The Effectiveness of Chiropractic Manipulation in the Treatment of Headache: An Exploration in the Literature

Vernon HConference Proceedings of the Chiropractic Centennial1995 Jul: 153-67

Practitioners of spinal manipulation have long been proponents of its effectiveness in the treatment of headaches. Reports to this effect exist in all literature of each of the main branches of manual therapy–chiropractic, osteopathy, manual medicine and physiotherapy. These reports range from anecdotal presentations, theoretical treatises, pathophysiologic and clinical studies to case series, cohort and randomized controlled studies [1,2]. There is a remarkable longevity and consistency to this literature, contributing to a coherent body of opinion and data which supports the role of the cervical spine in the etiology of a significant proportion of what we might call “benign headache”. As well, there is growing evidence for the efficacious role for manual therapeutics in the treatment of these kinds of headaches. Nevertheless, this coherent “manual therapy” paradigm is largely disregarded in orthodox circles, despite the introduction, in 1988, of a “cervicogenic headache” category in the Classification of Headaches of the International Headache Society [3]. This neglect of the “manual therapy model” also continues despite the large body of data which clearly delineates the role of the interconnection of neural pathways in what Bogduk has called the “trigemino-cervical nucleus” in the genesis of head and possibly face pain [4]. It is now indisputable that the afferent connections from the upper cervical joints have an enormous capacity to create referred head and facial pain [5,6,7], as well as muscle dysfunction in the cranio-vertebral region [8]. Manual therapy researchers have consistently reported on signs of cervicogenic dysfunction, including local and referred pain as well as myofascial dysfunction, in the upper cervical region of many sufferers of what has now come to be called “tension-type” and “migraine without aura” headache types [9,10]. This presentation will focus on the evidence which does exist in the literature mentioned above as to the “effectiveness” of spinal manipulation in the treatment of these types of headaches. The reader is referred to other sources on the issues of the cervicogenic basis of headache and the nature of the kinds of dysfunction which chiropractors and others target in their treatment approaches.

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