Previous research suggests that spinal manipulative therapy (SMT) may be helpful for various types of chronic headaches, including cervicogenic headache (CGH), which is associated with neck pain and dysfunction. In a recent randomized controlled trial, NCCAM-funded researchers from Western States Chiropractic College and other institutions evaluated the dose (number of treatments) and relative efficacy of SMT in a group of 80 patients with chronic CGH.
The study participants were assigned to an SMT group or a control group, which received light massage. Participants in both groups received treatments from chiropractors in 10-minute sessions either once or twice a week for 8 weeks, for a total of 8 or 16 treatments. Participants who were treated only once a week also had weekly examination visits, which included a discussion of the patient's condition followed by a manual examination, as a control for provider contact/attention. Researchers used pain and disability scales to evaluate the participants' response to treatment once every 4 weeks for 24 weeks. They also asked subjects about the number of headaches experienced.
Compared with massage, participants receiving SMT had greater improvements in CGH-related pain and disability, lasting to 24 weeks. These differences were clinically important and statistically significant. The dose effects of SMT treatments (i.e., differences between 8 and 16 treatments) were small but significant. The mean number of headaches reported by SMT subjects decreased by more than half during the study.
The researchers concluded that their findings support SMT as a viable option for treating CGH, but also point out that these findings should be considered preliminary. They suggest additional research to determine whether SMT results for patients with CGH are affected by treatment intensity and duration, use of other therapies, lifestyle changes, and an integrative care approach.
Haas M, Spegman A, Peterson D, et al. Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial. Spine Journal.;10(2):117–128.2010