Headache

Association Between Spinal Manipulation, Butalbital Prescription, and Medication Overuse Headache in Adults With Tension-Type Headache: Retrospective Cohort Study

By Frank M. Painter|December 8, 2024|Chiropractic Care, Headache|

Association Between Spinal Manipulation, Butalbital Prescription, and Medication Overuse Headache in Adults With Tension-Type Headache: Retrospective Cohort Study

SOURCE: Health Science Reports 2024 (Nov 29); 7 (12): e70218

Robert J Trager • Timothy J Williamson • Pratheek S Makineni • Lindsay H Morris

Connor Whole Health University Hospitals
Cleveland Medical Center
Cleveland Ohio USA.

Background and aims: Butalbital is an acute headache medication commonly prescribed for tension-type headache (TTH), although discouraged by guidelines due to a risk of medication overuse headache (MOH). Considering spinal manipulative therapy (SMT) may reduce TTH frequency and intensity, we hypothesized adults with TTH receiving chiropractic SMT would be less likely to receive a butalbital prescription over 2 years versus matched controls not receiving SMT. We secondarily compared likelihood of MOH between cohorts.

Methods: We searched a United States medical records database of patients attending academic medical centers for adults with TTH, from 2013 to 2024, excluding those diagnosed with other headaches and seen in inpatient/emergency settings. We divided patients into two cohorts: (1) SMT and (2) non-SMT, using propensity matching to control for demographics and other variables associated with likelihood of butalbital prescription and MOH.

Results: Three thousand one hundred and sixteen patients remained per cohort after matching. The incidence of butalbital prescription was lower in the SMT cohort compared to the non-SMT cohort (SMT: 1.7%; non-SMT: 3.8%), yielding an RR (95% CI) of 0.46 (0.33-0.63; p < 0.001). The incidence of MOH was lower in the SMT cohort versus non-SMT cohort (SMT: 0.5%; non-SMT: 1.2%), yielding an RR (95% CI) of 0.44 (0.25-0.80; p < 0.001).

Conclusion: Adults receiving chiropractic SMT had a significantly lower likelihood of butalbital prescription and, tentatively, MOH compared to matched controls not receiving SMT. These findings support current guideline recommendations favoring SMT in TTH care, though future studies should replicate and compare these findings with other nonpharmacologic clinicians and interventions.

Keywords: barbiturates; chiropractic; headache; spinal manipulation.

From the FULL TEXT Article:

Background

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The Physical Impact of Migraines on Female Chiropractic Patients: A Qualitative Study

By Frank M. Painter|December 27, 2023|Chiropractic Management, Chiropractic Research, Headache, Migraine|

The Physical Impact of Migraines on Female Chiropractic Patients: A Qualitative Study

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SOURCE: Health SA 2023 (Oct 25): 28: 2283

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Ashalya Pirthiraj and Raisuyah Bhagwan

Department of Chiropractic,
Faculty of Health Sciences,
Durban University of Technology,
Durban, South Africa.

Background: Migraines are highly prevalent among the female population and have a significant burden on one’s quality of life and physical functioning.

Aim: The study explored the physical impact and contributory factors of migraines on women and their experience of chiropractic treatment for migraine pain management.

Setting: The study was conducted in the eThekwini region of KwaZulu-Natal, South Africa.

Methods: The study used a qualitative descriptive design and adopted purposive sampling. The data were collected through 12 semi-structured interviews, between March and September 2021, and analysed using thematic analysis.

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Description of Recurrent Headaches in 7-14-year-old Children: Baseline Data From a Randomized Clinical Trial on Effectiveness of Chiropractic Spinal Manipulation in Children with Recurrent Headaches

By Frank M. Painter|February 2, 2023|Headache, Pediatrics|

Description of Recurrent Headaches in 7-14-year-old Children: Baseline Data From a Randomized Clinical Trial on Effectiveness of Chiropractic Spinal Manipulation in Children with Recurrent Headaches

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SOURCE: Chiropractic & Manual Therapies 2023 (Jan 30); 31 : 5

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Kristina Boe Dissing, Werner Vach, Susanne Lynge, Henrik Wulff Christensen & Lise Hestbaek

Chiropractic Knowledge Hub,
Campusvej 55, 5230,
Odense M, Denmark.

Background: Headaches in children are poorly described and diagnosing can be challenging. Objectives are: (1) to describe headache characteristics and child characteristics, (2) to explore whether data can suggest a more diverse way to categorize headaches than traditionally.

Methods: Baseline data for a clinical trial included a questionnaire and a physical screening. Children’s characteristics and detailed description of headache symptoms were provided. Children were classified for migraine or tension-type-headache based on questionnaire data reported by children and parents. This required to apply slightly modified classification criteria and a “non-classifiable” group was added. Severity and symptoms, related to the migraine versus tension type distinction, were investigated to define a migraine-tension-type-index.

