Headache is one of the most common complaints presented in a chiropractic office. It is not unusual for a few adjustments to correct a problem for which the patient has suffered for years and sought relief from a score of allopaths in vain. Nevertheless, headache is not a simple problem. Its origin may be traumatic, inflammatory, neurologic, psychologic, vascular, endocrine, metabolic, neoplastic, degenerative, deficiency, congenital, allergic, autoimmune, or toxic.

The Value of a Complete History

A thorough case history is mandatory. The cephalgia may be acute, chronic, transient or recurring. It may be primary or secondary. It may be unilateral, bilateral, or shifting. It may be localized or radiate from one area to another. Its course may be steady, intermittent, or throbbing. The initial site may be frontal, orbital, temporal, facial, vertex, or occipital. Its character may be perceived as a pressure, a tight band, an agonizing stabbing pain, or a dull ache. Its onset may be rapid or gradual. Its physiologic origin may be local, systemic, or be the result of noxious reflexes. In addition, its structural origin may be in the head, face, neck, cervical spine, or one or more structures far from the site of pain. Thus, a disorder in almost any function or tissue of the body may be the primary focus or a contributing factor to the complaint.

Besides the variables described above, the case history should determine duration (see Table 5.1), age of onset, frequency of occurrence, precipitating factors, aggravating factors, modes of relief, prodromata, associated symptoms, past therapy, and family tendency toward this type of headache.

The following associated complaints and findings are pertinent during differentiation:

Abnormal reflexes	Gait disturbances	Periorbital swelling
Altered mental state	Hyperesthesia	Photophobia
Cervical spasm	Hypertension	Prodrome or aura
Conjunctival injection	Lacrimation	Rhinorrhea
Digestive disturbances	Localized tenderness	Scotomata
Discharge	Meningismus	Seizures
Dizziness	Nasal congestion	Speech disturbances
Earache	Nausea without vomiting	Syncope
Fever and/or chills	Neck stiffness	Trigger point(s)
Flashes of light	Nuchal rigidity	Visual disturbances
Flush	Papilledema	Vomiting

Headache with blurred vision may suggest several disorders. Brain tumor or abscess, concussion, skull fracture, subdural or epidural hematoma, meningitis, orbital cellulitis, subarachnoid, and migraine are examples. When headache with "flashes of light" are reported, brain tumor, temporal arteritis, or migraine should be early suspicions. Meningitis, migraine, subarachnoid hemorrhage, and suboccipital neuralgia usually have headache with severe photophobia in their clinical picture. Headache with projectile vomiting suggests cranial trauma or tumor. Orbital pain and a dilated pupil suggest glaucoma if head trauma can be ruled out.


Clinical Analysis

The first concern in the treatment of a complaint of headache is to determine whether the lesion is extracranial or intracranial in origin and whether the complaint is associated with a life-threatening situation (eg, tumor, aneurysm, poisoning). Besides the value of a thorough case history, there are certain major distinguishing signs of organic brain damage that should be sought. Besides headache, other signs are:

(1) hyperglycemia,
(2) pupil inequality, and
(3) the promptness with which these signs appear. Confirmatory evidence will be found in positive roentgenographic evidence and the existence of local palsy. If brain damage is suspected, referral should be made to a neurologist for a complete workup, including cerebrospinal fluid analysis (especially for signs of blood).

The headache associated with cerebral contusion is characteristically much worse on stooping or during excitement.

The patient's history will show that the complaint will fall into one of two general categories:

(1) acute with no previous history or
(2) chronic and recurrent. Recently acquired acute headaches are often linked with signs of intracranial or systemic infection, focal nerve deficits, and/or a history of some type of seizure. Signs as these may suggest such lesions as brain tumor, meningismus, meningitis, encephalitis, subarachnoid hemorrhage, subdural hematoma, advanced temporal arteritis, or brain abscess — all which should be considered as a medical emergency.

Further deductive reasoning will help to arrive at an accurate diagnosis. Two general rules are:

1. Determine the site of the pain.   Pain originating above the tentorium cerebelli courses the trigeminal nerve and is perceived in the forehead, temples, or parietal area of the skull. Pain originating below the tentorium moves along the upper cervical, vagus, or glossopharyngeal nerves and is especially perceived in the occipital or suboccipital area.

2. Determine the mechanism(s) involved.   One or more of four mechanisms may be involved, and the faster this is determined the faster the patient can be given relief.
   
