Chiropractic spinal manipulative therapy for migraine: a three‐armed, single‐blinded, placebo, randomized controlled trial

Abstract

Background and purposeTo investigate the efficacy of chiropractic spinal manipulative therapy (CSMT) for migraineurs.MethodsThis was a prospective three‐armed, single‐blinded, placebo, randomized controlled trial (RCT) of 17 months duration including 104 migraineurs with at least one migraine attack per month. The RCT was conducted at Akershus University Hospital, Oslo, Norway. Active treatment consisted of CSMT, whereas placebo was a sham push manoeuvre of the lateral edge of the scapula and/or the gluteal region. The control group continued their usual pharmacological management. The RCT consisted of a 1‐month run‐in, 3 months intervention and outcome measures at the end of the intervention and at 3, 6 and 12 months follow‐up. The primary end‐point was the number of migraine days per month, whereas secondary end‐points were migraine duration, migraine intensity and headache index, and medicine consumption.ResultsMigraine days were significantly reduced within all three groups from baseline to post‐treatment (P < 0.001). The effect continued in the CSMT and placebo group at all follow‐up time points, whereas the control group returned to baseline. The reduction in migraine days was not significantly different between the groups (P > 0.025 for interaction). Migraine duration and headache index were reduced significantly more in the CSMT than the control group towards the end of follow‐up (P = 0.02 and P = 0.04 for interaction, respectively). Adverse events were few, mild and transient. Blinding was strongly sustained throughout the RCT.ConclusionsIt is possible to conduct a manual‐therapy RCT with concealed placebo. The effect of CSMT observed in our study is probably due to a placebo response.

The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta‐Analysis

“…All studies allowed patients to continue use of their current medications. Five studies enrolled episodic migraine patients and the minimum number of migraine attacks per month needed to be eligible ranged from 1 to 4 . Only 1 study enrolled patients diagnosed with chronic migraine according to ICHD‐II criteria …”

“…Five of the 6 studies employed active controls where the intervention group was compared to sham therapy, cervical mobilization (movement of joints within normal limitations), detuned interferential therapy (which served as a “placebo” therapy), or a combination of spinal manipulation and amitriptyline treatment . In addition to having an active control, 3 studies also contained a second “passive” control arm where patients were allowed to either continue usual pharmacological therapy, change medications as their physician directed, or were assigned to take amitriptyline . The sixth study only used a “passive” control group and compared those receiving the intervention to those not receiving spinal manipulation, sham treatment, or physical therapy .…”

“…Migraine days per month or the frequency of migraine attacks was assessed in all studies and was our primary outcome. We also analyzed migraine intensity or migraine pain and measures of migraine disability …”

“…Three systematic reviews have examined the effects of spinal manipulation on migraine, but these reviews included only 3 randomized controlled trials and did not include a meta‐analysis of the effects seen in these studies. Since the publication of these reviews, additional randomized controlled trials on spinal manipulation have been conducted . The aim of this study is to provide a synthesis of available clinical trials using a systematic review and to perform a preliminary meta‐analysis examining the effects of spinal manipulation on migraine frequency, pain, and disability.…”

Complementary and Integrative Medicine for Neurologic Conditions

“…Methodological shortcomings limit the interpretation of studies evaluating these treatment options, 17 and more rigorous studies may suggest no additional benefit beyond placebo. 18,19 Chiropractic manipulation has been associated with rare life-threatening events such as cervical artery dissection, although there is debate as to whether the association is causal. 20 Financial concerns often limit the widespread use of massage.…”