Results: 253 children were included. Mean pain intensity was 5.9/10. Over 2/3 of the children had headache for > 1 year, and > 50% for several days/week. Half of the children were non-classifiable, 22% were classified as migraine and 23% as tension-type headache. A migraine-tension-type-index was constructed and describes a continuous spectrum rather than two distinct groups.

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Effectiveness of Chiropractic Manipulation Versus Sham Manipulation for Recurrent Headaches in Children Aged 7-14 Years – A Randomised Clinical Trial

By Frank M. Painter|December 25, 2021|Headache, Pediatrics|

Effectiveness of Chiropractic Manipulation Versus Sham Manipulation for Recurrent Headaches in Children Aged 7-14 Years – A Randomised Clinical Trial

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2021 (Jan 7); 29: 1

Susanne Lynge, Kristina Boe Dissing, Werner Vach, Henrik Wulff Christensen, and Lise Hestbaek

Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark,
Campusvej 55, 5230, Odense M, Denmark.

Background: To investigate the effectiveness of chiropractic spinal manipulation versus sham manipulation in children aged 7–14 with recurrent headaches.

Methods: Design: A two-arm, single-blind, superiority randomised controlled trial.

Setting: One chiropractic clinic and one paediatric specialty practice in Denmark, November 2015 to August 2020.

Participants: 199 children aged 7 to 14 years, with at least one episode of headache per week for the previous 6 months and at least one musculoskeletal dysfunction identified.

Interventions: All participants received standard oral and written advice to reduce headaches. In addition, children in the active treatment group received chiropractic spinal manipulation and children in the control group received sham manipulation for a period of 4 months. Number and frequency of treatments were based on the chiropractor’s individual evaluation in the active treatment group; the children in the control group received approximately eight visits during the treatment period.

Primary outcome measures: ‘Number of days with headache’, ‘pain intensity’ and ‘medication’ were reported weekly by text messages, and global perceived effect by text message after 4 months. A planned fixed sequence strategy based on an initial outcome data analysis was used to prioritize outcomes. ‘Number of days with headache’ and ‘pain intensity’ were chosen as equally important outcomes of highest priority, followed by

Results: Chiropractic spinal manipulation resulted in significantly fewer days with headaches (reduction of 0.81 vs. 0.41, p = 0.019, NNT = 7 for 20% improvement) and better global perceived effect (dichotomized into improved/not improved, OR = 2.8 (95% CI: 1.5–5.3), NNT = 5) compared with a sham manipulation procedure. There was no difference between groups for pain intensity during headache episodes. Due to methodological shortcomings, no conclusions could be drawn about medication use.

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Chiropractic Treatment of Older Adults with Neck Pain

By Frank M. Painter|January 31, 2020|Headache, Neck Pain, Vertigo|

Chiropractic Treatment of Older Adults with Neck Pain with or without Headache or Dizziness: Analysis of 288 Australian Chiropractors’ Self-reported Views

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2019 (Dec 18); 27: 65

Dein Vindigni, Laura Zark, Tobias Sundberg, Matthew Leach, Jon Adams, and Michael F. Azari

Chiropractic Discipline,
School of Health and Biomedical Sciences,
RMIT University,
Melbourne, Australia.

BACKGROUND: Neck pain is a leading cause of individual and societal burden worldwide, affecting an estimated 1 in 5 people aged 70 years and older. The nature and outcomes of chiropractic care for older adults with neck pain, particularly those with co-morbid headaches, remains poorly understood. Therefore, we sought to ascertain: What proportion of Australian chiropractors’ caseload comprises older adults with neck pain (with or without headache); How are these conditions treated; What are the reported outcomes?

METHODS: An online survey examining practitioner and practice characteristics, clinical patient presentations, chiropractic treatment methods and outcomes, and other health service use, was distributed to a random nationally representative sample of 800 Australian chiropractors. Quantitative methods were used to analyze the data.

RESULTS: Two hundred eighty-eight chiropractors (response rate = 36%) completed the survey between August and November 2017. Approximately one-third (M 28.5%, SD 14.2) of the chiropractors’ patients were older adults (i.e. aged ≥65 years), of which 45.5% (SD 20.6) presented with neck pain and 31.3% (SD 20.3) had co-morbid headache. Chiropractors reported to combine a range of physical and manual therapy treatments, exercises and self-management practices in their care of these patients particularly:

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Integrating Chiropractic Care Into the Treatment of Migraine

By Frank M. Painter|April 7, 2019|Headache, Migraine|

Integrating Chiropractic Care Into the Treatment of Migraine Headaches in a Tertiary Care Hospital: A Case Series

The Chiro.Org Blog

SOURCE: Glob Adv Health Med. 2019 (Mar 28)

Carolyn Bernstein, MD, Peter M Wayne, PhD, Pamela M Rist, ScD, Kamila Osypiuk, MS, Audrey Hernandez, MS, and Matthew Kowalski, DC

Osher Clinical Center,
Brigham and Women’s Hospital,
Boston, Massachusetts.

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.

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