The effectiveness of chiropractic manipulation in the treatment of headache: an exploration in the literature.

OBJECTIVE To review the literature on outcome studies of chiropractic/manipulation for tension-type and migraine headaches. DESIGN Qualitative literature review. RESULTS Of nine studies of manipulation for tension-type headaches that reported quantitative outcomes, four were randomized clinical trials and five were case series designs. These studies reported on 729 subjects, 613 of whom received manipulation. Outcomes ranged from good to excellent. Manipulation seems to be better than no treatment, some types of mobilization and ice, and it seems to be equivalent to amitriptyline but with greater durability of effect than this medication. Of three studies on migraine, only one was a randomized clinical trial. These studies reported on 202 subjects, 156 of whom received manipulation. The outcomes ranged from fair to very good. CONCLUSION A modest body of clinical studies exists dealing with the effect of manipulation and headache. The overall results are encouraging, even if not quite supportive in the case of tension-type headache. Further studies in this area are definitely warranted, particularly well-controlled studies in migraine.