   These mechanisms are:

   a.   Determine if spasm (contraction) exists such as with cervical (especially suboccipital) muscle spasm. This may be the result of a local lesion or a reflex originating distally. About 90% of headaches will have this mechanism as its precipitating origin. Common causes are primary upper cervical subluxation/fixation, GI toxicosis and/or dysfunction, visual abuse, and excessive emotional stress (eg, anxiety, depression).
   
   b.   Compression such as from an inflammatory process producing a pressure mass that involves pain-sensitive brain tissue or a compression subluxation complex:

   (1) producing pressure on the vertebral nerves coursing with the vertebral arteries,
   (2) involving the autonomic cervical chain, or
   (3) interfering with normal cerebrospinal fluid flow at the atlanto-occipital area.

   c.   Traction/distention/inflammation such as with cervical or cerebral veins under tensile stress or a displaced venous sinus or traction or distention of meningeal arterioles (especially at the base of the brain). Headaches of traction/inflammatory origin are seen with chronic myositis; cervical osteoarthritis; diseases of the eye, nose, teeth, or throat; intracranial masses; cranial neuralgias and arteritis; TMJ dysfunction; and various infections and allergies. Headaches of vascular origin include hypertensive, migraine, cluster, facial, ophthalmoplegic, hemiplegic, and toxic syndromes. See Table 5.2.
   
   The recumbent position aids the patient with sinusitis or spastic headaches. A patient with vascular headaches (hypertensive, cluster, migraine) will feel more relief in the upright position. In addition, vascular headaches are often associated with a prodrome or aura (usually visual). This is attributed to an initial arterial spasm and resulting local ischemia in the area involved. In women, attacks become more frequent and severe just before the onset of menstruation.
   
   d.   Referred pain.   As explained earlier, the focal site of referred pain can be almost anywhere in the body or be the result of cephalgia from a systemic condition.

NOTE: Table 5.2 is too large for this format, but you can view it at:

Cluster migraine (Horton's histamine cephalgia) is the most severely painful type of headache. Patients unable to find relief often contemplate suicide. The unilateral, paroxysmal, localized pain usually begins in the temporal-supraorbital area and radiates to the occiput but the opposite course is sometimes seen.


      Background

The pain is usually first noticed when it awakes the patient after a few hours of sleep. Infrequently, it arises in the evening hours. The highest incidence is in adult males, and attacks appear to be severest in the spring and fall. This latter points suggests that an allergic reaction involved. The duration of an attack is usually from 30 to 90 minutes but may be sustained for several hours. The patient is pain free between attacks. The course reappears in episodes (clusters) that last from a few days to several months. The headaches disappear for several weeks or months, and then arise again.

Associated features include unilateral nasal stuffiness, conjunctival injection, flush, and other signs of vasodilation. Other related signs are tender carotid arteries, pupil constriction, photophobia, hyperlacrimation, and slight rhinorrhea. GI disturbance is invariably involved even if it is not reported by the patient.

The pain is so severe that even morphine offers little relief. Yet chiropractic attention toward correcting the focal disturbance (usually gastric or duodenal) will solve the problem in most instances.


      Diagnostic Workup

Conduct a thorough physical examination and consider the following workups according to clinical judgment:

Allergy tests	Hair analysis	Spinal roentgenography
Blood smear	Hemoglobin level	Thermography
CBC and differential	Sedimentation rate	Thyroid function tests
Chest x-ray	Serum electrolytes	Tonometry
ECG	Sinus/orbital x-ray	Urinalysis
EEG	Skull x-ray	VD serology

Motion palpate the spine, and relate findings with the patient's complaints. Confirm findings with appropriate orthopedic and neurologic tests (Table 16.16, Fig. 16.1). Test for autonomic imbalance (Table 16.7) if suspicions of vagotonia or sympathicotonia arise.


      Eclectic Diagnostic Aids

Check alarm points (Table 16.15), visceral Valleix areas of the foot (Fig. 16.2), Chapman's points (Fig. 16.6), and potential contributing trigger points (Tables 16.28 16.31).


      Spinal Adjustment

Spinal majors will likely be found at C1 and T7—T8. After relaxing the tissues and adjusting the subluxated/fixated segments, apply deep high-velocity percussion spondylotherapy over segments T6—T8 for 4—5 minutes (Table 16.20).


      Adjunctive Therapy

To restore further neurologic homeostasis and enhance healing:

• Treat acupoints LI–11, LU–7, ST–36, LV–3, CV–12, UB–54 (Table 16.21).

