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Clinical Effectiveness of Osteopathic Treatment in Chronic Migraine

Clinical Effectiveness of Osteopathic Treatment in Chronic Migraine: 3-Armed Randomized Controlled Trial Complementary Therapies in Medicine

April 2015; Vol. 23; No. 2; pp. 149—156

BACKGROUND

The primary measurement outcome in this study is the Headache Impact Test (HIT-6); below is the conclusion from the cited reference:

 “Our study shows that the HIT-6 is a reliable and valid tool for measuring the impact of headache on daily life in both episodic and chronic migraine sufferers. Furthermore, the HIT-6 tool discriminates well between chronic migraine, episodic migraine and non-migraine patients. As a brief tool, the HIT-6 is easy to score and interpret, and can be readily integrated into clinical practice, or clinical studies of migraine patients. It may offer clinicians a practical and easy-to implement tool to assist them with evaluating treatment effectiveness by obtaining input directly from the patient on aspects other than just the frequency of headache days.”

 KEY POINTS FROM THIS STUDY

 1) “This osteopathic manipulative therapy trial is the largest ever conducted on migraine adult patients.” These authors assessed the effectiveness of manipulative treatment on 105 chronic migraine patients using:

• Headache Impact Test (HIT-6) questionnaire [main outcome measure]

• Drug consumption

• Days of migraine

• Pain intensity

• Functional disability

 2) This is a randomized controlled trial. Patients received 8 treatments over a period of 6 months. Patients were randomly divided into three groups:

• Manipulation + medication therapy n=35

•• The manipulative techniques used in this study included myofascial release, treatment of ligamentous and membrane tensions, treatment of somatic dysfunctions, and treatment to asymmetries and imbalances in the pelvis and cranium.

• Sham manipulation + medication therapy n=35

•• The sham group received a false manipulation, in addition to drug care.

•• Sham therapy mimicked the manipulative care in terms of evaluation and treatment; it used light manual contact to ‘‘treat’’ the subject.

•• Both manipulative and sham therapy sessions lasted 30 minutes and were given weekly for the first two sessions, biweekly for the subsequent two, then monthly for the remained four sessions.

• Medication only n=35

3) “Migraine attacks are usually characterized by a unilateral and pulsating severe headache, lasting 4—72 hours, and are often associated with nausea, phono- and photophobia.”

4) “Migraine is a serious public health concern of considerable consequences to both the migraineur and society.”

5) The overall migraine prevalence in Europe is 10—15% of the population.

6) These authors make the following points pertaining to the etiology of migraine:

• In 20% of migraineurs, the attacks are anticipated by transient neurological symptoms, the aura.

• Migraine has a genetic etiology in about 50% of cases.

• Migraine etiology also has multifactorial epigenetic mechanisms.

• During a migraine attack, high levels of inflammatory cytokines are released causing neurogenic inflammation of the meninges and transmitting pain signals to the trigeminovascular system and autonomic nervous system nuclei.

 7) Criteria considered for manipulative evaluation and treatment were:

• Alteration of tissue consistency

• Asymmetry

• Range of motion restriction

• Tenderness

8) During migraine attacks, high levels of pro-inflammatory substances are released, altering neural autonomic pathways.

9) Manipulation influences the autonomic nervous system by producing a parasympathetic effect, and therefore, a “trophotropic tuning state.”

10) Manipulation is associated with a “reduction of pro-inflammatory substances.”

11) Manipulation in migraineurs could reduce the release of pro-inflammatory substances that have an effect on the autonomic nervous system function. “As a consequence, a cascade of biological and neurological events, potentially based on a rebalance of the abnormal activation of the habituation/sensitization mechanism, even between attacks, could occur resulting in an overall improvement of clinical outcomes.”

12) Manipulation “significantly reduced the frequency of migraine.”

13) At the end of the study period, there was a statistically significant difference on the overall HIT-6 score between the three groups; the manipulation group was statistically improved from control [drug only] and sham group.

14) “Considering migraine days per month, the three groups differed significantly at the end of the study period.”

15) Manipulation “significantly reduced the number of subjects taking medications.”

16) “No study participant reported any adverse effects of the [manipulation].”

17) “Migraine attacks, use of drugs, pain and disability scores were significantly reduced in the OMT group.”

18) “OMT showed a significant improvement in the migraineurs’ quality of life.”

19) Interestingly, the “sham group significantly reduced the HIT-6 score compared to the conventional [drug only] care. “The magnitude of the results suggests that the sham procedure may be clinically effective.” [Important]

20) The sham treatment used soft touch, which will induce responses at different levels of the central nervous system, reducing pain and improving well-being.

21) “The use of osteopathy [manipulative therapy] as an adjuvant therapy for migraine patients may reduce the use of drugs and optimize the clinical management of the patients.”

22) “The present study showed significant differences between OMT group compared to drug and sham groups, suggesting that OMT may be considered a clinically valid procedure for the management of patients with migraine.”

COMMENTS

 It is important to look at the numbers in the table and the graph in this Review. Again, it is noteworthy that sham manipulation is superior to drug-only treatment for migraine. Note that manipulation essentially eliminated migraine days per month, pain, disability, and reduced drug consumption by 80%. Note that for the group assigned to taking drugs-only, there was essentially no reduction in migraine days per month, pain, disability, and no reduction in drug consumption.

