Chiropractic for Headache

EFFECTIVENESS: 4/5

One recent study demonstrated that chiropractic care is the most frequently requested alternative medicine approach for chronic tension-type headaches, and slightly more than 40% reported improvement with the treatment. (Rossi).

A number of studies have shown manipulation can be helpful for headaches, but one problem with research on this issue is that there are many different types of headaches, and while manipulation may help some patients with different types of headaches, it is not effective for all headache sufferers. A number of studies, however, have shown that some patients who receive manipulation do better in the short and long term compared to usual medical care.

Bottom line: there is evidence that manipulation is effective for some types of headache, but more research needs to be done to help determine which types benefit and which don’t. One type of headache, called “cervicogenic” appears to respond well, and is due to mechanical issues affecting the neck. It may be worth a short trial of care, typically 6-12 visits, to see if it helps.

Sources:

Garcia JD, Arnold S, Tetley K, Voight K, Frank RA. Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence? Frontiers in Neurology. 2016;7:40. doi:10.3389/fneur.2016.00040.

The effect of manipulation plus massage therapy versus massage therapy alone in people with tension-type headache. A randomized controlled clinical trial. Espí-López GV¹, Zurriaga-Llorens R, Monzani L, Falla D. Eur J Phys Rehabil Med. 2016 Oct;52(5):606-617. Epub 2016 Mar 18.

Manual therapies for primary chronic headaches: a systematic review of randomized controlled trials

Aleksander Chaibi, Michael Bjørn Russell. The Journal of Headache and Pain201415:67 https://doi.org/10.1186/1129-2377-15-67

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

Bryans R¹, Descarreaux M, Duranleau M, Marcoux H, Potter B, Ruegg R, Shaw L, Watkin R, White E. J Manipulative Physiol Ther. 2011 Jun;34(5):274-89. doi: 10.1016/j.jmpt.2011.04.008.

Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence? Garcia JD¹, Arnold S¹, Tetley K¹, Voight K¹, Frank RA¹. Front Neurol. 2016 Mar 21;7:40. doi: 10.3389/fneur.2016.00040. eCollection 2016.

Use of complementary and alternative medicine by patients with chronic tension-type headache: results of a headache clinic survey.

Rossi P, Di Lorenzo G, Faroni J, Malpezzi MG, Cesarino F, Nappi G

Headache. 2006 Apr; 46(4):622-31.

Efficacy of manual therapy in the treatment of tension-type headache. A systematic review from 2000-2013. Lozano López C, Mesa Jiménez J, de la Hoz Aizpurúa JL, Pareja Grande J, Fernández de Las Peñas C. Neurologia. 2014 May 21. pii: S0213-4853(14)00011-5.

Effectiveness of manual therapy for chronic tension-type headache: a pragmatic, randomised, clinical trial. Castien RF¹, van der Windt DA, Grooten A, Dekker J. Cephalalgia. 2011 Jan;31(2):133-43. doi: 10.1177/0333102410377362. Epub 2010 Jul 20.

SELF CARE: 1/5

While some people do self-manipulation, we don’t recommend it. See a professional.

COST: 5/5

Manipulation, most commonly provided by chiropractors, is covered by most insurance plans, and typically costs between $25-60 per session. National guidelines recommend trials of care, that is, 6-12 visits with a reevaluation after the trial to ensure treatment is helping. If there is no improvement after 12 visits, it’s time to move on!

Sources:

Haldeman S, Carey P, Townsend M, Papadopoulos C. Arterial dissections following cervical manipulation: the chiropractic experience. CMAJ: Canadian Medical Association Journal. 2001;165(7):905-906.

Lanas A, Perez-Aisa MA, Feu F, Ponce J, Saperas E, Santolaria S wt al. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use. Am J Gastroenterol. 2005 Aug;100(8):1685-93

http://www.fda.gov/ohrms/dockets/ac/02/briefing/3882B2_02_McNeil-NSAID.htm

Bussières AE, Stewart G, Al-Zoubi F. The Treatment of Neck Pain-Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline. J Manipulative Physiol Ther. 2016 Oct;39(8):523-564.e27. doi: 10.1016/j.jmpt.2016.08.007.

USEFULNESS (overall rating): 4/5

Chiropractic care including manipulation is a widely used, safe and relatively inexpensive treatment for headaches. Given the low cost, safety and evidence of effectiveness, most patients should give chiropractic manipulation a try if they have not had success with other conservative treatments. And it is safer than ibuprofen!