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Chiropractic and Headaches
Chiropractic care does a great job at helping people who are
suffering with headaches. What's great about the
chiropractic approach is if the actual "cause" of your headache
is a physical problem, chiropractic care can heal that problem.
Below are two studies showing the positive results chiropractic
care has with headaches.
Study #1 - 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.
Study #2: Long Term Relief
From Headaches
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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