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Duke University Releases Headache Evidence Report

Substantial Evidence Shows Efficacy of Chiropractic
for Tension and Cervicogenic Headaches

In 1996, the Agency for Health Care Policy and Research (AHCPR) was scheduled to produce a set of clinical practice guidelines on available treatment alternatives for headache in much the same way the agency had previously done with its historic clinical guidelines, Acute Low Back Problems in Adults, released late in December 1994. This headache project was based on the systematic evaluation of the literature by a multidisciplinary panel of experts. Due to largely political circumstances, however, their efforts never came to fruition. The work was never released as guidelines, but was instead transformed with modifications and budget cuts into a set of evidence reports on only migraine headaches by the staff at the Center for Clinical Health Policy Research at Duke University.

The Foundation for Chiropractic Education and Research (FCER) is proud to announce that with its efforts and funding from the National Chiropractic Mutual Insurance Company (NCMIC), evidence reports have now been updated on both cervico-genic and tension-type headaches. This new report, Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache, essentially updates and releases much of the information on treatment alternatives for tension and cervico-genic headache that had been suppressed earlier.

Among the many treatment alternatives supported by evidence, chiropractic is buoyed by substantial evidence in this report as to its efficacy in the management of both tension-type and cervico-genic headaches:

  1. Compared to amitriptyline use, chiropractic is shown to produce slightly lesser effects during the treatment period, but markedly superior results afterward in the treatment of tension-type headache.
  2. Compared to various soft tissue procedures, a course of chiropractic treatments is shown to produce sustained improvement in headache frequency and severity in the treatment of cervico-genic headache.
  3. Compared to various soft tissue procedures, there was evidence to indicate that a course of chiropractic treatments produced further improvement in headache frequency and severity in the treatment of episodic tension-type headache.

This particular study's findings have important implications in choosing alternatives in procedures for managing different types of headaches. This new undertaking mandated the staff at the Duke Center to screen citations from the literature, abstract the data into evidence tables, analyze the quality and magnitude of results from these studies, and draft an evidence report with peer review from a panel of 25 reviewers, including researchers and clinicians in chiropractic.

Starting with over 2,500 citations from such online sources as MEDLINE, MANTIS, CRAC, CINAHL, PsychoINFO, the Cochrane Controlled Trials Register, and additional articles obtained by referral, the panel obtained bibliographies of both physical and behavioral options for treating headache that were prospective, controlled trials aimed at either relief from or prevention of attacks of tension-type or cervico-genic headache.

Among the physical interventions reviewed in this report:

Among the behavioral interventions reviewed are:

Even though further research is desirable-and mandatory-this report clearly positions chiropractic as a viable treatment alternative that lacks the detrimental and sometimes fatal side effects of conventional treatment options for managing tension and cervicogenic headache patients. Compared to other physical treatment methods (including physiotherapy, acupuncture, and electrical stimulation), the evidence supporting chiropractic is much more substantial. Consequently, this report is an invaluable resource for documenting chiropractic practice to practitioners in other health care professions, the public, and third-party payers.

Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache

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