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Effectiveness of Spinal Manipulation for Headaches

Headache is one of the most common conditions seen in chiropractic offices. Over the last decade headache represented 13% of chiropractic patient’s presenting complaints. Headaches not only have a significant adverse impact on adults but “frequent or severe headaches including migraine in the past 12 months were reported in 17.1% of children.” Extensive research has addressed the many types of headache and the last year has seen several important publications investigating the effectiveness of chiropractic treatment and spinal manipulation.

An extensive review of the literature will appear in the next issue of the Journal of Manipulative and Physiological Therapeutics (JMPT) and provides guidelines for chiropractic treatment of adult headaches. The work was done by a group of Canadians and documents the research support for chiropractic management (high-velocity, low-amplitude thrusts) for both migraine and cervicogenic headaches. Mobilization may also be effective for tension-type headache and cervicogenic headache.

A new Dutch study of chronic tension type headache (CTTH) compared treatment from medical providers in general practice (GP) to chiropractic. That study concluded that “Manual therapy is more effective than usual GP care in the short- and longer term in reducing symptoms of CTTH.”

Evidence-based guidelines for the chiropractic treatment of adults with headache. [Link]

J Manipulative Physiol Ther. 2011 Jun;34(5):274-89.

Bryans R, Descarreaux M, Duranleau M, Marcoux H, Potter B, Ruegg R, Shaw L, Watkin R, White E.
Guidelines Development Committee Chair and Chiropractor, Private Practice, Clarenville, Newfoundland and Labrador, Canada.

OBJECTIVE: The purpose of this manuscript is to provide evidence-informed practice recommendations for the chiropractic treatment of headache in adults.

METHODS: Systematic literature searches of controlled clinical trials published through August 2009 relevant to chiropractic practice were conducted using the databases MEDLINE; EMBASE; Allied and Complementary Medicine; the Cumulative Index to Nursing and Allied Health Literature; Manual, Alternative, and Natural Therapy Index System; Alt HealthWatch; Index to Chiropractic Literature; and the Cochrane Library. The number, quality, and consistency of findings were considered to assign an overall strength of evidence (strong, moderate, limited, or conflicting) and to formulate practice recommendations.

RESULTS: Twenty-one articles met inclusion criteria and were used to develop recommendations. Evidence did not exceed a moderate level. For migraine, spinal manipulation and multimodal multidisciplinary interventions including massage are recommended for management of patients with episodic or chronic migraine. For tension-type headache, spinal manipulation cannot be recommended for the management of episodic tension-type headache. A recommendation cannot be made for or against the use of spinal manipulation for patients with chronic tension-type headache. Low-load craniocervical mobilization may be beneficial for longer term management of patients with episodic or chronic tension-type headaches. For cervicogenic headache, spinal manipulation is recommended. Joint mobilization or deep neck flexor exercises may improve symptoms. There is no consistently additive benefit of combining joint mobilization and deep neck flexor exercises for patients with cervicogenic headache. Adverse events were not addressed in most clinical trials; and if they were, there were none or they were minor.

CONCLUSIONS: Evidence suggests that chiropractic care, including spinal manipulation, improves migraine and cervicogenic headaches. The type, frequency, dosage, and duration of treatment(s) should be based on guideline recommendations, clinical experience, and findings. Evidence for the use of spinal manipulation as an isolated intervention for patients with tension-type headache remains equivocal.