The Duke Study

Duke University Releases Headache Evidence Report

Substantial Evidence Shows Efficacy of Chiropractic for Tension and Cervicogenic Headaches

By Editorial Staff

Report from the FCER

DES MOINES, Iowa-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 headache 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 cervicogenic and tension-type

headaches. This new report, Evidence Report: Behavioral and Physical

Treatments for Tension-type and Cervicogenic Headache, is now

available to you exclusively from FCER. It essentially updates and

releases much of the information on treatment alternatives for tension

and cervicogenic headache that had been suppressed earlier. For

documenting both the quality and strength of research findings

pertaining to chiropractic and headache, this report represents an

invaluable addition to both your library and clinical practice. It does so

from the point of view of an impartial government agency-the

objectivity and credibility of which would be expected to have the

greatest public impact.

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 cervicogenic

headaches:

• 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.

• Compared to various soft tissue procedures, a course of

manipulation treatments (diversified and/or toggle-recoil

techniques, depending on the level of the palpated segmental

dysfunction) is shown to produce sustained improvement in

headache frequency and severity in the treatment of cervicogenic

headache.

• Compared to various soft tissue procedures, there was no evidence

to indicate that a course of manipulation treatments (diversified

and/or toggle-recoil techniques, depending on the level of the

palpated segmental dysfunction) 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 contact procedures in managing different types of

headache patients.

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 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

cervicogenic headache. Among the physical interventions reviewed in

this report:

• acupuncture

• cervical spinal manipulation

• low-force techniques such as cranial sacral therapy, massage

(including trigger point releases)

• mobilization

• stretching

• heat therapy

• ultrasound

• transcutaneous electrical nerve stimulation (TENS)

• exercise (including postural exercises)

Among the behavioral interventions reviewed are:

• relaxation

• biofeedback

• cognitive-behavioral (stress management) therapy

• hypnosis

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 appears to be more robust. Consequently, this

report is an invaluable resource for documenting chiropractic practice

to practitioners in other health care professions, the public, and thirdparty

payers. 

Source: click here.