Migraine Headache Page

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:     Frankp@chiro.org

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Migraine headaches are less common than tension–type headaches. Nevertheless, migraines afflict 25 to 30 million people in the United States. As many as 6% of all men, and up to 18% of all women experience a migraine headache at some time. Among the most distinguishing features is the potential disability accompanying the headache pain of a migraine: migraines may last 4–72 hours, are typically unilateral (60% of reported cases), throbbing, of moderate to severe intensity, and are aggravated by routine physical activity. Nausea, with or without vomiting, and/or sensitivity to light and sound often accompany migraines. An “aura” may occur before head pain begins – involving a disturbance in vision, and/or an experience of brightly colored or blinking lights in a pattern that moves across the field of vision. About one in five migraine sufferers experiences an aura.

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	The Physical Impact of Migraines on Female Chiropractic Patients: A Qualitative Study Health SA 2023 (Oct 25): 28: 2283 ~ FULL TEXT The majority of the participants experienced moderate to severe chronic migraines and migraines without aura. During their migraine attacks, the participants experienced debilitating effects, felt mentally or physically incapacitated, described that their life came to a standstill, were unable to complete daily activities and had a resultant decreased quality of life. The study highlighted that chiropractic treatment was favourable among the female population in improving the quality of life and reducing the severity, disability, duration of suffering and frequency of migraines. The study builds on the knowledge of the detrimental effects of migraines on physical functioning, with participant experiences confirming the use of chiropractic as an effective treatment approach for migraine pain management. The findings of the study contribute to a greater awareness of chiropractic as an effective evidence-based treatment approach for migraine pain management, which may be beneficial to migraineurs and healthcare practitioners seeking to co-manage patients.
	Headaches in Children: Part 1. The Changing Phenotypes of Migraine Headache in Infants, Children and Adolescents J Clinical Chiropractic Pediatrics 2022 (May); 20 (1): 1747–1756 ~ FULL TEXT Headaches in children are common and the prevalence is increasing worldwide. The phenotype of migraine headache changes with continuing development of the nervous system. Children of all ages experience headaches but these are typically difficult to recognize and diagnose in the younger ages. Early intervention addressing the chemical, mechanical and psychological factors contributing to an individual’s headache is essential. This reduces the risk for central sensitization associated with chronicity and disability including reducing the risk for headache in adulthood.
	Headaches in Children: Part 2. The Changing Phenotypes of Migraine Headache in Infants, Children and Adolescents J Clinical Chiropractic Pediatrics 2021 (Nov); 20 (2): 1802–1813 ~ FULL TEXT Headaches in children are common and the prevalence is increasing worldwide. The phenotypes of headaches change throughout growth and development making differential diagnosis a challenge. Children of all ages experience headaches but these can be difficult to recognize and diagnose particularly in the younger ages. Early intervention addressing the chemical, mechanical and psychological factors contributing to an individual’s headache is essential. This reduces the risk for central sensitization associated with chronicity and disability including the risk for headache in adulthood.
	Multimodal Chiropractic Care for Migraine: A Pilot Randomized Controlled Trial   NCT03177616 Cephalalgia 2021 (Mar); 41 (3): 318–328~ FULL TEXT For our primary clinical outcome of change in migraine days, we observed a mean decrease of ~3 migraine days per month for those randomized to the multimodal chiropractic care (MCC+) + enhanced usual care (EUC) compared to a mean decrease of ~1 migraine day per month for those randomized to EUC alone. This difference in mean change between the two groups may be clinically meaningful since it is comparable to the effect size seen for topiramate, propranolol, or erenumab compared to placebo, which is a decrease of about 2 days per month. [43–45] However, larger-scale studies are needed to determine the efficacy of chiropractic care for migraine. We observed some evidence of clinically meaningful changes in HIT-6 scores, MSQL role function-restriction, and potentially MIDAS scores for those randomized to chiropractic care+EUC. [46–48] However, effects of chiropractic care+EUC on migraine severity, migraine duration, number of medications used, and MQSL role function – preventive and emotional function were not clinically meaningful. [48]
