ChiroACCESS Article



Chiropractic Management of Migraine Headache



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ChiroACCESS Editorial Staff

  

ChiroACCESS



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February 16, 2011

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Migraine HeadacheJust as puzzles are completed piece by piece, the evidence for the positive effects of chiropractic care for migraines is slowly filling in and revealing a clearer picture.  That picture depicts a more meaningful role for chiropractic care in both the prevention and treatment of migraine headache.  A recent Norwegian systematic review of manual therapies for migraine prevention (4 Feb 2011) concluded that chiropractic spinal manipulation and some other conservative interventions appear to be equal to medications (propranolol & topiramate) in their ability to prevent migraines. 

Although most of the published research supporting chiropractic treatment of migraine is based upon case reports, there have been other studies including a limited number of randomized clinical trials.  A previous 2001 systematic review by Bronfort et. al. concluded that “SMT appears to have a better effect than massage for cervicogenic headache.  It also appears that SMT has an effect comparable to commonly used first-line prophylactic prescription medications for tension-type headache and migraine headache.  This conclusion rests upon a few trials of adequate methodological quality.  Before any firm conclusions can be drawn, further testing should be done in rigorously designed, executed, and analyzed trials with follow-up periods of sufficient length.”  Since this review favorable research continues to build.  There is a great need for the profession to provide stronger support for research because the stronger studies are the most needed and the most costly.

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.

Manual therapies for migraine: a systematic review.  [Full-Text Link]

J Headache Pain. 2011 Feb 5. [Epub ahead of print]

Chaibi A, Tuchin PJ, Russell MB.
Head and Neck Research Group, Research Centre, Akershus University Hospital, 1478, Lørenskog, Norway, alch79@gmail.com.

Migraine occurs in about 15% of the general population. Migraine is usually managed by medication, but some patients do not tolerate migraine medication due to side effects or prefer to avoid medication for other reasons. Non-pharmacological management is an alternative treatment option. We systematically reviewed randomized clinical trials (RCTs) on manual therapies for migraine. The RCTs suggest that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally effective as propranolol and topiramate in the prophylactic management of migraine. However, the evaluated RCTs had many methodological shortcomings. Therefore, any firm conclusion will require future, well-conducted RCTs on manual therapies for migraine.

Intractable migraine headaches during pregnancy under chiropractic care.  [Link]

Complement Ther Clin Pract. 2009 Nov;15(4):192-7. Epub 2009 May 2.

Alcantara J, Cossette M.
International Chiropractic Pediatric Association, 327 North Middletown Dr, Media, PA, USA. dr_jalcantara@yahoo.com

The absence of hormone fluctuations and/or the analgesic effects of increased beta-endorphins are thought to confer improvements in headache symptoms during pregnancy. However, for a number of pregnant patients, they continue to suffer or have worsening headache symptoms. The use of pharmacotherapy for palliative care is a concern for both the mother and the developing fetus and alternative/complementary care options are sought. We present a 24-year-old gravid female with chronic migraine headaches since age 12years. Previous unsuccessful care included osteopathy, physical therapy, massage and medication. Non-steroidal anti-inflammatory medication with codeine provided minor and temporary relief. Chiropractic care involving spinal manipulative therapy (SMT) and adjunctive therapies resulted in symptom improvement and independence from medication. This document provides supporting evidence on the safety and possible effectiveness of chiropractic care for patients with headaches during pregnancy.

A case of chronic migraine remission after chiropractic care.  [Link]

J Chiropr Med. 2008 Jun;7(2):66-70.

Tuchin PJ.
Senior Lecturer, Department of Chiropractic, Macquarie University, NSW 2109, Australia.

OBJECTIVE: To present a case study of migraine sufferer who had a dramatic improvement after chiropractic spinal manipulative therapy (CSMT).

CLINICAL FEATURES:
The case presented is a 72-year-old woman with a 60-year history of migraine headaches, which included nausea, vomiting, photophobia, and phonophobia.

