Osteopathic manipulative medicine in the management of headaches associated with postconcussion syndrome

Abstract

Context Previous studies have demonstrated the effectiveness of osteopathic manipulative treatment (OMT) for various headache types, with limited evidence of its use for headaches related to mild traumatic brain injury (MTBI). No studies prior studies were found regarding OMT for headaches in patients with postconcussion syndrome (PCS), defined as symptom persistence for longer than 3 months after MTBI. Objectives To evaluate OMT for headaches in patients with PCS. Methods A controlled pilot study was conducted of patients with PCS who presented to an outpatient interdisciplinary rehabilitation clinic; patients with symptoms lasting longer than 3 months were enrolled and randomly assigned to an OMT treatment group or a control group. Primary outcome measures were immediate change in headache scores according to a Visual Analog Scale (VAS) and change in the six item Headache Impact Test (HIT-6) between baseline and follow up visits. The participants in the control group completed the HIT-6 between baseline and follow up visits but did not receive OMT and did not complete the VAS. Mean immediate VAS score change for the treatment group and mean improvement in HIT-6 scores for both groups between baseline and follow up were analyzed for statistical significance. Results A total of 26 patients were included in this study: 13 (50%) in the treatment group and 13 (50%) in the control group. Six patients (23.1%), three from each group, did not complete the study, so 10 subjects in each group were included in the final analysis. Statistically significant improvement in VAS scores was seen immediately after OMT in the treatment group (mean change, 2.1;p=0.002). Mean HIT-6 scores showed improvement in the treatment group compared with the control group, although the change was not statistically significant (p=0.15) from baseline to follow up visit. No adverse effects from treatments were noted. Conclusions Patients with headaches secondary to PCS showed immediate benefit in headache pain intensity after OMT. However, no sustained benefit was found on the follow up visit compared with the control group.

A Systematic Review of Treatments of Post-Concussion Symptoms

“…Treatment was associated with a significant reduction of pain index 2 weeks after the end of treatment, but this effect was no more statistically significant 5 weeks later [ 50 ]. Esterov et al (2021) [ 51 ] showed a reduction in pain in 26 participants assessed using a visual analogic scale after an osteopathic manipulative treatment, but no significant difference regarding pain was found within the questionnaire results.…”

“…For example, recent reviews [ 75 , 76 , 77 ] focused on the effect of physical exercise in patients with persistent PCS and found that exercise significantly reduced the severity of PCS, the percentage of patients with PCS, and days off work, as compared to controls. Other recent reviews addressed issues such as interventions in sport-related concussion [ 17 , 78 ], reporting evidence in support of cervical rehabilitation, vestibulo-ocular rehabilitation, aerobic exercise, or rTMS [ 51 , 79 ], suggesting promising preliminary results for the treatment of post-concussive depression and headaches. As previously mentioned, a systematic review with meta-analysis provided only very low to low levels of evidence to support commonly applied non-pharmacological interventions for persistent PCS [ 16 ].…”

“… 60 Eye-tracking analyses No effect on post-concussive eye movement abnormalities after mTBI when compared with a sham-control. - A Esterov et al, 2021 [ 51 ] RCT 44 y.o. 65% female Motor vehicle accidents = 70%; falls = 20%; sports = 10% 3–88 months To assess the effect of osteopathic manipulative treatment on headaches after mTBI.…”

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Figure A2 Risk of Bias for each study included in the Section 3.2 , assessed using the Cochrane Rob2 tool revised version [ 37 , 38 , 40 , 44 ].

Figure A3 Risk of Bias for each study included in the Section 3.3 , assessed using the Cochrane Rob2 tool revised version [ 35 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 55 ].

Figure A4 Risk of Bias for each study included in the Section 3.4 , assessed using the Cochrane Rob2 tool revised version [ 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ].

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“… Risk of Bias for each study included in the Section 3.3 , assessed using the Cochrane Rob2 tool revised version [ 35 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 55 ]. …”