• Treat auriculopoints 31, 34, 37, 87, 51 ((Figs 16.3 4).

• Treat hand points LI–4 and SI–3 (Fig. 16.5).

• If the Valleix stomach or ileocecal valve reflex areas in the feet are tender, massage each to patient's tolerance for 20 seconds (Fig. 16.2).

• Treat trigger points discovered, especially those found in the rectus abdominis and sternocleidomastoideus muscles (Tables 16.28–31).

• If Chapman's gastric point is tender, deeply massage it to patient's tolerance for 10 seconds while simultaneously holding firm fingertip contact against the respective spinal area with your other hand (Fig. 16.6). These points are summarized in Figure 5.1.ds while simultaneously holding firm fingertip contact against the respective spinal area with your other hand (Fig. 16.6).

Frontal headaches, like cluster headaches, often originate from a gastrointestinal disturbances but the syndrome is far less severe. Symptoms mimicking an allergic reaction are absent, and radiation is rare. In women, a hormonal imbalance may be involved as the episodes usually peak just before the onset of menstruation.


      Background

Of all forms of headache, frontal headaches are more likely to be selflimiting. In contrast to common frontal headaches, periorbital or brow pain usually has its origin in the eyes —such as in glaucoma, iritis, refractive errors, and visual abuse. The pain is aggravated by continued use of the eyes.

Hypoglycemia frequently manifests as a diffuse frontal headache that lasts about 3 hours between meals. Some feel that it is easily recognized because it disappears on eating but this also may be true for a gastric ulcer-induced headache. Trembling, irritability, fatigue, dizziness, hyperhidrosis, and weakness are usually associated with hypoglycemia.


      Diagnostic Workup

Conduct a thorough physical examination and consider the following workups according to clinical judgment:

Allergy tests	Hemoglobin level	Spinal roentgenography
Blood smear	Sedimentation rate	Temperature chart
CBC and differential	Serum electrolytes	Tonometry
Discharge culture	Sinus/orbital x-ray	Urinalysis

Motion palpate the spine, and relate findings with the patient's complaints. Confirm findings with appropriate orthopedic and neurologic tests (Table 16.16, Fig. 16.1). Test for autonomic imbalance (Table 16.7) if suspicions of vagotonia or sympathicotonia arise.


      Eclectic Diagnostic Aids

Check alarm points (Table 16.15), visceral Valleix areas of the foot (Fig. 16.2), Chapman's points (Fig. 16.6), and potential contributing trigger points (Tables 16.28 16.31).


      Spinal Adjustment

Spinal majors will likely be found at C2, T7, and SI. After relaxing the tissues and adjusting the subluxated/fixated segments, apply deep high-velocity percussion spondylotherapy over segment T8 and low-velocity percussion over segments S2—S4.


      Adjunctive Therapy

To restore further neurologic homeostasis and enhance healing:

• Treat acupoints LU–7, GB–14, GB–20, UB–2, SP–6 (Table 16.21).

• Treat auriculopoints 33, 29, 37, 55, 34 (Figs 16.3 4).

• Treat hand points LI–4 and TH–1 (Fig. 16.5).

• If the Valleix stomach or ileocecal valve reflex areas in the feet are tender, massage each to patient's tolerance for 20 seconds (Fig. 16.2).

• Treat trigger points discovered, especially those found in the sternocleidomastoideus, frontalis, and zygomaticus muscles (Tables 16.28–31).

• If Chapman's gastric, duodenal, or uterus points are tender, deeply massage each to patient's tolerance for 10 seconds while simultaneously holding firm fingertip contact against the respective spinal area with your other hand (Fig. 16.6). These points are summarized in Figure 5.2.

Migraine is characterized by an initially unilateral localized throbbing temple or orbital pain (sometimes frontal) that soon radiates to the parietal or occipital skull. Bilateral types are not rare.


      Background

The disorder usually arises during early adulthood and is more common in females than males. A family tendency may be found in the history. If so, this author believes that this is more coincidental than indicative of a genetic factor. An attack may last for several days in which short periods of relief are found. A typical attack lasts less than 24 hours. Some type of stress is usually a precipitating factor.