INTERVENTION AND OUTCOME:
The average frequency of migraine episodes before treatment was 1 to 2 per week, including nausea, vomiting, photophobia, and phonophobia; and the average duration of each episode was 1 to 3 days. The patient was treated with CSMT. She reported all episodes being eliminated after CSMT. The patient was certain there had been no other lifestyle changes that could have contributed to her improvement. She also noted that the use of her medication was reduced by 100%. A 7-year follow-up revealed that the person had still not had a single migraine episode in this period.

CONCLUSION:
This case highlights that a subgroup of migraine patients may respond favorably to CSMT. While a case study does not represent significant scientific evidence, in context with other studies conducted, this study suggests that a trial of CSMT should be considered for chronic, nonresponsive migraine headache, especially if migraine patients are nonresponsive to pharmaceuticals or prefer to use other treatment methods.

Chiropractic management of a patient with migraine headache.  [Full-Text Link]

J Chiropr Med. 2005 Winter;4(1):25-31.

Harris SP.
Private practice of chiropractic, Thera-Spine Chiropractic and Rehabilitation.

OBJECTIVE:
To describe the use of chiropractic care for a patient with migraine headache.

CLINICAL FEATURES:
A patient suffered from migraine headaches after an automobile accident. Neck disability scores, visual analog score, and algometry scores were used to track patient progress.

INTERVENTION AND OUTCOME:
The patient's range of motion, flexibility, and strength improved following a regimen of spinal manipulation and active and passive therapeutic care. After 12 weeks of treatment, the duration, frequency, and intensity of her migraines decreased.

CONCLUSION:
This case offers an example of the potential effects of chiropractic and rehabilitative treatment for migraine headache sufferers.

Treatment of bipolar, seizure, and sleep disorders and migraine headaches utilizing a chiropractic technique.  [Link]

J Manipulative Physiol Ther. 2004 Mar-Apr;27(3):E5.

Elster EL.
erin@erinelster.com

OBJECTIVE: To discuss the use of an upper cervical technique in the case of a 23-year-old male patient with rapid-cycling bipolar disorder, sleep disorder, seizure disorder, neck and back pain, and migraine headaches.

CLINICAL FEATURES: The patient participated in a high school track meet at age 17, landing on his head from a height of 10 ft while attempting a pole vault. Prior to the accident, no health problems were reported. Following the accident, the patient developed numerous neurological disorders. Symptoms persisted over the next 6 years, during which time the patient sought treatment from many physicians and other health care practitioners.

INTERVENTION AND OUTCOME: At initial examination, evidence of a subluxation stemming from the upper cervical spine was found through thermography and radiography. Chiropractic care using an upper cervical technique was administered to correct and stabilize the patient's upper neck injury. Assessments at baseline, 2 months, and 4 months were conducted by the patient's neurologist. After 1 month of care, the patient reported an absence of seizures and manic episodes and improved sleep patterns. After 4 months of care, seizures and manic episodes remained absent and migraine headaches were reduced from 3 per week to 2 per month. After 7 months of care, the patient reported the complete absence of symptoms. Eighteen months later, the patient remains asymptomatic.

CONCLUSION: The onset of the symptoms following the patient's accident, the immediate reduction in symptoms correlating with the initiation of care, and the complete absence of all symptoms within 7 months of care suggest a link between the patient's headfirst fall, the upper cervical subluxation, and his neurological conditions. Further investigation into upper cervical trauma as a contributing factor to bipolar disorder, sleep disorder, seizure disorder, and migraine headaches should be pursued.

Chronic migraine and chiropractic rehabilitation: A case report.  [Full-Text Link]

J Chiropr Med. 2003 Spring;2(2):55-9.

Davis RC.
Private Clinical Practice of Chiropractic, Ketchikan, Alaska.

OBJECTIVE: To describe the use of chiropractic rehabilitation, functional assessment methods, and outcome measures in treatment of a single case of chronic recurrent migraine headache.

CLINICAL FEATURES:
A 22-year-old woman had migraine, recurrent duration 2 years. She had no history of trauma and the symptoms persisted despite multiple medical interventions. She had head pain, primarily left frontal retro-orbital, accompanied by nausea and visual aura of "spots" when severe.

