A Randomized Controlled Trial of the Effect of Spinal Manipulation in the Treatment of Cervicogenic Headache

A Randomized Controlled Trial of the Effect
of Spinal Manipulation in the Treatment
of Cervicogenic Headache

This section is compiled by Frank M. Painter, D.C.
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FROM:   J Manipulative Physiol Ther. 1995 (Sep);   18 (7):   435440

Nilsson N.

Nordic Institute of Chiropractic, Odense, Denmark.

Editor's Comment:   This study suffered from the affliction I refer to as The Problem with Placebos/Shams. Although there may not have been any pre-1995 literature in English regarding low-level laser or deep friction massage as palliative treatments, this study merely demonstrates that both groups actually improved, but that there was not significant difference between them because BOTH groups received (some form of) active treatments.

PURPOSE:   To determine whether the isolated intervention of high-velocity, low-amplitude spinal manipulation in the cervical spine has any effect on cervicogenic headache.

DESIGN:   Randomized controlled trial with a blind observer.

SETTING:   Ambulatory outpatient facility in an independent NHS-funded chiropractic research institution.

PARTICIPANTS:   Thirty-nine subjects suffering from frequent headaches who fulfilled the IHS criteria for cervicogenic headache (excluding radiological criteria). These subjects were recruited from among some 400 headache sufferers who responded to newspaper advertisements.

INTERVENTION:   Half of the group received high-velocity, low-amplitude cervical manipulation twice/wk for 3 wk. The other half received low-level laser in the upper cervical region and deep friction massage (including trigger points) in the lower cervical/upper thoracic region, also twice/wk for 3 wk.

MAIN OUTCOME MEASURE:   The change from week 2 to week 6 in analgesics use per day, headache intensity per episode and number of headache hr per day.

RESULTS:   Despite a significant reduction in the manipulation group on all three outcome measures, differences between the two treatment groups failed to reach statistical significance.

CONCLUSION:   The results suggest a possible effect of manipulation on cervicogenic headache, but because of methodological problems, such an effect could not be unequivocally demonstrated.

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