Despite the characteristics described, the diagnosis of migraine is usually supported by its confirmative prodromal features. There is an initial vasoconstriction (amine release) in 10% of migraine patients that produces prodromal symptoms such as a visual aura or motor or sensory perversions. This is the effect of ischemia, which signals a forthcoming period of vasodilation (vasoactive substance release). It is this vasodilation that produces the headache. Associated scintillating scotomata, nausea, vomiting, anorexia, and emotional problems are common prodromic neurologic signs are usually accentuated contralaterally. Hemianopsia, hemiparesis, amblyopia, and ophthalmoplegia manifest in severe cases. All cases appear to be sensitive to bright light and noise during an attack. Facial paresthesia, speech impairment, and general motor weakness are sometimes associated.


      Diagnostic Workup

Conduct a thorough physical examination and consider the following workups according to clinical judgment:

Allergy tests	Hemoglobin level	Spinal roentgenography
Blood smear	Sedimentation rate	Thermography
CBC and differential	Serum electrolytes	Tonometry
Chest x-ray	Sinus/orbital x-ray	Urinalysis
EEG	Skull x-ray	VD serology

Motion palpate the spine, and relate findings with the patient's complaints. Confirm findings with appropriate orthopedic and neurologic tests (Table 16.16, Fig. 16.1). Test for autonomic imbalance (Table 16.7) if suspicions of vagotonia or sympathicotonia arise.


      Eclectic Diagnostic Aids

Check alarm points (Table 16.15), visceral Valleix areas of the foot (Fig. 16.2), Chapman's points (Fig. 16.6), and potential contributing trigger points (Tables 16.28 16.31).


      Spinal Adjustment

Spinal majors will likely be found at C2, T1—T2, and SI. After relaxing the tissues and adjusting the subluxated/fixated segments, apply deep low-velocity percussion spondylotherapy over segments T1—T2 and high-velocity percussion over S2—S4 (Table 16.20).


      Adjunctive Therapy

To restore further neurologic homeostasis and enhance healing:

• Treat acupoints unilateral GB–8, GB–20, SP–6, CV–12, CV–4 (Table 16.21).

• Treat auriculopoints 34, 35, 37, 55, 95 (Figs 16.3 4).

• Treat hand points LU–9, LI–4 (Fig. 16.5).

• If the Valleix eye reflex areas in the feet are tender, massage each to patient's tolerance for 20 seconds (Fig. 16.2).

• Treat trigger points discovered, especially those found in the splenius cervicis, sternocleidomastoideus, temporalis, and suboccipital group muscles (Tables 16.28–31).

• If Chapman's eye or intrinsic spinal muscle points are tender, deeply massage each to patient's tolerance for 10 seconds while simultaneously holding firm fingertip contact against the respective spinal area with your other hand (Fig. 16.6). These points are summarized in Figure 5.3.

Occipital headache is a general term referring to any type of cephalgia perceived to originate in the back of the head. They are called hypertensive headaches when related with arterial hypertension or tension headaches when associated with an emotional base. Either situation signals a state of hypersympathicotonia, which directs chiropractic management. It should be noted, however, that sinusitis often refers pain to the occipital area. This is especially true for the maxillary and sphenoid sinuses.


      Background

Hypertensive headaches are frequently seen in patients with a diastolic pressure greater than 120 mm Hg. As in cardiac or renal insufficiency, the paroxysmal, diffuse, often throbbing occipital (sometimes vertex) pain is usually worse on awakening and improves as the day progresses.

In contrast to hypertensive headaches, tension headaches are absent on arising and gradually increase in severity as the day (and its stress) progresses. Similar to cluster headaches, they tend to manifest within a several week period and then disappear, only to rise again later.

The occipital type of tension headache exhibits severe contraction of the muscles of the neck and scalp during an attack. Residual effects of this spasm can be palpated for a day or two after an attack. It also can be demonstrated in electromyography. In severe attacks, the occipital pain will radiate over the entire cranium and down the back of the neck. Cervical stiffness, occipitoparietal paresthesia, and suboccipital trigger points are commonly associated.

In differentiation, another type of tension headache is the "hat band" type, which is perceived as a constriction around the circumference of the skull. Anxiety, depression, or a "burn out" syndrome is usually involved. Easily lost emotional control and hyperactive reflexes are usually associated.


      Diagnostic Workup

Conduct a thorough physical examination and consider the following workups according to clinical judgment:

Blood cholesterol	EMG	Spinal roentgenography
Blood lipids	Hemoglobin level	Thermography
CBC and differential	Sedimentation rate	Thyroid function tests
Chest x-ray	Serum electrolytes	Tonometry
ECG	Skull x-ray	Urinalysis

Motion palpate the spine, and relate findings with the patient's complaints. Confirm findings with appropriate orthopedic and neurologic tests (Table 16.16, Fig. 16.1). Test for autonomic imbalance (Table 16.7) if suspicions of vagotonia or sympathicotonia arise.

