Manipulation for Headache


Ice and Heat for Headache

Manipulation for Headache

Acupuncture for Headache

Injections for Headache

NSAIDs for Headache

TENS for Headache

Laser for Headache


Treatment Ratings


RISK: 5/5


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 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 is 2-3 per 100,000.

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.

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.



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.

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 GV1Zurriaga-Llorens RMonzani LFalla 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

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

Bryans R1Descarreaux MDuranleau MMarcoux HPotter BRuegg RShaw LWatkin RWhite 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 JD1Arnold S1Tetley K1Voight K1Frank 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 RF1van der Windt DAGrooten ADekker J. Cephalalgia. 2011 Jan;31(2):133-43. doi: 10.1177/0333102410377362. Epub 2010 Jul 20.




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 trial 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!

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 APerez-Aisa MAFeu FPonce JSaperas ESantolaria 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

Bussières AEStewart GAl-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 neck pain.



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