The Somatic Connection  |   January 2017
Recognizing the Value of Manual Therapy Interventions for Head Pain
Author Notes
  • University of California, San Diego School of Medicine 
Article Information
The Somatic Connection   |   January 2017
Recognizing the Value of Manual Therapy Interventions for Head Pain
The Journal of the American Osteopathic Association, January 2017, Vol. 117, 60-62. doi:
The Journal of the American Osteopathic Association, January 2017, Vol. 117, 60-62. doi:
Web of Science® Times Cited: 2
The 3 articles1-3 on head pain reviewed in the previous pages are among a growing literature base that shows the benefit of osteopathic manipulative treatment (OMT) for patients with various types of head pain. The Journal of the American Osteopathic Association (JAOA) has published reviews,4-9 case studies,10-13 a retrospective study,14 and a clinical research article on head pain.15 The case studies all show successful use of OMT for posttraumatic head pain, after tooth extraction, and in the rare condition of “daily persistent headache.” The retrospective study showed that the cost of treating patients with migraines was much less if OMT was applied than if OMT was not applied. Of note, no adverse events were reported in these studies. Clearly, OMT for head pain represents fertile ground for research at the clinical trial level. 
If we include temporomandibular joint (TMJ) pain as head pain, 2 additional JAOA articles16,17 should be noted. Both articles describe OMT procedures that were beneficial in the reported case studies for relief of TMJ pain, and again no adverse events were reported. 
“The Somatic Connection” column of the JAOA has also reviewed a number of clinical trials on the application of osteopathic manipulative therapy (OMTh; manipulative care provided by a foreign-trained osteopath) in patients with head pain.18-20 Patients with migraine headache have received relief from OMTh,18,20 including craniosacral therapy, and benefit was shown for tension-type headache.19 Studies showing benefit in cases of tension-type headache,21-24 migraine,25 facial pain, and TMJ,26,27 as well as head pain associated with traumatic brain injury28 by applying manual therapy were also reviewed in “The Somatic Connection.” 
As a body of literature, I believe there is substantial evidence supporting the use of OMT and manual therapy in virtually all types of head pain cases. My clinical experience certainly supports this view. With another 1 or 2 clinical trials, there may be enough data to conduct a systematic review and meta-analysis. 
Garcia J, Arnold S, Tetley K, Voight K, Frank RA. Mobilization and manipulation of the cervical spine in patients with cervicogenic headache: any scientific evidence? Front Neurol. 2016;7:40. doi:10.3389/fneur.2016.00040 [CrossRef] [PubMed]
Arnadottir TS, Sigurdardottir AK. Is craniosacral therapy effective for migraine? tested with HIT-6 questionnaire. Complement Ther Clin Prac. 2013;19:11-14. [CrossRef]
Espsí-López GV, López-Bueno L, Vicente-Herrero MT, Martinez-Arnau FM, Monzani L. Efficacy of manual therapy on anxiety and depression in patients with tension-type headache: a randomized controlled clinical trial [published online June 8, 2016]. Int J Osteopath Med. doi:10.1016/j.ijosm.2016.05.003
Hershey AD, Winner PK. Pediatric migraine: recognition and treatment. J Am Osteopath Assoc. 2005;4(suppl 2):S2-S8.
Nissan GR, Diamond ML. Advances in migraine treatment. J Am Osteopath Assoc. 2005;4(suppl 2):S9-S15.
Gallagher RM. Headache pain. J Am Osteopath Assoc. 2005;105(suppl 4):S7-S11. [PubMed]
Biondi DM. Cervicogenic headache: a review of diagnostic and treatment strategies. J Am Osteopath Assoc. 2005;105(suppl 4):S16-S22.
Silberstein SD. Chronic daily headache. J Am Osteopath Assoc. 2005;105(suppl 4);S23-S29. [PubMed]
Mueller LL. Diagnosing and managing migraine headache. J Am Osteopath Assoc. 2007;107(suppl 6):ES10-ES16. [PubMed]
Channell MK, Mueller LL, Hahn R. Management of chronic posttraumatic headache: a multidisciplinary approach. J Am Osteopath Assoc. 2009;109(9):509-513. [PubMed]
Meyer PM, Gustowski SM. Osteopathic manipulative treatment to resolve head and neck pain aftertooth extraction. J Am Osteopath Assoc. 2012;112(7):457-460. [PubMed]
Alexander J. Resolution of new daily persistent headache after manipulative treatment. J Am Osteopath Assoc. 2016;116(3):182-185. doi:10.7556/jaoa.2016.035 [CrossRef] [PubMed]
Kozminski M. Combat-related posttraumatic headache: diagnosis, mechanisms of injury, and challenges to treatment. J Am Osteopath Assoc. 2010;110(9):514-519. [PubMed]
Schabert E, Crow WT. Impact of osteopathic manipulative treatment on cost of care for patients with migraine headache: a retrospective review of patient records. J Am Osteopath Assoc. 2009;109(8):403-407. [PubMed]
Rolle G, Tremolizzo L, Somalvico F, Ferrarese C, Bressan LC. Pilot trial of osteopathic manipulative therapy for patients with frequent episodic tension-type headache. J Am Osteopath Assoc. 2014;114(9);678-685. doi:10.7556/jaoa.2014.136 [CrossRef] [PubMed]
Royder JO. Structural influences in temporomandibular joint pain and dysfunction. J Am Osteopath Assoc. 1981;80(7):460-473. [PubMed]
Hruby RJ. The total body approach to the osteopathic management of temporomandibular joint dysfunction. J Am Osteopath Assoc. 1985;85(8):502-510. [PubMed]
Martincik L, Seffinger MA. Osteopathic manipulative therapy efficacious for patients with chronic migraines [abstract of Cerritelli F, Ginevri L, Messi G, et al. Clinical effectiveness of osteopathic treatment in chronic migraine: 3-armed randomized controlled trial. Complement Ther Med. 2015;23(15):149-156.]. J Am Osteopath Assoc. 2015;115(10):628. doi:10.7556/jaoa.2015.127 [CrossRef]
Seffinger MA. Osteopathy for patients with tension-type headaches [abstract of Anderson RE, Seniscal C. A comparison of selected osteopathic treatment and relaxation for tension-type headaches. Headache. 2006;46(9):1273-1280]. J Am Osteopath Assoc. 2007;107(7):249-250.