In almost all cases of occipital headaches, it will be found that the occipitoatlantal area is severely fixated and the C2 segment is hypermobile. Palpation of C2 will reveal severe tenderness. Passive upper cervical traction will invariably reproduce both primary and secondary symptoms.


      Eclectic Diagnostic Aids

Check alarm points (Table 16.15), visceral Valleix areas of the foot (Fig. 16.2), Chapman's points (Fig. 16.6), and potential contributing trigger points (Tables 16.28 16.31).


      Spinal Adjustment

Spinal majors will likely be found at C1 and L3. After relaxing the tissues and adjusting the subluxated/fixated segments, apply deep low-velocity percussion spondylotherapy over the midlumbar segments and high-velocity percussion over the midsacrum.


      Adjunctive Therapy

To restore further neurologic homeostasis and enhance healing:

• Treat acupoints GB–20, UB–6, UB–60, HT–7, GV–19 (Table 16.21).

• Treat auriculopoints 29, 33, 34, 37, 55 (Figs 16.3 4).

• Treat hand point LI–4 (Fig. 16.5).

• If the Valleix colon or kidney reflex areas in the feet are tender, massage each to patient's tolerance for 20 seconds (Fig. 16.2).

• Treat trigger points discovered, especially those found in the occipitalis, suboccipital group, splenius cervicis, and trapezius muscles (Tables 16.28–31).

• If Chapman's colon or kidney points are tender, deeply massage each to patient's tolerance for 10 seconds while simultaneously holding firm fingertip contact against the respective spinal area with your other hand (Fig. 16.6). These points are summarized in Figure 5.4.

Temporal headaches are perceived to originate in the temple area and possibly radiate to the supraorbital and/or parietal regions. They are almost always unilateral, and their cause is often a noxious reflex arising from the mediastinum or pericardium. TMJ dysfunction is another common factor.


      Background

Nonpathologic temporal headaches must be differentiated from those associated with temporal arteritis — a potentially dangerous condition. Here, the temporal arteries will be tender to light touch and sometimes nodules will appear in the skin over the distribution of the temporal arteries. Attacks may last for several weeks and be associated with diplopia and an elevated erythrocyte sedimentation rate. Prompt attention is necessary to avoid permanent blindness.


      Diagnostic Workup

Conduct a thorough physical examination and consider the following workups according to clinical judgment:

Blood smear	Hemoglobin level	Skull x-ray
CBC and differential	Sedimentation rate	Spinal roentgenography
Chest x-ray	Serum electrolytes	Tonometry
ECG	Sinus/orbital x-ray	Urinalysis

Motion palpate the spine, and relate findings with the patient's complaints. Confirm findings with appropriate orthopedic and neurologic tests (Table 16.16, Fig. 16.1). Test for autonomic imbalance (Table 16.7) if suspicions of vagotonia or sympathicotonia arise.


      Eclectic Diagnostic Aids

Check alarm points (Table 16.15), visceral Valleix areas of the foot (Fig. 16.2), Chapman's points (Fig. 16.6), and potential contributing trigger points (Tables 16.28 16.31).


      Spinal Adjustment

Spinal majors will likely be found at C3—C4 and T3—T4. After relaxing the tissues and adjusting the subluxated/fixated segments, apply deep low-velocity percussion spondylotherapy over segments T3—T4 for 1—2 minutes (Table 16.20).


      Adjunctive Therapy

To restore further neurologic homeostasis and enhance healing:

• Treat acupoints ST–7, GB–8, LU–7, SP–6 (Table 16.21).

• Treat auriculopoints 29, 33, 34, 37, 55 (Figs 16.3 4).

• Treat hand points LI–4, TH–1 (Fig. 16.5).

• If the Valleix heart reflex area in the left foot is tender, massage to the patient's tolerance for 20 seconds (Fig. 16.2).

• Treat trigger points discovered, especially those found in the left pectoralis major, upper trapezius, and sternalis muscles (Tables 16.28–31).

• If Chapman's heart point is tender, deeply massage to patient's tolerance for 10 seconds while simultaneously holding firm fingertip contact against the respective spinal area with your other hand (Fig. 16.6). These points are summarized in Figure 5.5.

Toxic headaches are the result of foreign substances entering the blood or normal elements found in excessive amounts.