INTERVENTION AND OUTCOME:
This subject was managed with rehabilitative exercises in combination with chiropractic manipulation. Outcome measures, including the Headache Disability Index, are described.

CONCLUSION:
The chronic recurrent migraine resolved over a 12-week period with use of chiropractic rehabilitation in this patient. More research is necessary to determine whether this approach is consistently reproducible and how it compares with spinal manipulation alone and other forms of treatment. Further investigation of combining rehabilitation with chiropractic manipulation for some migraine patients should be considered.

Efficacy of spinal manipulation for chronic headache: a systematic review.  [Link]

J Manipulative Physiol Ther. 2001 Sep;24(7):457-66.

Bronfort G, Assendelft WJ, Evans R, Haas M, Bouter L.
Department of Research, Wolfe-Harris Center for Clinical Studies, Northwestern Health Sciences University, Bloomington, MN 55431, USA. gbronfort@nwhealth.edu

BACKGROUND:
Chronic headache is a prevalent condition with substantial socioeconomic impact. Complementary or alternative therapies are increasingly being used by patients to treat headache pain, and spinal manipulative therapy (SMT) is among the most common of these.

OBJECTIVE:
To assess the efficacy/effectiveness of SMT for chronic headache through a systematic review of randomized clinical trials.

STUDY SELECTION:
Randomized clinical trials on chronic headache (tension, migraine and cervicogenic) were included in the review if they compared SMT with other interventions or placebo. The trials had to have at least 1 patient-rated outcome measure such as pain severity, frequency, duration, improvement, use of analgesics, disability, or quality of life. Studies were identified through a comprehensive search of MEDLINE (1966-1998) and EMBASE (1974-1998). Additionally, all available data from the Cumulative Index of Nursing and Allied Health Literature, the Chiropractic Research Archives Collection, and the Manual, Alternative, and Natural Therapies Information System were used, as well as material gathered through the citation tracking, and hand searching of non-indexed chiropractic, osteopathic, and manual medicine journals.

DATA EXTRACTION:
Information about outcome measures, interventions and effect sizes was used to evaluate treatment efficacy. Levels of evidence were determined by a classification system incorporating study validity and statistical significance of study results. Two authors independently extracted data and performed methodological scoring of selected trials.

DATA SYNTHESIS:
Nine trials involving 683 patients with chronic headache were included. The methodological quality (validity) scores ranged from 21 to 87 (100-point scale). The trials were too heterogeneous in terms of patient clinical characteristic, control groups, and outcome measures to warrant statistical pooling. Based on predefined criteria, there is moderate evidence that SMT has short-term efficacy similar to amitriptyline in the prophylactic treatment of chronic tension-type headache and migraine. SMT does not appear to improve outcomes when added to soft-tissue massage for episodic tension-type headache. There is moderate evidence that SMT is more efficacious than massage for cervicogenic headache. Sensitivity analyses showed that the results and the overall study conclusions remained the same even when substantial changes in the prespecified assumptions/rules regarding the evidence determination were applied.

CONCLUSIONS:
SMT appears to have a better effect than massage for cervicogenic headache. It also appears that SMT has an effect comparable to commonly used first-line prophylactic prescription medications for tension-type headache and migraine headache. This conclusion rests upon a few trials of adequate methodological quality. Before any firm conclusions can be drawn, further testing should be done in rigorously designed, executed, and analyzed trials with follow-up periods of sufficient length.

The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache.  [Link]

J Manipulative Physiol Ther. 1998 Oct;21(8):511-9.

Nelson CF, Bronfort G, Evans R, Boline P, Goldsmith C, Anderson AV.
Center for Clinical Studies, Northwestern College of Chiropractic, Bloomington, MN 55431, USA. cnelson@nwchiro.edu

BACKGROUND: Migraine headache affects approximately 11 million adults in the United States. Spinal manipulation is a common alternative therapy for headaches, but its efficacy compared with standard medical therapies is unknown.

