Chiropractic for Headache

Closeup of a chiropractor adjusting a senior patient's cervical spine (neck).

Overview

Chiropractic care including manipulation is a widely used, safe and relatively inexpensive treatment for headaches. Studies have shown that some patients who receive manipulation do better in the short and long term compared to usual medical care.

RESCU Treatment Ratings

R = Risk      E = Effectiveness      S = Self-Care

C = Cost     U = Usefulness (overall rating)

1 = Least Favorable     5 = Most Favorable

R

RISK: 5/5

5_Hearts_Treatment_Rating

Manipulation of the neck is a remarkably safe procedure, particularly in comparison to other treatments used for neck pain and related conditions. Some M.D.’s have cautioned that there might be an increased risk of stroke and even death associated with neck manipulation, but even the more conservative estimates put that risk at less than one in 100,000. So how rare are these events? A study by a major chiropractic malpractice carrier in Canada found that stroke related to vertebral artery dissection (VAD)  will occur in 1 in 8 million chiropractic office visits, 1 in 5.85 million cervical adjustments, and once in nearly 50 chiropractic careers.

By comparison, the risk of bleeding to death from NSAIDs (anti-inflammatory medications like ibuprofen or aspirin) is 2-3 per 100,000. Statistically, manipulation is much safer than taking these kinds of drugs.

Some M.D.s have cautioned patients not to have their necks manipulated, but that recommendation is not supported by widely accepted current scientific evidence. Other recent studies by neurosurgeons found there was no increased risk of stroke from neck manipulation.

The majority of recent studies suggest an “association” with stroke, but not causation.  So the best evidence shows it is hundreds of times safter than ibuprofen.

Sources:

Hawk C. The Praeger Handbook of Chiropractic Health Care. Santa Barabara CA: ABC-CLIO; 2017.

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

Cassidy JD, Boyle E, Côté P, et al. Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study. European Spine Journal. 2008;17(Suppl 1):176-183.

Dabbs V, Lauretti W. A risk assessment of cervical manipulation vs NSAIDS for the treatment of neck pain. J Manipulative Physiol Ther1995; 18: 530–536.

Church EW, Sieg EP, Zalatimo O, Hussain NS, Glantz M, Harbaugh RE. Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus. 2016 Feb 16;8(2):e498. doi: 10.7759/cureus.498. 

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