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Center for Integrative Medicine, Spring 2013

Chiropractic Treatment for Migraines

Think outside the box for pain relief

If you suffer from migraines, and medications don’t help, Cleveland Clinic’s Center for Integrative Medicine offers an alternative: chiropractic treatment.

“Migraine patients will come in and say, ‘I didn’t know there were other options!’” says Andrew Bang, DC, a chiropractic physician in the Center for Integrative Medicine.

Migraine headaches can last from two to 72 hours, causing intense pain and symptoms such as visual disturbances, nausea and light sensitivity. Chiropractic treatment can lessen their intensity and frequency.

“Some people find instant relief and walk out of the office with no pain,” says Dr. Bang. “Others follow an in-office treatment plan and home instructions, and find that migraines occur less often.”

Evaluating muscles and vertebrae

Migraines may be caused by problems in the muscles or spine. Dr. Bang begins his evaluation by examining the muscles of the neck, shoulder and back. Muscles that are tight or constricted and spasmodic (hypertonic) can affect migraines.

“I also check the form and alignment of the cranial bones in the skull. They play a major role in migraines,” says Dr. Bang. He then checks the alignment of the entire spine.

Manipulation can bring quick relief

Different therapies are employed depending on the problems found. Chiropractic manipulation can help when vertebrae in the upper spine or cranial bones are misaligned. Gentle realignments that ensure good range of motion can sometimes bring quick relief.

Manipulation is done only when safe for the particular patient; those with bones weakened by osteoporosis are not candidates, for example.

Therapy can reduce intensity

In other instances, Dr. Bang prescribes physical therapy to do at home. Basic stretches can slow the progression of a headache and prevent it from becoming a full-blown migraine.

“Occasionally, some patients will experience stiffness in the neck after their first visit, like going to the gym for the first time,” says Dr. Bang.

The Center for Integrative Medicine also offers acupuncture treatment for migraines.

For appointments with Dr. Bang in the Center for Integrative Medicine, call 216.986.HEAL (4325).

Integrative Treatments for Allergies

Answers to questions about two popular products

By Christine Spiroch, PhD, PA-C, Integrative Medicine Practitioner

The time for seasonal allergies is upon us. Environmental allergies may also flare. Choices to treat nasal congestion, watery eyes, itchy noses and other symptoms of allergic rhinitis range from single ingredients to combination products.

Below are answers to some questions about two popular integrative medicine treatments:

What is stinging nettle?
Stinging nettle (Urtica dioica) is derived from the leaves of a flowering plant. It is found in many over-the-counter decongestants, antihistamines and other allergy relief products.

How do you use stinging nettle?
A common dose is 600 milligrams of the freeze-dried plant at the onset of symptoms for one week if taken alone. Over-the-counter combination products are available, usually in capsules that may include about 200 milligrams of stinging nettle leaf plus:

  • Quercetin: About 200 milligrams
  • Bromelain (from pineapple): About 50 milligrams
  • N-acetyl-l-cysteine: About 25 milligrams
  • Vitamin C (as ascorbic acid): About 150 milligrams

Find the recommended amount on the Supplement Facts panel on the product package.

How well does stinging nettle work?
The use of stinging nettle for allergic rhinitis has received only moderate endorsement from a research perspective, according to the Natural Standard Database.

Are there risks associated with stinging nettle?
For some people, stinging nettle can intensify allergy symptoms. It may be best not to take alone, but as part of a combination product for allergies.

What is a neti pot?
The neti pot, resembling a teapot or Aladdin’s lamp, is a form of nasal irrigation. Many people with chronic nasal congestion, sinusitis, or allergies use the neti pot either on a regular basis or as needed. The process of flushing out the mucus differentiates the neti pot from many nasal sprays.

How do you use the neti pot?
Typically, lukewarm distilled water is mixed with about 1 teaspoon of sea salt to irrigate the nasal passages. As you stand over a sink, pour the neti pot in one nostril; the water comes out through the other nostril. Repeat the process on the other side.

How well does the neti pot work?
Many people are faithful neti pot users, employing it daily to maintain clear nasal passages, or to improve or maintain healthy breathing. Those who are impatient for results may not succeed. It can take a few tries to feel comfortable inserting the neti pot spout into the nostril.

Are there risks associated with the neti pot?
It’s important to be careful whenever you insert a foreign object into a body cavity. Be sure to properly clean and store the neti pot after each use.

To make an appointment in the Center for Integrative Medicine with Dr. Spiroch or other experts, please call 216.986.HEAL (4325).

An Integrative Medicine Approach to Fatigue

Looking for less obvious causes

If you have persistent fatigue and your doctor’s tests all come back normal, don’t sink back into that sofa. Ask for an integrative medicine consult.

Once thyroid, heart, liver, kidney and other problems are ruled out, integrative medicine experts step in.

“We look for the less obvious roots of fatigue — that’s our job,” says Tanya Edwards, MD, of the Center for Integrative Medicine.

She starts by addressing the most likely dietary cause for fatigue with solutions like these:

1. Eat a healthy diet.
Eating lots of trans and saturated fats, processed foods and added sugars doesn’t help fatigue.

“I recommend a diet that is high in good sources of protein — mainly fish, nuts, seeds and beans,” says Dr. Edwards. “If you do dairy, choose organic fat-free dairy sources. And if you do meat, choose meat that is organic, free range, with no antibiotics, no hormones and no steroids.”

