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Chiropractic for migraine

Clinical bottom line

There is limited evidence that spinal manipulative therapy may reduce the frequency and intensity of migraine attacks, but the evidence that spinal manipulation is better than amitriptyline, or adds to the effects of amitriptyline, is insubstantial.


Bandolier could find no systematic review of chiropractic or spinal manipulation for the prophylactic treatment of migraine or headaches, so we carried out a brief review.

A literature review from 1995 [1] was not systematic, in that it did not give its search strategy. It found four randomised trials. Two randomised trials for tension-type headache were reported as being significantly better than ice in one and better than amitriptyline in the other [2]. That trial was of reasonable quality and was conducted in 126 patients over a total of 12 week period, including four weeks of follow up after the treatment ended. Spinal manipulation produced better reductions in pain at during the trial and especially the four week follow up, with a more sustained effect with spinal manipulation.

A randomised trial [3] that compared spinal manipulation, amitriptyline and the combination in about 75 patients with migraine in each group showed similar efficacy in all three treatments during and eight week treatment period and four weeks of follow up. Spinal manipulative therapy was somewhat better than an inactive control in another randomised trial [4].

Comment

There may be other trials, but there is no great weight of evidence. What there is is mildly supportive, and spinal manipulative therapy might be worth trying for some patients with migraine or tension headaches.

References:

  1. HT Vernon. The effectiveness of chiropractic manipulation in the treatment of headache: an exploration of the literature. Journal of Manipulative and Physiological Therapeutics 1995 18:611-617.
  2. PD Boline et al. Spinal manipulation vs amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. Journal of Manipulative and Physiological Therapeutics 1995 18:148-154.
  3. CF Nelson et al. The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. Journal of Manipulative and Physiological Therapeutics 1998 21:511-519.
  4. PJ Tuchin et al. A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. Journal of Manipulative and Physiological Therapeutics 2000 23:91-95.