      Background

The term toxicosis (poisoning) is a confusing word because of its scope. It may refer to such states as heavy metal poisoning, drug poisoning, poisoning from noxious fumes, the accumulation of bacterial toxins, septicemia, bromism, hypervitaminosis, etc. It may refer to the impure state of the blood as seen in uremia and many metabolic disorders or from the ingestion of high levels of lead or copper from one's water supply. It may be the result of eating a large quantity of a single type of food. It can be the result of inhalation or ingestion of many household pesticides, cleaning fluids, exhaust fumes, and caustic powders or solutions. Inhalation of the fumes of burning fat in an outdoor grill can be highly toxic. It also may refer to the common overuse of caffeine, nicotine, alcohol, or nitrates. More commonly, it is used to describe a chronic state of endogenous toxication resulting from partially digested proteins, fats, or carbohydrates entering the blood stream where they serve more as "pollutants" than nutrients (and a hardship on the liver, kidneys, and enzyme system). Only by understanding the context in which the word is used can it be differentiated.

Toxic headaches can be the result of any of these factors. The detoxification and elimination mechanisms of the body can handle just so much. After the limit is reached, toxicosis results.


      Diagnostic Workup

Conduct a thorough physical examination and consider the following workups according to clinical judgment:

Allergy tests	Hair analysis	Serum bicarbonates
Blood pH	Hemoglobin level	Serum CO425
Blood smear	Plasma adolase	Verum electrolytes
CBC and differential	Plasma creatine phosphokinase	Serum total protein
Discharge culture	Plasma globulins	Spinal roentgenography
Drug scan	Platelet count	Stool analysis
ECG	Renal function studies	Urinalysis
EEG	Sedimentation rate	Urine calcium
EMG	Serum albumin	Urine pH

Motion palpate the spine, and relate findings with the patient's complaints. Confirm findings with appropriate orthopedic and neurologic tests (Table 16.16, Fig. 16.1). Check pertinent tendon and superficial reflexes (Tables 16.2), and grade the reaction (Table 16.3). Check involved joint motion and muscle strength against resistance, and grade resistance strength (Table 16.9). Interpret resisted motion signs (Table 16.6). Perform tests for autonomic imbalance (Table 16.7) if suspicions of vagotonia or sympathicotonia arise.


      Eclectic Diagnostic Aids

Check alarm points (Table 16.15), visceral Valleix areas of the foot (Fig. 16.2), Chapman's points (Fig. 16.6), and potential contributing trigger points (Tables 16.28 16.31).


      Spinal Adjustment

When endogenous toxicosis is involved, spinal majors will likely be found at C2—C3, T10—T11. After relaxing the tissues and adjusting the subluxated/fixated segments, apply deep low-velocity percussion spondylotherapy over segments T10—T11 for 1—2 minutes and high-velocity percussion over the base of the sacrum for 3—4 minutes (Table 16.20).


      Adjunctive Therapy

To restore further neurologic homeostasis and enhance healing:

• Treat acupoints LV–3, ST–36, LU–7 (Table 16.21).

• Treat auriculopoints 55, 61, 76, 95, 97 (Figs 16.3 4).

• Treat hand points LU–10, SI–1 (Fig. 16.5).

• If the Valleix liver, kidney, or colon reflex areas in the feet are tender, massage each to patient's tolerance for 20 seconds (Fig. 16.2).

• Treat trigger points discovered, especially those found in the rectus abdominis and oblique muscles (Tables 16.28–31).

• If Chapman's liver, kidney, or colon points are tender, deeply massage each to patient's tolerance for 10 seconds while simultaneously holding firm fingertip contact against the respective spinal area with your other hand (Fig. 16.6). These points are summarized in Figure 5.6.

      Nutritional Therapy

Supplemental nutrients B1, C, choline, pantothenic acid, and magnesium are recommended. Counsel the patient to avoid appropriate antivitamin and antimineral factors (Tables 16.56 and 16.58).


      Elective Procedures

A 2–day fast excepting fresh fruit and raw vegetable juices and a coffee enema each day of the fast is very helpful in cleaning the intestinal tract. An abundance of fresh fruits and vegetables should be incorporated into the diet. The following should be used freely in cooking for several months: cored apple with peel, figs, honey, licorice, prunes, raw spinach, strawberries, basil, cloves, pinches of cayenne pepper, powdered fennel, oatmeal, and brewed peach pits in herbal tea that contains no cloves.