Eight to 10 servings of fruits and vegetables per day are essential, says Dr. Edwards. But she limits grain because of its effects on insulin. “Insulin is the storage hormone that makes us heavier. The heavier we are, the higher our blood sugar becomes and the more insulin resistance (prediabetes) we develop,” she explains.

2. Take a multivitamin.
The best diet in the world can’t make up for minerals and vitamins lost from industrial farming practices. “That is why I recommend a multivitamin/mineral supplement,” says Dr. Edwards.

Examples of fatigue-fighting nutrients not easily found in food are:

  • Selenium, a mineral important for thyroid function and metabolism.
  • Iodine, a mineral present in iodized salt, which people with heart disease and high blood pressure avoid. “Low iodine states can result in fatigue,” says Dr. Edwards.

3. Take an omega 3 supplement.
Omega 3 fatty acids, which combat fatigue, are present in fish. But most of us don’t eat enough of it. “I recommend about 1,000 milligrams of an omega 3 supplement,” says Dr. Edwards. “My preference is fish oil because it is the long-chain form that our body needs.”

4. Get sufficient vitamin D.
Vitamin D is needed for energy — low levels cause low energy and depression. “Vitamin D and omega-3 are necessary for every single cell in the body — including brain cells — to work properly,” says Dr. Edwards. If blood tests reveal low vitamin D levels, she recommend supplements.

5. Take magnesium.
We are born with a finite amount of magnesium — a mineral needed for energy production — in our bones and muscles. The vast majority of Americans get less than half the amount needed in their diet.

“Magnesium is still leaching out of our bones and muscles in our 40s and 50s,” says Dr. Edwards. She recommends magnesium replacement for people with symptoms of a total body deficit. These include insomnia, fatigue, constipation, muscle cramps and pain, joint pain, anxiety and elevated blood pressure.

6. Get help for sleep problems.
When it comes to sleep difficulties, “we’ve got the perfect storm happening in our 40s and 50s,” says Dr. Edwards. Reasons for lost sleep include increased work responsibilities, living with teenagers, aging parents and falling magnesium levels.

For women, menopause and perimenopause are also factors. Falling levels of progesterone — a female hormone that helps us sleep — combine with hot flashes to deprive women of sleep.

So does a change in women’s ability to metabolize caffeine. “Women who have had two cups of coffee a day since age 20 suddenly can’t metabolize it as fast at age 50,” says Dr. Edwards. Caffeine takes eight to 10 hours — rather than five — to clear the system. So it may be time to switch to just one cup of regular coffee, before 10 a.m.

7: Move.
Dr. Edwards also advocates exercise. Ironically, not getting enough of it can make us feel tired.

Finally, if fatigue does not improve after a couple of months, she may recommend:

  • Acupuncture. “It can be huge for fatigue, sleep, pain and hot flashes,” says Dr. Edwards.
  • B complex vitamins. These help our bodies make energy, especially in times of stress.
  • Coenzyme Q10. This cofactor helps body enzymes produce energy, but its production in our cells can be blocked by statin drugs.

For an integrative medicine consult about fatigue with one of our physicians, call the Center for Integrative Medicine at 216.986.HEAL (4325).

Women, Empower Yourselves in Our Week-long Event

Join us for Women's Wellness Week, a unique experience at the Center for Integrative Medicine from Nov. 10 to 17, 2013, in Captiva, Fla. Get the integrative medicine perspective on fitness, nutrition, stress reduction and life balance. Enjoy healthy Mediterranean-style cuisine prepared by our chef. Leave with all the tools you’ll need to make healthy changes happen!

Visit for details and registration.

New Hypnotherapist Joins Center for Integrative Medicine

The Center for Integrative Medicine welcomes clinical hypnotherapist and social worker Kathleen Usaj, LISW-S, CHT. Ms. Usaj is certified as a heart-centered hypnotherapist, child light yoga instructor, reiki practitioner and breathwork practitioner. She comes to our center with more than 20 years’ experience helping children and families who struggle with physical and mental health challenges. Ms. Usaj blends transformational healing practices with traditional therapies to address mind, body and spirit. She has a Master of Science in social administration from Case Western Reserve University and extensive postgraduate training.

To see Ms. Usaj at our Lyndhurst campus starting June 7, 2013, please call 216.986.HEAL (4325).

Recipe: Easy Spinach Frittata

From the Center for Integrative Medicine's TRIM-LIFE® program


2 cups fresh spinach
¼ cup chopped green onion
½ teaspoon dill weed (fresh or dried)
1 teaspoon olive oil
Two omega-3 eggs
¼ cup organic low-fat feta cheese
Salt and pepper to taste
1/3 cup organic fat-free plain yogurt

  1. Sauté spinach, green onion and dill in olive oil. When completely cooked, spread out evenly over bottom of pan, and add beaten, salt-and-peppered eggs.
  2. Sprinkle with feta cheese. Cover pan and cook on low heat until completely done (5 to 10 minutes).
  3. Slide from pan onto plate, and eat with plain yogurt if desired.
Nutrition Information

Makes one serving

Calories: 320
Total fat: 18 g
Saturated fat: 6 g
Trans fat: 0 g
Cholesterol: 440 mg
Sodium: 880 mg
Total carbohydrate: 15 g
Dietary fiber: 3 g
Sugars: 8 g
Protein: 24 g