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The Somatic Connection  |   October 2011
Osteopathic Manipulative Therapy Helps Patients With Migraines
Article Information
The Somatic Connection   |   October 2011
Osteopathic Manipulative Therapy Helps Patients With Migraines
The Journal of the American Osteopathic Association, October 2011, Vol. 111, 572-573. doi:10.7556/jaoa.2011.111.10.572
The Journal of the American Osteopathic Association, October 2011, Vol. 111, 572-573. doi:10.7556/jaoa.2011.111.10.572
Voigt K, Liebnitzky J, Burmeister Uet al. Efficacy of osteopathic manipulative treatment of female patients with migraine: results of a randomized controlled trial. J Altern Complement Med. 2011;17(3):225-230. 
In the August 2009 issue of JAOA—The Journal of the American Osteopathic Association (2009;109[8]:403-409), Schabert and Crow reported that, according to their retrospective chart review, osteopathic manipulative treatment (OMT) as performed by US-trained osteopathic physicians is a cost-effective approach to treating patients with migraine cephalgia. At about the same time, researchers in Germany used a randomized clinical trial design to assess the effectiveness of osteopathic manipulative therapy as performed by a European osteopath in treating patients with migraine cephalgia. Their results were reported in March 2011 in The Journal of Alternative and Complementary Medicine. 
The study by Voigt et al assessed the effectiveness of osteopathic manipulative therapy plus standard care (ie, medication) vs standard care only for women with histories of migraine, as defined by the International Classification of Disease (ICD-10, G43; migraine with or without aura). The clinical researchers recruited 65 patients, of whom 42 were women (age range, 24-66 y; mean age, 45 y) meeting the study's inclusion criteria: history of a minimum of 3 migraine attacks per month as diagnosed by a physician. Thirteen of the women had been diagnosed as having migraine with aura. The duration of migraine symptoms ranged from 2 to 45 years, with a mean of 23 years. The other patients were excluded from the study because of 1 or more of the following reasons: they had received nonmedical therapies (eg, acupuncture, homeopathy) within 8 weeks before the beginning of the study; they were pregnant or lactating; they had underlying neurologic disease (eg, brain tumors, multiple sclerosis). 
The 42 participants were randomly assigned to the 2 study groups, with each group having 21 participants. All participants continued using their previously prescribed medications. A physiotherapist licensed to practice osteopathy (a graduate of the AVT-College for Osteopathic Medicine in Nagold, Germany) provided osteopathic manipulation to each of the participants in the intervention group in 5 sessions lasting 50 minutes each over a 10-week period. The osteopathic manipulation consisted of a variety of techniques at the discretion of the osteopath based on examination findings of each participant. The control group did not receive osteopathic manipulation, sham treatment, or physical therapy. 
There were 2 dropouts in each group. All remaining participants filled out 3 standardized health outcomes questionnaires before the study and at 6-months follow-up to assess pain intensity, the impact of migraine on daily life and health-related quality of life (HRQoL), and the number of days with migraine headache. The questionnaires used were the Migraine Disability Assessment (MIDAS), the Short Form-36 (SF-36), and a German ”pain questionnaire” 
Based on an intention-to-treat analysis design, 4 of the 8 HRQoL domains of SF-36 (ie, bodily pain, mental health, physical role functioning, vitality) showed statistically significant improvement (P≤.05) in the intervention group. In addition, the total MIDAS score, the pain intensity, and the disturbance in occupation and number of disablement days caused by migraine showed statistically significant reductions (P<.05) in the intervention group. The control group had statistically significant decreases only in emotional role functioning (P=.02). 
This study supports the effectiveness of osteopathic manipulative therapy combined with standard medication for women with migraine headache in regard to decreased pain intensity, reduced number of days with migraine, reduced working disability, and improvement in some areas of HRQoL. The researchers recommended that future studies use a larger sample size, give placebo therapy to the control group, and have long-term follow-up beyond 6 months.—M.A.S. 
   “The Somatic Connection” highlights and summarizes important contributions to the growing body of literature on the musculoskeletal system's role in health and disease. This section of JAOA—The Journal of the American Osteopathic Association strives to chronicle the significant increase in published research on manipulative methods and treatments in the United States and the renewed interest in manual medicine internationally, especially in Europe.    To submit scientific reports for possible inclusion in “The Somatic Connection,” readers are encouraged to contact JAOA Associate Editor Michael A. Seffinger, DO (mseffinger@westernu.edu), or Editorial Board Member Hollis H. King, DO, PhD (hollis.king@fammed.wisc.edu).