Saturday, March 06, 2010

Chiropractic care for headaches

More Evidence Supporting the Effectiveness of Chiropractic Spinal Manipulation for Cervicogenic Headache

A study published in the February 2010 issue of The Spine Journal added additional evidence supporting the effectiveness of chiropractic spinal manipulation (SMT) for cervicogenic headache (CGH). Dr. Mitch Haas and his team at Western States Chiropractic College investigated the differences in dose (8 versus 16 treatments) and between high velocity low amplitude spinal manipulation versus light massage in the treatment of cervicogenic headache. Both interventions were provided by experienced chiropractors. There were multiple outcomes assessed and the SMT group had clinically significant improvement over the light massage control. However, there was only a small dose effect difference between the groups receiving eight versus sixteen treatment sessions.

In that same issue of the journal, Drs. Haldeman and Dagenais provide commentary on this research. They conclude by stating that, despite some weaknesses in the research, “this study represents a step forward for stakeholders considering SMT )spinal manipulation therapy) for CGH. For clinicians who establish a working diagnosis of CGH that conforms to accepted diagnostic criteria, it appears reasonable, based upon currently available evidence, to consider a trial of SMT.”

Treatment of cervicogenic headache is one of the areas were the evidence is strongest for SMT and chiropractic. As the number of studies increases and improve, using different patient demographics, different techniques, different doses, etc., the stronger the position of the chiropractic profession becomes in the care of this condition.

Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial.

Spine J. 2010 Feb;10(2):117-28.

Haas M, Spegman A, Peterson D, Aickin M, Vavrek D.
Center for Outcomes Studies, Western States Chiropractic College, 2900 NE 132nd Ave., Portland, OR 97230, USA.

BACKGROUND CONTEXT: Systematic reviews of randomized controlled trials suggest that spinal manipulative therapy (SMT) is efficacious for care of cervicogenic headache (CGH). The effect of SMT dose on outcomes has not been studied.

PURPOSE: To compare the efficacy of two doses of SMT and two doses of light massage (LM) for CGH.

PATIENT SAMPLE: Eighty patients with chronic CGH.

MAIN OUTCOME MEASURES: Modified Von Korff pain and disability scales for CGH and neck pain (minimum clinically important difference=10 on 100-point scale), number of headaches in the last 4 weeks, and medication use. Data were collected every 4 weeks for 24 weeks. The primary outcome was the CGH pain scale.

METHODS: Participants were randomized to either 8 or 16 treatment sessions with either SMT or a minimal LM control. Patients were treated once or twice per week for 8 weeks. Adjusted mean differences (AMD) between groups were computed using generalized estimating equations for the longitudinal outcomes over all follow-up time points (profile) and using regression modeling for individual time points with baseline characteristics as covariates and with imputed missing data.

RESULTS: For the CGH pain scale, comparisons of 8 and 16 treatment sessions yielded small dose effects: AMD. There was an advantage for SMT over the control: AMD=-8.1 (95% confidence interval=-13.3 to -2.8) for the profile, -10.3 (-18.5 to -2.1) at 12 weeks, and -9.8 (-18.7 to -1.0) at 24 weeks. For the higher dose patients, the advantage was greater: AMD=-11.9 (-19.3 to -4.6) for the profile, -14.2 (-25.8 to -2.6) at 12 weeks, and -14.4 (-26.9 to -2.0) at 24 weeks. Patients receiving SMT were also more likely to achieve a 50% improvement in pain scale: adjusted odds ratio=3.6 (1.6 to 8.1) for the profile, 3.1 (0.9 to 9.8) at 12 weeks, and 3.1 (0.9 to 10.3) at 24 weeks. Secondary outcomes showed similar trends favoring SMT. For SMT patients, the mean number of CGH was reduced by half.

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