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Efficacy of Spinal Manipulation for Chronic Headache:
A Systematic Review
J Manipulative Physiol Ther 2001 (Sep); 24 (7): 457–466
SMT appears to have a better effect than massage for cervicogenic headache. It also appears that SMT has an effect comparable to commonly used first-line prophylactic prescription medications for tension-type headache and migraine headache. This conclusion rests upon a few trials of adequate methodological quality. Before any firm conclusions can be drawn, further testing should be done in rigorously designed, executed, and analyzed trials with follow-up periods of sufficient length.
Spinal Manipulation vs. Amitriptyline for the Treatment of Chronic Tension-type Headaches: A Randomized Clinical Trial
J Manipulative Physiol Ther 1995 (Mar); 18 (3): 148–154
The results of this study show that spinal manipulative therapy is an effective treatment for tension headaches. Amitriptyline was slightly more effective in reducing pain by the end of the treatment period, but was associated with more side effects. Four weeks after cessation of treatment however, patients who received spinal manipulation experienced a sustained therapeutic benefit in all major outcomes in contrast to the amitriptyline group, who reverted to baseline values.
The Effect of Spinal Manipulation in the Treatmentof Cervicogenic Headache
J Manipulative Physiol Ther 1997 (Jun); 20 (5): 326–330
The use of analgesics decreased by 36% in the manipulation group, but was unchanged in the soft-tissue group. The number of headache hours per day decreased by 69% in the manipulation group, compared with 37% in the soft-tissue group. Finally, headache intensity per episode decreased by 36% in the manipulation group, compared with 17% in the soft-tissue group.
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- A randomized controlled trial reported by medical doctors and doctors of chiropractic in Denmark found manipulation to have "a significant positive effect" on intensity and duration of cervicogenic headaches compared to "soft-tissue" therapy (Nilsson, Christensen, and Hartrigsen 1997).
- Boline et al. (1995) conducted a study comparing manipulation to pain medication (amitriptyline) in the treatment of tension headaches. The authors found that pain medication had short-term effectiveness--although with side effects--while "four weeks after the end of intervention, the spinal manipulation group showed a 32% reduction in headache intensity, 42% [reduction] in headache frequency, 30% [reduction] in over-the-counter medication usage, and a 16% improvement in functional health status... The amitriptyline therapy group showed no improvement or slight worsening" (150).
- In 1998, Hack et al. reported a new anatomical discovery: bridges of connective tissue establish a direct connection between neck muscles and the protective covering of the brain and spinal cord. This is a probable cause-and-effect connection between headaches and cervical spine dysfunction. The authors hypothesized that chiropractic treatment of muscle tension headaches is effective because it can "decrease muscle tension and thereby reduce or eliminate pain by reducing the potential forces exerted on the dura via the muscle-dura connection" (22).
- In 1998, Mitchell, Humphreys, and O'Sullivan described previously unreported ligaments of the neck attached to the base of the skull. This discovery has implications for manual therapy and the treatment of cervicogenic headaches caused by damaged ligaments, mainly in cases of moderate to severe whiplash.
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