Resources and Strategies

The Evidence-Informed Chiropractor


Chiropractic and Headache Management


In reviewing the literature evidence regarding chiropractic management of headache, it becomes apparent that some studies are specific to chiropractic manipulation (adjustment) while others refer to manipulation or mobilization performed by other health professionals.


Taken as a whole, there is general agreement through systematic reviews that there is value in utilizing manipulation for patients with headache.

Some of the results and reviews are specific to specific headache types. Following are some summaries:


Cochrane Review of the Literature[1]

  • For the prophylactic (preventive) treatment of migraine headache, there is evidence that spinal manipulation may be an effective treatment option with a short-term (3-month follow-up) effect similar to that of a commonly used drug (i.e. amitriptyline)[2]
  • For the prophylactic treatment of chronic tension-type headache, although amitriptyline is more effective during treatment, spinal manipulation is superior in the short-term (3-month follow-up) after cessation of both treatments [3]
  • For the prophylactic (preventive) treatment of cervicogenic headache, there is evidence that both exercise (low-intensity, endurance training) and spinal manipulation are effective in the short and long-term when combined and when compared to no treatment
  • A small study by Haas [4] indicates that for chronic cervicogenic headache high-frequency chiropractic care (3 to 4 times per week) for three weeks is more effective than low-frequency care (1 to 2 times per week).

1. Bronfort, G., et al., Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database Syst Rev, 2004(3): p. CD001878.

2. Nelson, C.F., et al., The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. J Manipulative Physiol Ther, 1998. 21(8): p. 511-9.

3. Boline, P.D., et al., Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial.J Manipulative Physiol Ther, 1995. 18(3): p. 148-54.

4. Haas, M., et al., Dose response for chiropractic care of chronic cervicogenic headache and associated neck pain: a randomized pilot study. J Manipulative Physiol Ther, 2004. 27(9): p. 547-53.

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