While most people will experience a headache at some point in their life, for some the severity and frequency can be debilitating. Migraine headaches affect over 38 million people in the US alone and that’s just 1 type of headache in 1 country! This type of headache is so severe and common that it has become one of the most frequent causes of disability.
Often, the first treatment administered is medications with muscle relaxants, nonsteroidal anti-inflammatory drugs being among the most used. However, these medications are known to have side-effects that create additional problems. Additionally, for some patients with other health issues, they may not interact well with other medications leaving the patient to have to choose what ailment to treat. For reasons such as these, more and more people are seeking NON-pharmacological treatment for their headaches.
Growing interest in non-pharmaceutical treatments for headaches and other conditions has led to an increase in research in these areas. It has also spurred the development of integrative medicine clinics where multiple providers from various specialties work together to provide patients multiple treatment options from a single source.
For example, in 2007, Harvard Medical School Osher Center for Integrative Medicine established the Osher Clinical Center (OCC) for Complementary and Integrative Therapies with its central focus being the treatment of musculoskeletal pain. There, the most frequently used treatment is chiropractic care provided by 2 staff chiropractors. In 2015, a neurologist and headache/migraine expert joined the team.
Due to many migraine patients also experiencing issues with the neck, back and/or face and jaw, they developed an integrated model of neurologic and chiropractic care. When the attending neurologist noted overlying musculoskeletal complaints and physical findings, the patient was referred to the chiropractor for evaluation. From there, treatment could be made up of any combination of spinal manipulative therapy, soft tissue therapies (myofascial release, massage, trigger point therapies, etc), rehabilitation/exercises, ergonomic advice, lifestyle management, and nutritional counseling.
The goal of the chiropractic care was to “optimize neuromusculoskeletal health and reduce the patient’s overall pain burden”. Clinicians observed patients who were treated with the integrated approach reported greater therapeutic benefits. Additionally, the subjects experienced “improvement in pain scores, increase in pain-free days, decreased medication usage, and patient reported decreased anxiety/dysthymia”,
Migraine is not the only type of headache that responds well to chiropractic care. A 2001 study reviewed multiple randomized clinical trials that dealt with chiropractic as a treatment for chronic headache (tension, migraine and cervicogenic). They reviewed 9 trials involving a total of 683 patients. Some patients take medications daily as a preventative treatment for headaches. This study found evidence that spinal manipulative therapy (SMT, also known as a chiropractic adjustment) provides similar relief without the side effects of the medication for chronic tension-type headache and migraine.”
Additionally, SMT was found to be more effective than massage for cervicogenic headache (a headache that is caused by an issue in the neck and refers pain up the neck into the head and/or face).
About 10 years later, a more expansive review was conducted by National University of Health Sciences, in order to provide “evidence-informed practice recommendations for the chiropractic treatment of headache in adults.” This review included more than double the articles (21 met inclusion criteria) and produced similar results for migraine and cervicogenic headaches. Specifically:
- For migraine, spinal manipulation and multimodal multidisciplinary interventions including massage are recommended for management of patients with episodic or chronic migraine.
- For cervicogenic headache, spinal manipulation is recommended. Joint mobilization or deep neck flexor exercises may improve
While there are risks and benefits to all treatments, studies reviewing the safety of the chiropractic adjustment (SMT), specifically of the neck region, have repeatedly shown that the risk of severe adverse effects resulting from SMT is negligible.
“Adverse events in a chiropractic spinal manipulative therapy single-blinded, placebo, randomized controlled trial for migraineurs,” a report published in the journal Musculoskeletal Science and Practice evaluated both the efficacy of chiropractic care for migraine headache relief as well as the risk of that treatment. They found that adverse events (AE) were mild and short term, with the most common being “local tenderness” and “tiredness”. When combined with knowledge from other previous studies, they concluded: “AEs are usually mild and transient, and severe and serious AEs are rare.”
This is further confirmed by the World Health Organization guidelines which consider chiropractic care to be “an efficient and safe treatment modality.” Additionally, they noted that the risk of an Adverse Effect (AE) during manual therapy to be “substantially lower than the risk accepted in any medical context for both acute and prophylactic migraine medication.” Specifically in this study, they noted fewer AEs than what is typically reported for common preventative medications such as topiramate, metoprolol or candesartan.
In addition to having lower risk, the study showed chiropractic care to “have a similar effect as the drug topiramate on migraine frequency, migraine duration, migraine intensity and medicine consumption.” The number of migraine days were significantly reduced among all groups in the study. However, while the control group reverted to baseline levels, those who received SMT continued to have fewer migraine days for up to a year.
Headaches of any type are never fun, and for some, they can become debilitating. While there are many types of headaches, with various causes, chiropractic has been proven to be not only safe, but also effective at relieving many of them, especially migraine, tension and cervicogenic, which are some of the most common, and most frequent types.
Talk to your doctor of chiropractic about how you can find drug-free pain relief and even prevention with chiropractic. In addition to SMT, your chiropractor can help identify other components that may be contributing to your headaches and recommend nutrition, exercises, ergonomics or other activities that may help you. Your doctor can also refer you to other healthcare specialists when needed.
Bernstein C, Wayne PM, Rist PM, Osypiuk K, Hernandez A, Kowalski M. Integrating Chiropractic Care Into the Treatment of Migraine Headaches in a Tertiary Care Hospital: A Case Series. Global Advances in Health and Medicine. January 2019. doi:10.1177/2164956119835778
Bronfort G, Assendelft WJ, Evans R, Haas M, Bouter L. Efficacy of spinal manipulation for chronic headache: a systematic review. J Manipulative Physiol Ther. 2001 Sep;24(7):457-66. PMID: 11562654.
Bryans R, Descarreaux M, Duranleau M, Marcoux H, Potter B, Ruegg R, Shaw L, Watkin R, White E. Evidence-based guidelines for the chiropractic treatment of adults with headache. J Manipulative Physiol Ther. 2011 Jun;34(5):274-89. doi: 10.1016/j.jmpt.2011.04.008. PMID: 21640251.
Chaibi A, Benth JŠ, Tuchin PJ, Russell MB. Adverse events in a chiropractic spinal manipulative therapy single-blinded, placebo, randomized controlled trial for migraineurs. Musculoskelet Sci Pract. 2017 Jun;29:66-71. doi: 10.1016/j.msksp.2017.03.003. Epub 2017 Mar 14. Erratum in: Musculoskelet Sci Pract. 2017 Oct;31:21. PMID: 28324697.