If your patient is failing to respond to conservative drug treatments for their headache, may be developing unwanted side effects or drug/OTC dependency, or simply is inquiring about non-drug options, then chiropractic care is a possible consideration.
Various RCTs and systematic reviews of manipulation have been done on chiropractic care and head pain (e.g. cervicogenic, tension type, and migraine headache). Safety appears to be good and benefits can be substantial for many sufferers, and modest for others. One of the most comprehensive systematic reviews comes from the Center for Clinical Health Policy Research at Duke University (Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache. From the FCER. 800-622-6309). Some of the findings from the report were:
In tension-type headache, compared to amitriptyline (tri-cyclic antidepressant), chiropractic care (generally high-velocity low amplitude adjustments of the upper cervical vertebrae) was shown to produce slightly lesser effects during the treatment period, but markedly superior results after active treatment; and
- for cervicogenic headache, frequency and severity was reduced with chiropractic adjustments
A recent study looked at positive clinical predictors for patients receiving neck adjustments (Thiel HW, Bolton JE. J Manipulative Physiol Ther 2008;31:172-83). Patients who have symptoms which include neck pain; shoulder and arm pain; reduced neck, shoulder, and arm movement; stiffness, upper back pain; and headache tended to have a more positive response to cervical adjustments.
Headache patients will generally improve relatively quickly (6-8 visits). Failure to get at least a decrease in severity or frequency of the headache soon, would not justify further care. Chronic sufferers and those trying to wean themselves off OTC medications, may need more long term care, but the frequency of treatments should continually decrease.