Background: Primary headache disorders,
especially migraine, are commonly accompanied by neck pain or other
symptoms. Because of this, physical therapy (PT) and other physical
treatments are often prescribed. This review updates and synthesizes
published clinical trial evidence, systematic reviews, and case
series regarding the efficacy of selected physical modalities in
the treatment of primary headache disorders.
Methods: The National Library of Medicine, The
Cochrane Library, and other sources of information were searched
through June 2004 to identify clinical studies, systematic reviews,
case series, or other information published in English that assessed
the treatment of headache of migraine with chiropractic, osteopathic,
PT, or massage interventions.
Results: PT is more effective than massage therapy
or acupuncture for the treatment of tension-type headache (TTH) and
appears to be most beneficial for patients with a high frequency of
headache episodes. PT is most effective for the treatment of
migraine when combined with other treatments such as thermal
biofeedback, relaxation training, and exercise. Chiropractic
manipulation demonstrated a trend toward benefit in the treatment
of TTH, but evidence is weak. Chiropractic manipulation is probably
more effective in the treatment of TTH than it is in the treatment
of migraine. Evidence is lacking regarding the efficacy of these
treatments in reducing headache frequency, intensity, duration,
and disability in many commonly encountered clinical situations.
Many of the published case series and controlled studies are of
low quality.
Conclusions and Recommendations: Further studies of
improved quality are necessary to more firmly establish the place
of physical modalities in the treatment of primary headache
disorders. With the exception of high velocity chiropractic
manipulation of the neck, the treatments are unlikely to be
physically dangerous, although the financial costs and lost
treatment opportunity by prescribing potentially ineffective
treatment may not be insignificant. In the absence of clear
evidence regarding their role in treatment, physicians and
patients are advised to make cautious and individualized
judgments about the utility of physical treatments for headache
management; in most cases, the use of these modalities should
complement rather than supplant better-validated forms of therapy.
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