	Perceptions of Chiropractic Care Among Women with Migraine: A Qualitative Substudy Using a Grounded-Theory Framework J Manipulative Physiol Ther 2021 (Feb); 44 (2): 154–163~ FULL TEXT In this qualitative study, women with episodic migraine after receiving comprehensive chiropractic care described chiropractic as a multimodal intervention where they learned about musculoskeletal contributions to migraine, discovered new ways to affect their symptoms, and developed a collaborative patient-practitioner relationship. The results of this study provide insights into perceptions of chiropractic care among women with migraine and suggestions for future trials.
	Outcome Measures for Assessing the Effectiveness of Non-pharmacological Interventions in Frequent Episodic or Chronic Migraine: A Delphi Study BMJ Open. 2020 (Feb 12); 10 (2): e029855 ~ FULL TEXT The aim of this Delphi survey was to establish an international consensus on the most useful outcome measures for research on the effectiveness of non-pharmacological interventions for migraine. Results suggest the use of the Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT-6) and headache frequency as primary outcome measures. Patient experts suggested the inclusion of a measure of quality of life and evaluation of associated symptoms and fear of attacks.
	The Integrative Migraine Pain Alleviation Through Chiropractic Therapy (IMPACT) Trial: Study Rationale, Design and Intervention Validation Contemp Clin Trials Commun 2020 (Jan 22); 17: 100531 ~ FULL TEXT This pilot study represents a novel contribution to the field because prior studies among individuals with migraine have only focused on spinal manipulation and have not evaluated chiropractic care as an integrative approach to migraine treatment. [5] In addition, as part of this pilot study, we developed and report here a chiropractic care protocol for individuals with migraine that was validated by a team of senior chiropractors using the Delphi method. As a next step in a large trial, we will evaluate the fidelity of protocol delivery. Finally, we used the PRECIS-2 framework to articulate the rationale for choosing key study design elements, which includes both pragmatic and explanatory features. This analysis could assist others in the design of other complex, multimodal and non-pharmacological interventions for the treatment of other neuromusculoskeletal pain-related conditions.
	The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta-Analysis Headache. 2019 (Apr); 59 (4): 532–542 ~ FULL TEXT Spinal manipulation may be an effective therapeutic technique to reduce migraine days and pain/intensity. However, given the limitations to studies included in this meta-analysis, we consider these results to be preliminary. Methodologically rigorous, large-scale RCTs are warranted to better inform the evidence base for spinal manipulation as a treatment for migraine.
	Integrating Chiropractic Care Into the Treatment of Migraine Headaches in a Tertiary Care Hospital: A Case Series Glob Adv Health Med. 2019 (Mar 28); 8: 2164956119835778 ~ FULL TEXT This case series illustrates an integrated model of care for migraine that combines standard neurological care with chiropractic treatment. For each patient, we describe the rationale for referral, diagnosis by both the neurologist and chiropractor, the coordinated care plan, communication between the neurologist and chiropractor based on direct face-to-face "hallway" interaction, medical notes, team meetings, and clinical outcomes. Findings are evaluated within the broader context of the multicause nature of migraine and the impact of integrative chiropractic. Suggestions for future areas of research evaluating integrative approaches are discussed.
	The Treatment of Migraine Patients Within Chiropractic: Analysis of a Nationally Representative Survey of 1869 Chiropractors BMC Complement Altern Med 2017 (Dec 4); 17 (1): 519 ~ FULL TEXT Uncertainty remains regarding the mechanisms associated with the initiation of migraine pain. Evidence suggests migraine pain has a central origin involving the cortex and brainstem. [5, 6] Indirect evidence also suggests migraine pain has a peripheral origin whereby peripheral input from within cervical spine structures causes sensitization of trigeminal nociceptive pathways. [7–9] This may be more common in sufferers with neck pain and may involve convergent nociceptive input via the trigeminal nerve and the upper cervical afferents to the trigeminal cervical complex. [10–12]
	Chiropractic Spinal Manipulative Therapy for Migraine: A Three-Armed, Single-Blinded, Placebo, Randomized Controlled Trial Eur J Neurol. 2017 (Jan); 24 (1): 143–153 ~ FULL TEXT The blinding was strongly sustained throughout the RCT, adverse events (AEs) were few and mild, and the effect in the chiropractic spinal manipulative therapy (CSMT) and placebo group was probably a placebo response. Because some migraineurs do not tolerate medication because of AEs or co-morbid disorders, CSMT might be considered in situations where other therapeutic options are ineffective or poorly tolerated.
	Chiropractic Spinal Manipulative Therapy for Migraine: A Study Protocol of a Single-blinded Placebo-controlled Randomised Clinical Trial BMJ Open. 2015 (Nov 19); 5 (11): e008095 ~ FULL TEXT Migraine affects 15% of the population, and has substantial health and socioeconomic costs. Pharmacological management is first-line treatment. However, acute and/or prophylactic medicine might not be tolerated due to side effects or contraindications. Thus, we aim to assess the efficacy of chiropractic spinal manipulative therapy (CSMT) for migraineurs in a single-blinded placebo-controlled randomised clinical trial (RCT).
