Headaches are the third most common reason for seeking chiropractic care in the United States. Chiropractors commonly use a variety of treatment modalities to care for patients with headaches, including spinal manipulation, joint mobilization, massage, stretching exercises, and soft-tissue therapies. Many studies on chiropractic for headache focus on a specific type of headache or a specific treatment modality but few systematic reviews have examined the overall efficacy of chiropractic for headache. Do certain headaches respond more favorably to chiropractic treatments? Will a person with migraine need more exercise therapy compared to someone with tension-type headache?
To answer these questions, researchers from Canada sought to develop evidence-based guidelines for the chiropractic treatment of headache. They performed an extensive literature review of the research on chiropractic for headache published through August 2009. The findings of the controlled clinical trials were assessed to assign an overall strength of evidence and to formulate practice recommendations.
The researchers found a need for further clinical research involving patients with headaches in order to confirm these benefits. However, the available evidence suggests that chiropractic care, including spinal manipulation, improves many types of headaches. Given the current knowledge regarding chiropractic care for headaches, the study authors formulated treatment recommendations based on the type of headache.
For episodic or chronic migraine headaches, spinal manipulation and multimodal multidisciplinary inventions (including massage) were found to be most effective. For patients with tension-type headaches, there is some evidence that spinal manipulation could be clinically effective, although more research must be done to examine this possibility. Low-load craniocervical mobilization may also provide long-term benefits for patients with chronic or episodic tension-type headaches. Spinal manipulation is recommended for cervicogenic headaches; deep neck flexor exercises or joint mobilization may also improve the symptoms associated with these headaches.
While each patient has his or her own set of symptoms and needs, these guidelines can assist doctors in the development of evidence-based treatment plans.
In a previous study, patients with cervicogenic headache experienced significant reductions in pain and headache intensity after receiving chiropractic or a combination of chiropractic and exercise treatments. And in another earlier study, patients had a 90% reduce in migraine treatment after receiving chiropractic adjustments.
Written by Megan Churchwell and Marissa Luck
Bryans R, Descarreaux M, et al. Evidence-based guidelines for the chiropractic treatment of adults with headache. Journal of Manipulative and Physiological Therapeutics 2011; 34(5):274-89. doi: 10.1016/j.jmpt.2011.04.008.