OBJECTIVE:
To measure the relative efficacy of amitriptyline, spinal manipulation and the combination of both therapies for the prophylaxis of migraine headache.

DESIGN:
A prospective, randomized, parallel-group comparison. After a 4-wk baseline period, patients were randomly assigned to 8 wk of treatment, after which there was a 4-wk follow-up period.

SETTING:
Chiropractic college outpatient clinic.

PARTICIPANTS:
A total of 218 patients with the diagnosis of migraine headache.

INTERVENTIONS:
An 8-wk course of therapy with spinal manipulation, amitriptyline or a combination of the two treatments.

MAIN OUTCOME MEASURES:
A headache index score derived from a daily headache pain diary during the last 4 wk of treatment and during the 4-wk follow-up period.

RESULTS:
Clinically important improvement was observed in both primary and secondary outcomes in all three study groups over time. The reduction in headache index scores during treatment compared with baseline was 49% for amitriptyline, 40% for spinal manipulation and 41% for the combined group; p = .66. During the posttreatment follow-up period the reduction from baseline was 24% for amitriptyline, 42% for spinal manipulation and 25% for the combined group; p = .05.

CONCLUSION:
There was no advantage to combining amitriptyline and spinal manipulation for the treatment of migraine headache. Spinal manipulation seemed to be as effective as a well-established and efficacious treatment (amitriptyline), and on the basis of a benign side effects profile, it should be considered a treatment option for patients with frequent migraine headaches.

A randomized controlled trial of chiropractic spinal manipulative therapy for migraine.  [Link]

J Manipulative Physiol Ther. 2000 Feb;23(2):91-5.

Tuchin PJ, Pollard H, Bonello R.
Department of Chiropractic, Macquarie University, New South Wales, Australia.

OBJECTIVE:
To assess the efficacy of chiropractic spinal manipulative therapy (SMT) in the treatment of migraine.

DESIGN:
A randomized controlled trial of 6 months' duration. The trial consisted of 3 stages: 2 months of data collection (before treatment), 2 months of treatment, and a further 2 months of data collection (after treatment). Comparison of outcomes to the initial baseline factors was made at the end of the 6 months for both an SMT group and a control group. Setting: Chiropractic Research Center of Macquarie University.

PARTICIPANTS:
One hundred twenty-seven volunteers between the ages of 10 and 70 years were recruited through media advertising. The diagnosis of migraine was made on the basis of the International Headache Society standard, with a minimum of at least one migraine per month.

INTERVENTIONS:
Two months of chiropractic SMT (diversified technique) at vertebral fixations determined by the practitioner (maximum of 16 treatments).

MAIN OUTCOME MEASURES:
Participants completed standard headache diaries during the entire trial noting the frequency, intensity (visual analogue score), duration, disability, associated symptoms, and use of medication for each migraine episode.

RESULTS:
The average response of the treatment group (n = 83) showed statistically significant improvement in migraine frequency (P < .005), duration (P < .01), disability (P < .05), and medication use (P< .001) when compared with the control group (n = 40). Four persons failed to complete the trial because of a variety of causes, including change in residence, a motor vehicle accident, and increased migraine frequency. Expressed in other terms, 22% of participants reported more than a 90% reduction of migraines as a consequence of the 2 months of SMT. Approximately 50% more participants reported significant improvement in the morbidity of each episode.

CONCLUSION:
The results of this study support previous results showing that some people report significant improvement in migraines after chiropractic SMT. A high percentage (>80%) of participants reported stress as a major factor for their migraines. It appears probable that chiropractic care has an effect on the physical conditions related to stress and that in these people the effects of the migraine are reduced.

Chiropractic management of migraine without aura. A case study.  [Full-Text Link]

Australas Chiropr Osteopathy. 1999 Nov;8(3):85-90.

Cattley P, Tuchin PJ.

OBJECTIVE: To assess the response of a patient with chronic migraines to a short program of chiropractic care (diversified technique).