	Chiropractic Spinal Manipulative Treatment of Migraine Headache of 40-year Duration Using Gonstead Method: A Case Study J Chiropractic Medicine 2011 (Sep); 10 (3): 189–193 ~ FULL TEXT The patient reported all episodes being eliminated following CSMT. At 6–month follow-up, the patient had not had a single migraine episode in this period. The patient was certain that there had been no other lifestyle changes that could have contributed to her improvement. This case adds to previous research suggesting that some migraine patients may respond favorably to CSMT. The case also provides information on the Gonstead method. A case study does not represent significant scientific evidence in context with other studies conducted; this study suggests that a trial of CSMT using the Gonstead methods could be considered for chronic, nonresponsive migraines.
	Manual Therapies for Migraine: A Systematic Review J Headache and Pain 2011 (Apr); 12 (2): 127–133 ~ FULL TEXT Migraine occurs in about 15% of the general population. Migraine is usually managed by medication, but some patients do not tolerate migraine medication due to side effects or prefer to avoid medication for other reasons. Non-pharmacological management is an alternative treatment option. We systematically reviewed randomized clinical trials (RCTs) on manual therapies for migraine. The RCTs suggest that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally effective as propranolol and topiramate in the prophylactic management of migraine. However, the evaluated RCTs had many methodological shortcomings.
	A Case of Chronic Migraine Remission After Chiropractic Care J Chiropractic Medicine 2008 (Jun); 7 (2): 66–70 ~ FULL TEXT The average frequency of migraine episodes before treatment was 1 to 2 per week, including nausea, vomiting, photophobia, and phonophobia; and the average duration of each episode was 1 to 3 days. The patient was treated with CSMT. She reported all episodes being eliminated after CSMT. The patient was certain there had been no other lifestyle changes that could have contributed to her improvement. She also noted that the use of her medication was reduced by 100%. A 7-year follow-up revealed that the person had still not had a single migraine episode in this period.
	Analgesic Use: A Predictor of Chronic Pain and Medication Overuse Headache Neurology 2003 (Jul 22); 61 (2): 160–164 ~ FULL TEXT Overuse of analgesics strongly predicts chronic pain and chronic pain associated with analgesic overuse 11 years later, especially among those with chronic migraine.
	A Randomized Controlled Trial of Chiropractic Spinal Manipulative Therapy for Migraine J Manipulative Physiol Ther 2000 (Feb); 23 (2): 91–95 ~ FULL TEXT The results of this study support previous results showing that some people report significant improvement in migraines after chiropractic SMT. A high percentage (>80%) of participants reported stress as a major factor for their migraines. It appears probable that chiropractic care has an effect on the physical conditions related to stress and that in these people the effects of the migraine are reduced.
	Chiropractic Management of Migraine Without Aura: A Case Study Australasia Chiropractic and Osteopathic Journal 1999 (Nov): 8 (3): 85–90 ~ FULL TEXT It now appears clear that chiropractic care may be used to assist patients with migraine. Research is currently being undertaken to investigate the potential mechanisms of chiropractic in the treatment of migraine. This research should also assess what (if any) prognostic signs can be identified to assist practitioners making a more informed decision on the treatment of choice for migraine.
	A Twelve Month Clinical Trial of Chiropractic Spinal Manipulative Therapy for Migraine Australasia Chiropractic and Osteopathic Journal 1999 (Jul): 8 (2): 61–65 ~ FULL TEXT 32 participants showed statistically significant (p < 0.05) improvement in migraine frequency, VAS, disability, and medication use, when compared to initial baseline levels. A further assessment of outcomes after a six month follow up (based on 24 participants), continued to show statistically significant improvement in migraine frequency (p < 0.005), VAS (p < 0.01), disability (p < 0.05), and medication use (p < 0.01), when compared to initial baseline levels.
	The Efficacy of Spinal Manipulation, Amitriptyline and the Combination of Both Therapies for the Prophylaxis of Migraine Headache J Manipulative Physiol Ther 1998 (Oct); 21 (8): 511–519 There was no advantage to combining amitriptyline and spinal manipulation for the treatment of migraine headache. Spinal manipulation seemed to be as effective as a well-established and efficacious treatment (amitriptyline), and on the basis of a benign side effects profile, it should be considered a treatment option for patients with frequent migraine headaches.

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Since 5–01–1998

Updated 12-27-2023