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The Somatic Connection  |   July 2018
Safety of Chiropractic Manipulation in Patients With Migraines
Author Notes
  • Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California 
Article Information
The Somatic Connection   |   July 2018
Safety of Chiropractic Manipulation in Patients With Migraines
The Journal of the American Osteopathic Association, July 2018, Vol. 118, 482-483. doi:10.7556/jaoa.2018.103
The Journal of the American Osteopathic Association, July 2018, Vol. 118, 482-483. doi:10.7556/jaoa.2018.103
Chaibi A, Benth JRS, Tuchin PJ, Russell MB. Adverse events in a chiropractic spinal manipulative therapy single-blinded, placebo, randomized controlled trial for migraineurs. Musculoskelet Sci Pract. 2017;29:66-71. doi:10.1016/j.msksp.2017.03.003 
Risk of adverse events related to spinal manipulation is a concern for osteopathic and other health care professionals who use this intervention for pain relief in patients with musculoskeletal dysfunction.1 Researchers in Norway performed a rigorously designed prospective, single-blinded, placebo-controlled randomized clinical trial (RCT) using chiropractic spinal manipulative therapy (CSMT) for patients with migraines to assess adverse events (AE) after the manual intervention. 
Ninety-seven patients with migraines (83 women) aged 18 to 70 years were recruited from general practitioner offices and media advertisements. Participants who had at least 1 migraine attack per month were randomly assigned to the CSMT group, a placebo group (received nonspecific manual touch and nontherapeutic push maneuver), or a control group (continued usual medications). Interventions were applied during twelve 15-minute sessions over 3 months. The researchers compared the AEs of participants who completed the study from the 2 intervention groups (n=70). Outcomes were assessed at 3, 6, and 12 months. 
Initial exclusion criteria were contraindication to spinal manipulative therapy, spinal radiculopathy, pregnancy, depression, and CSMT within the previous 12 months. During the trial, exclusion criteria were any other manual interventions by any health professional, change of prophylactic migraine medicine, or new-onset pregnancy. However, the participants could continue and change their acute migraine medication throughout the trial. Researchers applied the recommendations by CONSORT (Consolidated Standards of Reporting Trials) and the International Headache Society's Task Force on AEs in migraine RCTs. 
Adverse events were assessed in 703 sessions (355 and 348 in CSMT and placebo groups, respectively). Local tenderness was the most common AE (11.3% in CMST; 6.9% in placebo). Tiredness on the intervention day was reported by 8.5% of participants in the CSMT group and 1.4% in the placebo group. Adverse events were mild and transient, with no serious AEs reported. 
Osteopathic researchers are encouraged to use similarly designed assessments of adverse events in RCTs using osteopathic manipulative treatment (OMT). Using patient survey data from a practice-based research network, Degenhardt et al2 also reported that pain and discomfort after OMT was the most common AE, but it occurred in only 0.9% of 1847 OMT sessions (884 patients). Furthermore, patients who received high-velocity, low-amplitude (HVLA) OMT had the fewest AEs. This finding begs the question, Does HVLA OMT create fewer AEs compared with CSMT? Further prospective OMT studies are warranted for patients with migraines. 
References
Vogel S, Mars T, Keeping S, et al Clinical Risk Osteopathy and Management Scientific Report: The CROaM Study. London, England: The British School of Osteopathy; 2013. http://www.osteopathy.org.uk/news-and-resources/document-library/research-and-surveys/the-croam-study-february-2013/croam-full-report-0313.pdf. Accessed August 17, 2017.
Degenhardt BF, Johnson JC, Brooks WJ, Norman L. Characterizing adverse events reported immediately after osteopathic manipulative treatment. J Am Osteopath Assoc. 2018;118(3):141-149. doi: 10.7556/jaoa.2018.033 [CrossRef] [PubMed]