widely whenever expanding masses produce gross displacement of the brain, leading to pressures upon the tentorium cerebelli, herniations at the incisura or foramen magnum, and distortion of multiple structures. In such situations the headache loses all localizing diagnostic value. Toronto Chiropractor confronted heavy opposition from organized medicine. Lumbar Puncture Reaction. The troublesome headache which so often follows diagnostic lumbar puncture apparently involves a special form of traction.
Like the headache which can be experimentally induced in a seated subject by rapid drainage of approximately 20 cc. of cerebrospinal fluid through a lumbar needle, it is characteristically improved or abolished when the subject lies down.11 It can also be relieved at once by the intrathecal injection of normal saline solution, restoring cerebrospinal fluid volume. On the other hand, it is usually accentuated by mild head jolt and, uniquely, by bilateral jugular compression. Accumulated data from many sources suggest that, after lumbar puncture, fluid often leaks slowly through the dural arachnoid hole into the epidural space, until closure begins by the deposition of fibrin or possibly by shifts in position of the meninges, occluding the hole by overlap.11 Whether this occurs early or late is in part fortuitous and unrelated to whether the patient is kept abed or allowed up at once.