Migraine is the seventh leading cause of years lived with disability (YLDs) and a common neurological disorder. During an attack, migraine symptoms are characterised by severe, throbbing, unilateral headaches associated with nausea, vomiting, photophobia and/or phonophobia and aggravation from physical activity and while less common, a migraine with aura is further associated with visual, sensory or speech related symptoms. A variety of precipitating factors have been associated with triggering a migraine pain attack. Triggers reported include weather, stress, poor or over-sleeping, odours, missing meals and certain foods, menses and neck pain.
While the clinical role of manual therapies in migraine management is unclear, the use of chiropractors for this condition is considerable. The aim of this study is to evaluate the prevalence and characteristics of chiropractors who frequently manage patients with migraine.
Chiropractic care, which includes a combination of spinal manipulation, active and passive exercises, and massage, is often used for headache management and prevention. While chiropractic treatment is popular, there is limited evidence regarding its effectiveness for most headache types, and there are potential adverse outcomes of spinal manipulation. Guidelines regarding the use of chiropractic care for headaches have emerged, with a number of research studies underway. The headache types for which chiropractic therapy is often sought out—cervicogenic headaches, migraines, and tension headaches—each respond differently to chiropractic treatment.
A large proportion of chiropractors report having a high migraine caseload (HMC) (n = 990; 53.0%). The strongest factors predicting a chiropractor having a HMC include the frequent treatment of patients with axial neck pain (OR = 2.89; 95%CI: 1.18, 7.07), thoracic pain (referred/radicular) (OR = 2.52; 95%CI: 1.58, 3.21) and non-musculoskeletal disorders (OR = 3.06; 95%CI: 2.13, 4.39).
Migraines are characterized by headaches, as well as other symptoms, such as dizziness and nausea. There are effective medications that can be used for migraine prevention or for acute migraine episodes.3 Some procedures, such as pain injections, have also been successful.
Chiropractic treatment is not among the most effective or commonly recommended options for migraines, but there are some types of chiropractic therapies that may be effective.
Chiropractic therapy options for migraines include:
Neuromuscular massage: Massage with a focus on trigger points within the back, shoulder, neck, and head may ease symptoms.
Multidisciplinary care intervention: This approach, which combines physical therapy exercises, relaxation techniques, stress management, and dietary counseling, has been found to be effective in reducing migraine pain, frequency, duration, and disability.
Several practice-setting and clinical management characteristics are associated with chiropractors managing a HMC. These findings raise key questions about the therapeutic approach to chiropractic migraine management that deserves further examination. There is a need for more primary research to assess the approach to headache and migraine management provided by chiropractors and to understand the prevalence, burden and comorbidities associated with migraine found within chiropractic patient populations. This information is vital in helping to inform safe, effective and coordinated care for migraine sufferers within the wider health system.
