Boline, 1995¹⁸⁸

1 month

Duration of pain: 13.5 years

Poor

A. Spinal Manipulative Therapy (n=70): short-lever, low-amplitude, high-velocity thrust techniques on cervical, thoracic or lumbar spinal segments. Moist heat and light massage preceded manipulation; 12, 20 minute sessions (2 per week for 6 weeks)

B. Amitriptyline (n=56): dose titration of amitriptyline for 6 weeks. Nighttime, daily doses began at 10mg/day for first week, then increased to 20mg/day in the second, followed by 30mg/day in the third week and after; continued use of OTC medications as-needed.

A vs. B

Age: 41 vs. 42 years

Female: 54% vs. 70%

Race: NR

Baseline Daily headache intensity (0-20)^b: 5.6 vs. 5.0

Baseline Weekly headache frequency (0-28)^c: 12.4 vs. 10.8

A vs. B

1 month

Daily headache intensity^b: adjusted means 3.8 vs. 5.2; difference 1.4 (95% CI 0.3, 2.3)

Weekly headache frequency^c: adjusted means 7.6 vs. 11.8; difference 4.2 (95% CI 1.9, 6.5)

A vs. B

1 month

SF-36 Function Health Status Global Score (% points): adjusted means 78.8 vs. 73.9; difference 4.9 (95% CI 0.4, 9.4)

OTC medication usage: adjusted means 1.3 vs. 2.2; difference 0.9 (95% CI 0.3, 1.5)

Castien, 2011¹⁸⁷

4.5 months

Duration of pain: 13 years

Fair

A. Spinal Manipulation (n=38): combination of 3 approaches at the therapist discretion: mobilizations of the cervical and thoracic spine, craniocervical muscle exercises and posture correction; maximum of 9, 30-minute sessions over 2 months

B. Usual Care (n=37): 2-3 general practitioner visits over 2 months

A vs. B

Age, years: 40 vs. 40 years

Female: 78% vs. 78%

Race: NR

Mean frequency of headache (days/month): 24 vs. 24

NSAID use: 29% (mean 3 pills/week); Analgesic use: 59% (mean 1.5 pills/week)

Baseline HIT-6 (36-78): 62.6 vs. 61.2

Baseline HDI (0-100): 39.6 vs. 44.2

Baseline Pain intensity, NRS (0-10): 6.3 vs. 5.7

A vs. B

4.5 months

Proportion of patients with ≥50% reduction in headache frequency: 81.6% vs. 40.5%; RR 2.01 (95% CI 1.32 to 3.05)

HIT-6, mean change from baseline: −10.6 vs. −5.5; difference 5.0 (95% CI −9.02 to −1.16)

HDI, mean change from baseline: −20.0 vs. −9.9; difference −10.1 (95% CI −19.5 to −0.64)

Headache frequency (days/14 days), mean change from baseline: −9.1 vs. −4.1; difference −4.9 (95% CI −6.95 to −2.98)

Pain intensity mean change from baseline: −3.1 vs. −1.7; difference −1.4 (95% CI −2.69 to −0.16)

Headache duration (hrs./day), mean change from baseline: −7.0 vs. −3.5; difference −3.5 (95% CI −7.71 to −0.63)

A vs. B

4.5 months

Resource use, proportion who used:

≥1 sick leave day: 7.9% vs. 32.4%; RR 0.23 (95% CI 0.07 to 0.79)

Any additional healthcare: 13.2% vs. 59.4%; RR 0.22 (95% CI 0.09 to 0.52)

Additional physical therapy: 2.6% vs. 40.5%; RR 0.06 (95% CI 0.01 to 0.47)

Additional medical specialist care: 2.6% vs. 16.2%; RR 0.16 (95% CI 0.02 to 1.28)

Additional “other” healthcare”: 7.8% vs. 2.7%; RR 2.9 (95% CI 0.3 to 26.8)