Duke University Researchers Determine
Spinal Manipulation is Effective for Headaches (March, 2001)

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 six 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., MI-ISc; 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 nearbaseline 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 headache as well. We expect that this will publication 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.”

This report was produced by the Duke University Evidence-based Practice Center (EPC) that is one of 12 institutions to be awarded the trademark designation “EPC” by the Agency for Healthcare Research and Quality.

FCER Study Determines Chiropractic Offers Long Term Relief For Headache

Chronic tension headache sufferers should consider chiropractic treatment as a long-term solution to their ailment without the side effects of drugs, according to a study funded by the Foundation for Chiropractic Education and Research (FCER). The study found that when six weeks of spinal manipulative treatment by chiropractors was compared to six weeks of medical treatment with amitriptyline, an antidepressant used to control severe headache pain, the chiropractic patients experienced fewer side effects, and the positive effects of chiropractic proved to be longer term, with patients reporting continued relief after the study was completed.

While anecdotal evidence has supported chiropractic treatment of tension headaches for years, until now, there have been no clinical trials that corroborate this reported success. The study that brings scientific support to these claims, "Chiropractic Spinal Manipulative Therapy vs. Amitriptyline for the Treatment of Chronic Tension-type Headaches: A Randomized Comparative Clinical Trial," was conducted by Dr. Patrick D. Boline (principal investigator) at Northwestern College of Chiropractic and published in the March/April issue of the Journal of Manipulative and Physiological Therapeutics.

For the study, a total of 126 patients between the ages of 18 and 70 were divided into two groups that were screened and randomly assigned to receive either chiropractic spinal manipulation or pharmaceutical treatment consisting of amitriptyline, a tricyclic antidepressant commonly known by the brand name Elavil. The spinal manipulation group received short-lever, low-amplitude, high-velocity thrust techniques with moist heat and light massage of the cervicothoracic musculature prior to manipulation. Patients were palpated to determine the cervical, thoracic, or lumbar spinal segment to be manipulated with special attention to the upper three cervical segments. The patients in the amitriptyline therapy group received 10 mg daily for the first week, 20 mg daily for the second week, and 30 mg daily thereafter. This dosage was decreased if adverse side effected weren't tolerated by the patient.

During the six weeks that both groups received treatment, both reported similar improvements; however, four weeks after the end of the clinical trial, the superiority of chiropractic treatment was evident. The group receiving spinal manipulation showed a reduction of 32 percent in headache intensity, 42 percent in headache frequency, 30 percent in over-the-counter medication usage, and a 16 percent improvement in functional health status. The group receiving amitriptyline reverted to the levels recorded at the beginning of the study. The groups also differed greatly in their reporting of side effects. While 82.1 percent of the patients who received medical treatment suffered from drowsiness, dry mouth and weight gain, only 4.3 percent of the spinal manipulation group reported side effects consisting of neck soreness and stiffness.

"At last, with the results of this study, the claims of thousands of chiropractic patients who have enjoyed relief from pain without drugs will have to be taken seriously by the medical community," said Stephen R. Seater, CAE, Executive Director of FCER. "At last, chiropractic will be recognized as a viable and scientific alternative for relief of common tension headaches."

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