Confessions of a Quackbuster

This blog deals with healthcare consumer protection, and is therefore about quackery, healthfraud, chiropractic, and other forms of so-Called "Alternative" Medicine (sCAM).

Monday, December 19, 2005

Spinal manipulation for headache disorders

Spinal manipulation for headache disorders

Clinical bottom line

There is no evidence of specific benefit with chiropractic for headache. It was no better than oral amitriptyline over six weeks.


Systematic review

These two reviews appear to have found much the same trials using slightly different search strategies. They also used different methods of quality scoring, with those in the Astin review somewhat more familiar.


JA Astin, E Ernst. The effectiveness of spinal manipulation for the treatment of headache disorders: a systematic review of randomized clinical trials. Cephalalgia 2002 22: 617-623.

G Bronfort et al. Efficacy of spinal manipulation for chronic headache: a systematic review. Journal of Manipulative and Physiological Therapeutics 2001 24: 457-466.

a.. Date review completed: 2001
b.. Number of trials included: 9
c.. Number of patients: 750
d.. Control group: sham therapy, oral antidepressant, massage
e.. Main outcomes: pain, headache intensity, frequency or duration of headaches


The trials found examined a variety of different types of headache, including tension headache, migraine, and others. Two trials comparing chiropractic with oral amitriptyline found no difference over about six weeks. Four studies used a sham chiropractic compared with true spinal manipulation came to no agreement.

It was unclear how much any effects observed could be due to chiropractic or other, non-specific, factors.


There is no evidence of specific benefit with chiropractic for headache.

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