Skip to main content

Headache Treatment

A New Study On Chiropractic Effectiveness

Spinal Manipulation is Effective for Headaches, According to Duke University Researchers.

Spinal manipulation may be an effective treatment option for tension headaches and headaches that originate in the neck, according to a new report released by researchers at the Duke University Evidence-Based Practice Center in Durham, NC.

Based on a literature review of several headache treatment options, a panel of 25 multidisciplinary experts concluded that spinal manipulation resulted in almost immediate improvement for cervicogenic headaches, or those that originate in the neck, and had significantly fewer side effects and longer-lasting relief of tension-type headache than a commonly-prescribed medication.

The report, titled "Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache," brings to fruition work begun years ago by an Agency for Health Care Policy and Research (AHCPR) panel. In 1995, that panel was charged with the responsibility of developing evidence- based guidelines on treatment options for headache, but its work was halted before a report was actually printed and disseminated. The new report was authored by Douglas C. McCrory, M.D., MHSC; Donald B. Penzien, Ph.D., and Rebecca N. Gray, D.Phil.

It is estimated that 20 to 30 percent of adults have more than one episode of tension-type headache a month. Over 17 percent of those with frequent headache meet diagnostic criteria for cervicogenic headache. Headaches result in a significant number of missed work days each year and can have an untold negative impact on the personal lives of headaches sufferers.

Spinal manipulation or adjustment is the primary treatment option performed by doctors of chiropractic. In addition, according to the Rand Corp., doctors of chiropractic perform 94 percent of all spinal manipulation in the country.

The researchers at Duke examined the quality research for physical methods, such as acupuncture, cervical spinal manipulation, and physiotherapy, and behavioral methods, such as relaxation, biofeedback, and stress management training, of treating the two types of headache - tension and cervicogenic.

Researchers concluded the following:

"Cervical spinal manipulation was associated with improvement in headache outcomes in two trials involving patients with neck pain and/or neck dysfunction and headache. Manipulation appeared to result in immediate improvement in headache severity when used to treat episodes of cervicogenic headache when compared with an attention-placebo control. Furthermore, when compared to soft-tissue therapies (massage), a course of manipulation treatments resulted in sustained improvement in headache frequency and severity."

For tension-type headache, the researchers point to a study that compared manipulation to amitriptyline, a drug commonly prescribed for headache. Said the researchers from Duke, "despite the uniform and relatively low dose of amitriptyline, however, adverse effects were much more common with amitriptyline (82 percent of patients) than with manipulation (4 percent). During the 4-week period after both treatments ceased, patients who had received manipulation were significantly better than those who had taken amitriptyline for both headache frequency and severity. Although amitriptyline is usually continued for longer than 6 weeks, the return to near-baseline values for headache outcomes in this group contrasts with a sustained reduction in headache frequency and severity in those who had received manipulation."

"The authors from Duke have conscientiously and methodically resurrected and updated the evidence underlying the behavioral and physical treatment options for headache," said Anthony L. Rosner, Ph.D., the director of research for the Foundation for Chiropractic Education and Research (FCER). "In so doing, they have recognized the elements of chiropractic management as viable options for treating cervicogenic and possibly tension headaches as well. We expect that this publication will gain the appropriate recognition in the healthcare marketplace."

"This new report helps validate what doctors of chiropractic and their patients have known for decades - that chiropractic adjustments are an effective treatment option for headache sufferers," said American Chiropractic Association (ACA) President James A. Mertz, DC, DACBR. "As alarming reports about the risks of prescription and over-the-counter drugs continue to surface, the health care community and patients should consider safe and effective non-drug treatments such as chiropractic care."

Further research on manipulation and tension-type headache is required to confirm these results and validate the conclusions. The complete Executive Summary of "Evidence Report: Behavioral and Physical Treatments for Tension- type and Cervicogenic Headache" can be found on the FCER Web site at .

This report was produced by the Duke University Evidence-based Practice Center (EPC), with funding provided solely by FCER through a restricted grant from the NCMIC Insurance Company. The Duke University EPC is one of 12 institutions to be awarded the trademark designation "EPC" by the Agency for Healthcare Research and Quality.