A Cochrane review [Abstract] 1 [withdrawn from publication] on the effect of spinal manipulation therapy (SMT) for migraine headache included three studies with a total of 433 subjects.
The comparison of SMT (14 sessions) to amitriptyline (100 mg per day; n=218) showed similar reductions in headache index (ES -0.1; 95% CI -0.5 to 0.3) and pain medication use (ES -0.2; 95% CI -0.6 to 0.2) in the SMT and amitriptyline groups during the last 4 weeks of treatment. However, during the 4-week post-treatment period, patients in the SMT group recorded a significantly greater reduction in headache index than patients in the amitriptyline group (ES 0.4; 95% CI 0.0 to 0.8); pain medication use was again similar in the two groups (ES 0.2; 95% CI -0.2 to 0.6). The combination of SMT plus amitriptyline was no better than amitriptyline alone for headache index or medication use at either time point.
In the comparison of SMT provided by chiropractors to mobilization provided by medical doctors or physical therapists (up to two sessions per week for 8 weeks; n=88) SMT provided by chiropractors was more favorable than mobilization for headache pain intensity (ES 0.4; 95% CI -0.2 to 1.0), but not for disability, duration, or frequency (ES for all three outcomes 0.1; 95% CI -0.5 to 0.7) at 8 weeks post-treatment.
In the comparison of SMT (up to 16 times over 8 weeks; n=127) with placebo electrotherapy there was no statistically significant difference between SMT and placebo for headache pain at 8 weeks post-treatment (ES -0.4; 95% CI -0.8 to 0.1). However, SMT resulted in statistically significant lower headache frequency (ES 0.5; 95% CI 0.1 to 0.9), duration (ES 0.5; 95% CI 0.1 to 0.9), and medication use (ES 0.6; 95% CI 0.3 to 1.0).
Comment: The quality of evidence is downgraded by potential reporting bias and by indirectness (the reliability of different scoring systems is uncertain).
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