Migraine Relief After Chiropractic Manipulation Likely a Placebo Effect

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Spinal manipulation may be an option for patients with migraine refractory to treatment.
Spinal manipulation may be an option for patients with migraine refractory to treatment.

In the first manual-therapy randomized controlled trial  on headaches to include successfully documented single-blinding with a placebo group,1 a significantly reduced number of migraine days was seen in both the chiropractic spinal manipulation and placebo groups.

Migraines are one of the leading causes of disability and have a high prevalence rate, causing a substantial socioeconomic burden.2 However, standard treatments are frequently ineffective or poorly tolerated.3 In a recent study evaluating the effectiveness of nonpharmacologic interventions for headaches, manual therapy was found to be potentially beneficial.4

Aleksander Chaibi, MChiro, and colleagues evaluated the efficacy and safety of chiropractic spinal manipulative therapy (CSMT) in patients with migraine. They developed a sham procedure, “where participants with migraine were unable to distinguish between real and sham CSMT.”

The study was a prospective 3-armed, single-blinded, placebo-controlled, randomized trial lasting 17 months. The groups consisted of CSMT (n = 35), sham (placebo: n = 35), and control (usual pharmacologic management: n = 34). After a 1-month baseline there were 12 treatment sessions over 3 months, with follow-up assessments after the intervention and 3, 6, and 12 months later.

The primary end point of migraine days per month was significantly reduced in all groups from baseline to post-treatment (P <.0001), with the effect continuing in CSMT and sham groups but not in the control group after 3, 6, and 12 months of follow-up. Comparing CSMT to the sham group from baseline to post-treatment revealed a greater improvement in the CSMT group (P =.04). However, this failed to reach the significance level of P <.025.

The secondary end points of migraine duration, intensity, and headache index (HI) were significantly reduced in the CSMT (P =.003, P =.002, and P <.001, respectively) and sham groups (P <.001, P =.001, and P <.001, respectively). These effects continued at 3, 6, and 12 months of follow-up.

The CSMT group was found to be significantly superior to the control group in change in migraine duration (P =.002) and HI (P =.004).

Additionally, the change in consumption of paracetamol at 12 months was significantly lower in the CSMT group compared to the sham (P =.004) and control (P =.003) groups.

Adverse events were few, mild, and temporary, although they occurred significantly more frequently in the CSMT group (P <.001).

The authors concluded that the effect in the CSMT and the sham groups “was probably a placebo response.” However, due to the inability of migraine sufferers to tolerate medication, “CSMT might be considered in situations where other therapeutic options are ineffective or poorly tolerated.”

References

  1. Chaibi A, Benth JS, Tuchin PJ, Russell MB. Chiropractic spinal manipulative therapy for migraine: a three-armed, single-blinded, placebo, randomized controlled trial. Eur J Neurol. 2017;24:143-153.
  2. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163-2196.
  3. Diener HC, Charles A, Goadsby PJ, Holle D. New therapeutic approaches for the prevention and treatment of migraine. Lancet Neurol. 2015;14(1):1010-1022.
  4. Varatharajan S, Ferguson B, Chrobak K, et al. Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur Spine J. 2016;25(7):1971-1999.
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