Abstract
Osteopathic manipulative treatment reduces symptoms in patients with headache disorders, but the underlying mechanisms are unclear. To evaluate blood flow in the intracranial and extracranial vasculature before and after occipitoatlantal decompression (OAD) using Doppler ultrasonography. Healthy, first-year osteopathic medical students from A.T. Still University's Kirksville College of Osteopathic Medicine participated in a randomized, single-blinded, two-period, two-treatment crossover study. The participants were randomly assigned to 1 of 2 treatment interventions: OAD or sham touch. After one week, participants returned to have the other intervention performed. Blood flow parameters-peak systolic velocity (PSV) and end-diastolic velocity (EDV)-in the middle cerebral artery (MCA), internal carotid artery (ICA), and vertebral artery (VA) were evaluated before, immediately after, 5minutes after, and 10minutes after treatment. Differences in PSV, EDV, heart rate (HR), and blood pressure (BP) for both interventions were analyzed for the four time points using mixed-effects models. Thirty healthy medical students (11 men, 19 women; mean age, 24years) participated in this study. EDV increased after OAD in the MCA, ICA, and VA (all p<0.001); no change occurred after sham touch (all p>0.05). EDV was greater for all post-treatment timepoints after OAD in the MCA, ICA, and VA than after sham touch (all p<0.001). Although baseline PSV in the MCA measured before treatment was different between treatment interventions (p=0.01), no difference was found between interventions at any post-treatment time point (all p>0.59). Changes in PSV in the ICA and VA and for HR and BP did not depend on treatment intervention (p>0.06). Increases in EDV occurred in major cranial arteries after OAD but not after sham touch, indicating that OAD improves blood flow to the brain. The exact mechanism of this increase is unknown; however, it can be explained by either parasympathetic stimulation through the secretion of vasodilating neurotransmitters or by a decrease in external tissue pressure on ICA and VA, with the resulting flow causing further dilation in the MCA.
Highlights
Context: Osteopathic manipulative treatment reduces symptoms in patients with headache disorders, but the underlying mechanisms are unclear
end-diastolic velocity (EDV) increased over time after occipitoatlantal decompression (OAD) in the middle cerebral artery (MCA), internal carotid artery (ICA), and vertebral artery (VA); no changes occurred after sham touch
The current study evaluated the effects of OAD on intracranial and extracranial blood flow dynamics
Summary
Context: Osteopathic manipulative treatment reduces symptoms in patients with headache disorders, but the underlying mechanisms are unclear. Similar techniques with slightly different force vectors are used in this anatomical area as well, including condylar decompression for the occipital condyles and suboccipital decompression for the area surrounding the suboccipital muscles.[1–5] These techniques can be used to normalize parasympathetic tone, improve infant feeding issues, and manage headaches.[1,3–6]. Nociceptors in large intracranial vessels and dura mater are stimulated and send afferent pain signals to the trigeminal ganglia, which form the trigeminovascular system and contribute to the development of migraines.[21,22] Vasoactive neuropeptides, such as calcitonin gene-related peptide, are released in the vascular terminals of the trigeminal nerve and its nucleus.[23]. A local cortical spreading depression has been suggested to release calcitonin gene-related peptide, potassium ions, glutamate, nitrous oxide, and other molecules that diffuse and activate the nociceptors involved in the trigeminovascular response observed during the headache phase of migraines.[27,28]
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