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.”
A previous review of cervicogenic headache can be found here.
Note: These mini-reviews are designed as updates and direct the reader to the full text of current research. The abstracts presented here are no substitute for reading and critically reviewing the full text of the original research. Where permitted we will direct the reader to that full text.
Evidence-based guidelines for the chiropractic treatment of adults with headache.
] J Manipulative Physiol Ther.
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.
Effectiveness of manual therapy for chronic tension-type headache: a pragmatic, randomised, clinical trial.
2011 Jan;31(2):133-43. Epub 2010 Jul 20.
Castien RF, van der Windt DA, Grooten A, Dekker J. Healthcare Centre Haarlemmermeer, The Netherlands. firstname.lastname@example.orgOBJECTIVE:
To evaluate the effectiveness of manual therapy (MT) in participants with chronic tension-type headache (CTTH). SUBJECTS AND METHODS:
We conducted a multicentre, pragmatic, randomised, clinical trial with partly blinded outcome assessment. Eighty-two participants with CTTH were randomly assigned to MT or to usual care by the general practitioner (GP). Primary outcome measures were frequency of headache and use of medication. Secondary outcome measures were severity of headache, disability and cervical function. RESULTS:
After 8 weeks (n = 80) and 26 weeks (n = 75), a significantly larger reduction of headache frequency was found for the MT group (mean difference at 8 weeks, -6.4 days; 95% CI -8.3 to -4.5; effect size, 1.6). Disability and cervical function showed significant differences in favour of the MT group at 8 weeks but were not significantly different at 26 weeks. CONCLUSIONS:
Manual therapy is more effective than usual GP care in the short- and longer term in reducing symptoms of CTTH. Dutch Trial Registration no. TR 1074.
Effectiveness of manual therapies: the UK evidence report.
] Chiropr Osteopat.
2010 Feb 25;18:3.
Bronfort G, Haas M, Evans R, Leininger B, Triano J. Northwestern Health Sciences University, Bloomington, MN, USA. email@example.comBACKGROUND:
The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions. METHODS:
The conclusions are based on the results of systematic review
s of randomized clinical trials (RCT
s), widely accepted and primarily UK and United States evidence-based clinical guidelines, plus the results of all RCTs not yet included in the first three categories. The strength/quality of the evidence regarding effectiveness was based on an adapted version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs. RESULTS:
By September 2009, 26 categories of conditions were located containing RCT evidence for the use of manual therapy: 13 musculoskeletal conditions, four types of chronic headache and nine non-musculoskeletal conditions. We identified 49 recent relevant systematic reviews and 16 evidence-based clinical guidelines plus an additional 46 RCTs not yet included in systematic reviews and guidelines.Additionally, brief references are made to other effective non-pharmacological, non-invasive physical treatments. CONCLUSIONS:
Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation.Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic.