New Meta-Analysis on Migraine Pain and Disability and Spinal Manipulation

It is estimated that migraine affects around one in seven people worldwide, making it more prevalent than diabetes, epilepsy and asthma and ranking as the seventh most disabling disease “among all diseases.” [1]. While types of migraine differ, this isn’t a regular headache but rather a neurological event that can create a significant amount of impairment during attacks.

The causes of migraine remain somewhat mysterious (apart from solid indications that there is likely to be a genetic component), and most people treat their migraines at onset. Research indicates though, that “approximately 40% of those with episodic migraine have unmet treatment needs [2].” At present, most treatment is pharmaceutical and thus the need to explore “alternative or integrative treatment for migraine” is evident.

The recent study, released in March of 2019 and published in a journal dedicated specifically to research around headaches, set about undertaking a systematic review and analysis of available literature on migraine pain, the degree of disability it created, and spinal manipulation’s effect on it. After scouring more than 650 studies, the search narrowed down to 6 eligible randomised controlled trials. The interventions detailed within these studies ranged from 2-6 months and included a range of outcomes. Some of these were:

  • Migraine pain and intensity
  • Migraine disability
  • Measures of migraine days

Spinal manipulation, practiced in various forms by chiropractors and other manual practitioners, is “one potential non-pharmacological approach to treatment of migraine patients.” American statistics reveal some interesting insights to the treatment paradigms, as approximately 15% of individuals who suffer from migraines have sought chiropractic care in the past year. While chiropractors aren’t the only manual practitioners who use spinal manipulation, 94% of spinal manipulation claimed for reimbursement in the United States was delivered by chiropractors.

The study also listed an Australian chiropractic survey which revealed “53% of chiropractors reported managing patients with migraine ‘often’ and 40.9% of chiropractic reported managing patients with migraine ‘sometimes [2].’

Given the sheer number of people who suffer from this condition and seek chiropractic care as a method of managing the severity and prevalence of their migraines, it’s an important area of research.

The meta-analysis and systemic review in question covered six studies and a total of 677 patients with an average age of 39.3 years. Of these, 75% were female – a fact which is consistent with the higher prevalence of migraine among women. All studies allowed participants to use their normal medication and minimum attacks per month ranged from 1-4. The studies used data capture tools such as migraine diaries and questionnaires. Five of the six studies indicated that “spinal manipulation had a greater impact on reducing the number of migraine days compared to controls” although the effect size was small. There was a similar effect on pain and intensity in the five studies. Four of the studies measured elements of migraine disability but due to the smaller dataset, analysis couldn’t be included in the paper.

The pain, intensity and duration findings are encouraging for migraine sufferers who undergo chiropractic care. However, it is preliminary work, and more research needs to be done so we can understand the mechanisms and parameters around this complex condition.

The paper does give indications that spinal manipulation may be a helpful therapeutic tool. Further research with larger sample sizes is needed to better inform the practices and provide an evidence base for spinal manipulation as a treatment (either prophylactically or otherwise) for migraine. Still, these preliminary findings provide a great basis for further research to be done. We look forward to seeing what emerges.

REFERENCES:

  1. Staff Writer (2020). Facts and Figures about migraine. The Migraine Trust. org/about-migraine/migraine-what-is-it/facts-figures retrieved 13 November 2020
  2. Rist, P. M., Hernandez, A., Bernstein, C., Kowalski, M., Osypiuk, K., Vining, R., Long, C. R., Goertz, C., Song, R., & Wayne, P. M. (2019). The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta-Analysis. Headache59(4), 532–542. https://doi.org/10.1111/head.13501

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