We know this monster well: migraines are thought to affect 15% of the global population, though that number could be much higher given that many sufferers opt to self-medicate rather than seek medical care. For those who suffer from migraines, the impacts on quality of life and daily function during an episode are immense. From the intense pain to the neurological symptoms that distinguish migraine from other forms of headaches, medications are usually the first line of attack when a migraine strikes.
Increasingly, patient education is stepping into focus, with emphasis placed on tracking patterns and learning how to prevent episodes. Still, this doesn’t always stop episodes attacks in their tracks. This new systematic and critical review, published in the Asia Pacific Chiropractic Journal, provides a critical examination of the management of diagnosed migraine patients through manual therapy modalities. In it, they centre chiropractic and chiropractic adjustments.
In undertaking any systematic review, the exploration stage is a giant undertaking. Hunting through multiple libraries and journals to find the relevant literature and then narrowing it down based on exclusion criteria is critical to finding the right information. In this case, the keywords included migraine, migraine disorder, manual therapy, physical therapy, and musculoskeletal manipulation. This was balanced against types of manual therapies and filtered to include only randomised clinical trials published in English or French, and then assessed against the SIGN quality assessment tool.
This left them with seven eligible trials, taking in an impressive 453 participants. When the results came in, the findings suggested that chiropractic ‘manipulation’, including high-velocity low-amplitude (HVLA) adjustments, may be effective in managing migraine. Its research language specified the Gonstead Technique as well as soft tissue relaxation techniques, but these two modalities were the standouts in the literature.
The use of the word ‘may’ is often used in academic literature to avoid overclaiming.  So too is the word ‘spinal manipulation’ used in publications that still reject the words ‘chiropractic adjustment’ – for now. Still, this paper directly discusses the Gonstead technique, HVLA, low velocity high amplitude, as well as Trigger point and Active Release Techniques. All of these are chiropractic specific terms and techniques.
There were a few interesting takeaways from the detail of the study. The first was that spinal manipulations (Chiropractic, and the Gonstead technique) and soft tissue work may reduce the intensity, frequency and duration of migraine attacks. Given they can range from hours to days, and debilitate the sufferer to the point of being bedridden for the duration of the attack, this is significant.
The second major takeaway from this study is that chiropractic and soft tissue work may reduce analgesic medication usage. Given the recent and continuing opioid crisis, in America and other countries, reducing reliance on pain medication is an important element of health. While migraine medication ordinarily comes in the form of Non-Steroidal Anti-Inflammatory Drugs or triptans, other forms of analgesics may be used, and adverse side effects of such medication makes their use restrictive at best. Therefore, reducing the frequency, intensity and duration of migraine attacks as well as reducing the need for analgesic medication can be interpreted as a positive thing across numerous domains.
The authors of the paper also held up the multi-pronged approach chiropractors could use in migraine management: that is, spinal mobilisation (adjustments), muscle and tissue work, as well as relevant patient information and education.
While there were varying effect sizes in the different studies, and the detail is significant (see the full study referenced below for all of that!) it does reinforce the current scientific opinion as to manual therapies’ role in migraine management. The big difference here is that the authors of the study have centred chiropractic in the picture.
There is still much to learn, as the relevant literature is limited. But the more we understand migraine, and the more we understand the neurological impacts of chiropractic, the more this while picture is likely to come into focus.
We can’t wait.
References:
Allix F, Aubry A, Hoog V, Lorenzelli C, Sok S. The management of diagnosed Migraine patients through manual therapy: A Systematic and Critical Review. Asia-Pac Chiropr J. 2025;6.1. www.apcj.net/papers-issue-6-1/#AllixMigraine Â