METHOD:
The study was run over a 13 week period with chiropractic spinal manipulative therapy (CSMT) on a once weekly schedule for 5 weeks, followed by an 8 week re-evaluation.

OUTCOME MEASURES:
To measure the effect of treatment, a previously reported diary system was used which noted the intensity of a range of symptoms that are recorded following each migraine episode.

RESULTS:
The results attained showed there was a marked improvement in the migraine symptoms following the chiropractic care. The patient reported an improvement in frequency, intensity, duration and use of medication. These findings appear to also confirm other evidence which documented similar changes following a large randomised controlled trial of chiropractic treatment of migraine.

DISCUSSION:
The case is presented as further support for CSMT in the treatment of migraine. The outcome of this case is also discussed in relation to recent research that concludes that CSMT is a very effective treatment for some people with non-neuromusculoskeletal conditions.

CONCLUSION:
It now appears clear that chiropractic care may be used to assist patients with migraine. Research is currently being undertaken to investigate the potential mechanisms of chiropractic in the treatment of migraine. This research should also assess what (if any) prognostic signs can be identified to assist practitioners making a more informed decision on the treatment of choice for migraine.

A twelve month clinical trial of chiropractic spinal manipulative therapy for migraine.  [Full-Text Link]

Australas Chiropr Osteopathy. 1999 Jul;8(2):61-5.

Tuchin PJ.

OBJECTIVE:
To assess the efficacy of Chiropractic spinal manipulative therapy (SMT) in the treatment of migraine.

DESIGN:
A prospective clinical trial of twelve months duration. The trial consisted of 3 stages: two month pre-treatment, two month treatment, and two months post treatment. Comparison of outcomes to the initial baseline factors was made and also 6 months after the cessation of the study.

SETTING:
Chiropractic Research Centre of Macquarie University.

PARTICIPANTS:
Thirty two volunteers, between the ages of 20 to 65 were recruited through media advertising. The diagnosis of migraine was based on a self reported detailed questionnaire, with minimum of one migraine per month.

INTERVENTIONS:
Two months of chiropractic SMT at vertebral fixations determined by the practitioner, through orthopedic and chiropractic testing.

MAIN OUTCOME MEASURES:
Participants completed diaries during the entire trial noting the frequency, intensity (visual analogue score), duration, disability, associated symptoms and use of medication for each migraine episode.

RESULTS:
The initial 32 participants showed statistically significant (p < 0.05) improvement in migraine frequency, VAS, disability, and medication use, when compared to initial baseline levels. A further assessment of outcomes after a six month follow up (based on 24 participants), continued to show statistically significant improvement in migraine frequency (p < 0.005), VAS (p < 0.01), disability (p < 0.05), and medication use (p < 0.01), when compared to initial baseline levels. In addition, information was collected regarding any changes in neck pain following chiropractic SMT. The results indicated that 14 participants (58%) reported no increase in neck pain as a consequence of the two months of SMT. Five participants (21%) reported a slight increase, three participants (13%) reported mild pain, and two participants (8%) reported moderate pain.

CONCLUSION:
The results of this study support the hypothesis that Chiropractic SMT is an effective treatment for migraine, in some people. However, a larger controlled study is required.

A case series of migraine changes following a manipulative therapy trial.  [Full-Text Link]

Australas Chiropr Osteopathy. 1997 Nov;6(3):85-91.

Tuchin PJ.

OBJECTIVE:
To present the characteristics of four cases of migraine, who were included as participants in a prospective trial on chiropractic spinal manipulative therapy for migraine.

METHOD:
Participants in a migraine research trial, were reviewed for the symptoms or clinical features and their response to manual therapy.

RESULTS:
The four selected cases of migraine responded dramatically to SMT, with numerous self reported symptoms being either eliminated or substantially reduced. Average frequency of episodes was reduced on average by 90%, duration of each episode by 38%, and use of medication was reduced by 94%. In addition, several associated symptoms were substantially reduced, including nausea, vomiting, photophobia and phonophobia.

DISCUSSION:
The various cases are presented to assist practitioners making a more informed prognosis.
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