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10 Articles in Volume 9, Issue #5
Dextrose Prolotherapy for Recurring Headache and Migraine Pain
Diagnosis of Low Back Pain
Ethics, Education, and Policy: Relationship and Mutual Reliance
Human Chorionic Gonadotropin in Pain Treatment
Musculoskeletal Ultrasound
Painful Herpetic Reactivation and Degenerative Musculoskeletal Injury
Post-stroke Pain
Preventive Medications for Chronic Daily Headache
The Pathophysiology of Neuropathic Pain
Use of Pulsed Radiofrequency in Clinical Practice

Dextrose Prolotherapy for Recurring Headache and Migraine Pain

This retrospective case series study revealed that Hackett-Hemwall dextrose prolotherapy appears to provide an effective, long-lasting treatment for recurring tension and migraine headache pain and their associated symptoms.
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Headaches and migranes are a common occurrence and can be multi-factorial in origin with various triggers. It is thought that weak or loose neck ligaments and/or tendons may act as headache triggers in some people, validating the use of dextrose prolotherapy as a reasonable treatment option. To this end, the authors of this retrospective pilot study analyzed treatment of patients at the Beulah Land charity medical clinic which operated from 1994 to 2005 in Thebes, Illinois. The authors have done an excellent job of collecting and interpreting the data and discussing the issues in this most interesting study.

Approximately four percent of adults experience headaches nearly every day.1 Migraine headaches, tension-type headaches, and other recurrent headache pain syndromes remain challenging for clinicians and patients alike in terms of finding the most effective and safest therapies. According to the National Institute of Neurological Disorders and Stroke (NINDS), the American Council for Headache Education (ACHE), and the National Headache Foundation, over 45 million Americans suffer from chronic, recurring headaches and, of these, 28 million suffer from migraines.2,3 While migraines affect 12% of the adult population in the United States, at least 90% have experienced a tension-type headache.4 Despite headache being one of the top 10 reasons cited for an outpatient medical visit, they continue to present a challenging and difficult problem for both medical professionals and patients.5,6 Debilitating headache pain presents a tremendous economic impact on society—not only with direct costs, but also on indirect costs such as a loss of productivity.7 Unfortunately, a reported 49% of headache sufferers do not seek medical care and of those who do, only 28% are very satisfied with the treatment they receive.8

While medicine carries 150 diagnostic headache categories, the vast majority of recurring headaches are classified as either migraine or tension. The most common headache types among adults and adolescents are tension headaches, chronic daily headaches or chronic non-progressive headaches. These muscle contraction headaches cause mild to moderate pain and come and go over a prolonged period of time. Migraine headache pain is often moderate to severe and described as a pounding, throbbing pain lasting from four hours to three days, and usually occurring one to four times per month. Migraines are associated with symptoms such as light sensitivity, noise or odor sensitivity, nausea or vomiting, loss of appetite and stomach upset or abdominal pain. Typical medical treatments for tension or migraine headaches involve the use of medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), triptans or muscle relaxants. Despite the advances in migraine-specific drugs, only 50% of patients with migraine headaches attain more than 50% reduction of headache frequency after three months of treatment.9,10

While some headache sufferers get relief—with avoidance of various foods like chocolate, tyramine-containing cheese and alcoholic beverages, work station ergonomic modification, rest, stress control, and other lifestyle modifications—the bottom line of most of these traditional approaches is that the individual becomes dependent on headache medications and often lives in fear of the next migraine attack or tension headache.11,12 Sometimes, the drugs themselves can transform episodic headaches into continuous daily headaches.13,14

Other modalities for treating headaches relate evidence associating headache and migraine pain to vascular changes. Current research suggests that a vascular concept is implausible since vascular changes do not explain the symptoms of attacks and, at the same time, drugs used to treat headaches and migraines do not demonstrate much effect on blood vessels.15-22

Numerous risk factors, often labeled “triggers,” may result in a migraine-eliciting environment. These include skipped meals, sleep deprivation, hormonal changes, alcohol consumption and acute stress, among others. Individuals may also report pain sensations in areas innervated by the trigeminal system—notably nasal and neck regions, which can then lead to misdiagnosis of sinus or tension headache.23

Figure 1. Typical areas injected during cervical Hackett-Hemwall dextrose prolotherapy.

Weak or loose ligaments and tendons similarly can become “triggers” for migraine and headache pain. Without treatment, over time, one would begin to see an increase in frequency, duration or intensity of migraine or tension headaches if these loose areas were left untreated.24 Given the limitations of traditional medical therapies for headaches, some headache sufferers are turning to alternative therapies—including prolotherapy which addresses the issue of loose ligaments and tendons in the head and/or neck.25,26

Prolotherapy Modality

Prolotherapy, as defined by Webster’s Third New International Dictionary, is “the rehabilitation of an incompetent structure, such as a ligament or tendon, by the induced proliferation of cells.” The word “prolo” comes from the word proliferate meaning “to grow.” George S. Hackett, MD, the originator of the technique, coined the term prolotherapy.27 Gustav A. Hemwall, MD was Hackett’s protégé and the main proponent for utilizing and teaching the technique of dextrose prolotherapy from the 1950s through the late 1990s, hence the “Hackett-Hemwall” name. Prolotherapy injections proliferate or stimulate the growth of new, normal ligament and tendon tissue.28 In human prolotherapy studies, biopsies performed after the completion of treatment showed statistically significant increases in collagen fiber and ligament diameter of up to 60% in the treated areas.29 Prolotherapy is based on the theory that the cause of most chronic musculoskeletal pain is ligament and/or tendon weakness (or laxity). Prolotherapy has been shown in one double-blind animal study over a six-week period to increase ligament mass by 44%, ligament thickness by 27%, and the ligament-bone junction strength by 28%.30 Another animal study confirmed that prolotherapy induced the normal healing reaction that occurs when an injured tissue is healing itself. In this study, the prolotherapy treatment caused the circumference of tendons to increase by approximately 25% after six weeks.31

Last updated on: January 28, 2012