Seffinger MA. Osteopathic manipulative therapy helps patients with migraines [abstract of Voight K, Liebnitsky J, Burmeister U, et 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]. J Am Osteopath Assoc. 2011;111(10):572-573.
Halbeisen A, Seffinger MA. Headaches are a pain in the neck [abstract of Espí-López GV, Rodriguez-Blanco C, Oliva-Pascual-Vaca A, Benítez-Martínez JC, Lluch-Girbés E, Falla D. The effect of manual therapy techniques on headache disability in patients with tension-type headache. Eur J Phys Rehabil Med. 2014;50(6):641-647]. J Am Osteopath Assoc. 2014;114(7):590-591. doi:10.7556/jaoa.2014.118
King HH. Manual therapy shown to be effective for tension-type headache [abstract of Espí-López GV, Gömez-Conseca A, Gömez AA, Martinez JB, Pascual-Vaca AO, Blanco CR. Treatment of tension-type headache with articulatory and suboccipital soft tissue therapy: a double-blind, randomized, placebo-controlled clinical trial. J Bodyw Mov Ther. 2014;18(4):569-575]. J Am Osteopath Assoc. 2014;114(5):403-404. doi:10.7556/jaoa.2014.080 [CrossRef]
Rahim A, Seffinger MA. Myofascial trigger point release massage therapy relieves tension-type headaches [abstract of Moraska AF, Stenerson L, Butryn N, et al. Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial. Clin J Pain. 2015;31(2): 159-168]. J Am Osteopath Assoc. 2016;116(1):55-56. doi:10.7556/jaoa.2016.009 [CrossRef] [PubMed]
King HH. Myofascial trigger point massage reduces pain of chronic tension-type headache [abstract of Berggreen S, Wiik E, Lund H. Treatment of myofascial trigger points in female patients with chronic tension-type headache – a randomized controlled trial. Adv Physiother. 2012;14:10-17]. J Am Osteopath Assoc. 2012;112(7):410-411.
King HH. Migraine headaches successfully treated with myofascial stretching [abstract of Sorrell MR. Myofascial examination leads to diagnosis and successful treatment of migraine headache. J Musculoskel Pain. 2010;18(1):31-37.] J Am Osteopath Assoc. 2010;110(5):273.
King HH. Efficacy of cervical manipulation and mobilization on face pain is demonstrated [abstract of Oliveira-Campelo NM, Rubens-Rebelatto J, Martin-Vallejo FJ, Alburquerque-Sendin F, Fernández-de-las-Peñas C. The immediate effects of atlanto-occipital joint manipulation and suboccipital muscle inhibition technique on active mouth opening and pressure pain sensitivity over latent myofascial trigger points in the masticatory muscles. J Orthop Sports Phys Ther. 2010;40(5):310-317]. J Am Osteopath Assoc. 2011;111(1):11-12.
King HH. Manual therapy for patients with temporomandibular disorders [abstract of La Touche R, Fernández-de-las-Peñas C, Fernández-Carnero J, et al. The effects of manual therapy and exercise directed at the cervical spine on pain and pressure pain sensitivity in patients with myofascial temporomandibular disorders. J Oral Rehab. 2009;36:644-652]. J Am Osteopath Assoc. 2009;109(12):626-627.
King HH. Support for application of cranial osteopathic manipulative medicine in patients with PTSD and TBI [abstract of Davis L, Hanson B, Gilliam S. Pilot study of the effects of mixed light touch manual therapies on active duty soldiers with chronic post-traumatic disorder and injury to the head. J Bodyw Mov Ther. 2016;16(1):42-51.]. J Am Osteopath Assoc. a2015;115(7):464. doi:10.7556/jaoa.2015.098 [CrossRef]