Research Review: Prevalence of manual therapy treatment for headaches

Dr. Shawn Thistle
June 29, 2017
Written by
Migraine and tension headaches are common and can co-occur for some patients.

Study title: A Critical Review of Manual Therapy Use for Headache Disorders: Prevalence, Profiles, Motivations, Communication and Self-Reported Effectiveness
Authors: Moore CS, Sibbritt DW & Adams J, Faculty of Health, University of Technology Sydney, Australia
Publication information: BMC Neurology 2017; 17: 61. DOI 10.1186/s12883-017-0835-0

Migraine and tension headaches are common and can co-occur for some patients. The authors of this review sought to critically review the prevalence of manual therapy (MT) use for the treatment of chronic recurrent headaches, and review the patient-related factors associated with the use of MT.

Key findings from the 35 included studies were grouped and analyzed utilizing a critical review approach, which was adapted from previous research. Prevalence findings were reported within one of two possible categories: either as migraine for papers reporting on the populations predominantly or entirely made up of migraine patients (10 studies), or as headache for studies where the included population was predominantly comprised of other headache types. Three studies reported findings on both categories.

Chiropractic
  • The prevalence of chiropractic use for those in the general population with migraine ranged from 1 to 36.2 per cent (average 14.4 per cent), and from 8.9 to 27.1 per cent (average 18 per cent) in headache patient populations.
  • The prevalence of chiropractic use for those in the general population reporting headaches ranged from 4 to 28 per cent (average 12.9 per cent). Utilization within the headache-pain clinic population ranged from 12 to 22 per cent (average 18.6 per cent).
  • Interestingly, headache prevalence ranged from 1.9 to 45.5 per cent (average 9.8 per cent) in chiropractic populations.
Physiotherapy
  • The prevalence of physiotherapy use for those in the general population suffering from migraine ranged from 9 to 57 per cent (average 24.7 per cent). Utilization within headache-pain clinic populations ranged from 4.9 to 18.7 per cent (average 11.8 per cent).
  • The prevalence of physiotherapy use in the general population with headaches ranged from 12.2 to 52 per cent (average 32.1 per cent). MT utilization prevalence ranged from 27.8 to 35 per cent within headache-pain clinic populations.
Massage therapy
  • Massage use for those with migraine ranged from 2 to 29.7 per cent (average 15.6 per cent) within the general population, and from 10.1to 56.4 per cent (average 33.9 per cent) within the headache-pain clinic population.
  • Massage/acupressure use in those reporting headache within headache-pain clinic populations ranged from 12 to 54 per cent (average 32.5 per cent).
Osteopathy
  • Osteopathy use in those in the general population suffering from migraine was approximately one per cent. Utilization was 2.7 per cent within a headache-pain clinic population. Migraines occupied approximately 1.7 per cent of an osteopathy patient population.
  • For headache sufferers, the prevalence of osteopathy use was nine per cent within a headache-pain clinic population. Headaches occupied 2.7 to 10 per cent of the osteopathy patient populations.
Application, conclusions
This was the first study to critically review the prevalence and key factors associated with use of MT for headache within the peer-reviewed literature. The review demonstrated that MT use was higher within medical headache-pain clinic populations in comparison to the general population. Overall, the use of MT for headaches and migraines appears to be substantial, and is likely the most common physical modality used for treatment in many countries. Still, the needs of those suffering from headaches can be complex, and may require a multidisciplinary approach to care. Given its relatively high utilization and efficacy, clinicians should remain cognizant of, and open to discussing MT as a possible adjunct treatment.


Dr. SHAWN THISTLE is the founder and CEO of RRS Education, providing weekly research reviews, online courses and seminars to help busy clinicians integrate current research evidence rationally into practice. For more information, visit: www.rrseducation.com. Shawn can be reached by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it

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