 Our interpretation of this data is that it appears that manipulation is actually addressing the causative pathophysiology of migraine headache; in contrast, it appears that taking drugs is nothing more than temporary pain control with no benefit to the causative pathophysiological of migraine headache. We remain perplexed as to why any healthcare delivery system would favor drugs for migraine (and many other pain syndromes) over mechanical therapy.

Categories: Chiropractic Tags: ,

Common Questions and Myths about the Chiropractor 

Common Questions and Myths about the Chiropractor 

“Once you go to a chiropractor you always have to go for the rest of your life.”Or …“I hear people get addicted to it.”

People do get addicted to feeling better than they have in a long, long time. Will you be going to a dentist, or your medical doctor or optometrist the rest of your life? How long should you exercise or eat right? These are just healthy lifestyle choices. Many people recognize the value of having a nervous system free of interference and choose regular adjustments to keep it that way.

“Why do I need to come in so often?”

We are doing something physical to change your body physically. Two things are required for that: enough frequency over a long enough time, just like getting in shape to run a marathon. It doesn’t matter how out of shape you are. If you work out frequently enough over a long enough period of time you can get into shape to run a marathon.

“Chiropractors aren’t real doctors.”

Our schooling is the same as medical schools. The difference is our philosophy. M.D.’s have two ways to treat: drugs and surgery. Their philosophy is that healing comes from the outside. This pill will make you better, or I’ll remove this body part to make you better. Our philosophy is that healing comes from the inside and our bodies are self healing as long as there is no interference and we give it the right ingredients for health (nutrition and exercise). We remove the interference to the the nervous system.

“Is it going to hurt?”

There are many techniques in chiropractic. One technique in which I specialize uses an adjusting instrument that gently taps to get the bone off of the nerve. Sometimes people go through retracing, which can be uncomfortable but is a wonderful sign because it is the body getting rid of old traumas from the past, allowing for a more complete healing.

“Chiropractic is too expensive.”

Compared to what? Braces for the teeth – $4,000-$6,000, M.R.I. for the full spine, – $1,800-$2,400, Lasik Eye Surgery – $3,500-$5,000, Breast Augmentation – $4,000-$10,000, Dental Implants – $1,250-$3000 per tooth, Year supply of Claritin – $1,200, Year supply of Cholesterol lowering drugs – $1,500 (without doctor visits), 6-12 month Chiropractic care plan – $1,800-$3,600 (plus the savings of getting off of medications), What is the value of having your brain communicate properly with the rest of your body?

“Chiropractic is dangerous”

Studies show that there is very little risk with the chiropractic adjustment and virtually none with the adjustment instrument. Statistically, it is more of a risk to take 2 Advil a day for 2 weeks than to get adjusted. A look at malpractice insurance premium costs says it all; M.D. costs $22,000 – $175,000 per year while Chiropractic malpractice insurance premium costs are $1,500 – $3,000 for the same liability limits.

“Infants and Children should never be adjusted.”

Do they have a spine and a nervous system? One of the biggest traumas we ever go through is being born. Have you ever seen a child learn to walk? They will fall 30 times a day. Children respond to chiropractic care so much faster than adults. They haven’t had the years and years of physical, emotional, chemical stress and traumas that we have accumulated as adults.

If I can crack my own back, why do I need a chiropractor?

There is a big difference between cracking your own back and having a specific spinal adjustment. When someone feels the need to crack their own spine it is a sign that things aren’t working right. When you crack your back, if you don’t mess it up, it will generally feel better but main subluxations (misalignments) can’t be gotten yourself. So a few hours later you feel the need to do it again. All this self cracking creates looseness in the joints that can lead to degeneration. The main subluxations will still be there, creating havoc with your nervous system.

What is a subluxation?

In simplest terms, a subluxation is when one or more of the bones of your spine (Vertebrae) move out of normal position and create pressure on, or irritate spinal nerves. This pressure or irritation on the nerves then causes a change in the signals (or nerve energy) traveling over those nerves. Therefore, the area where the signal ends up will not function the way the brain intends.

So how does Chiropractic help with other health issues besides back pain (i.e. asthma,allergies, ulcers, bowel movements)?.

Well, if a nerve is pinched and it’s responsible for your stomach working, your stomach will decrease its function by as much as 60%. So if your stomach doesn’t digest your food as it should, it could lead to ulcers or acid reflux.

Can I tell if I have a subluxation without consulting a Chiropractor?

Not always. A subluxation is like a dental cavity-you may have it for a long time before symptoms appear. That’s why periodic spinal check-ups are so important. Although it may be possible to know you have a subluxation, it is rarely possible to be sure you don’t. An occasional spinal check-up is always a good idea.

Effectiveness of Adjustments in Chronic Migraine

Effectiveness of Adjustments in Chronic Migraine: Armed Randomized Controlled Trial. Complementary Therapies in Medicine. April 2015; Vol. 23; No. 2; pp. 149—156

Francesco Cerritelli, Liana Ginevri, Gabriella Messi, Emanuele Caprari, Marcello Di Vincenzo, Cinzia Renzetti, Vincenzo Cozzolino, Gina Barlafante, Nicoletta Foschi, Leandro Provincial: This study was carried out in the Department of Neurology of Ancona’s United Hospitals, Ancona, Italy. This article has 54 references.

The primary measurement outcome in this study is the Headache Impact Test (HIT-6); below is the conclusion from the cited reference:

“Our study shows that the HIT-6 is a reliable and valid tool for measuring the impact of headache on daily life in both episodic and chronic migraine sufferers. Furthermore, the HIT-6 tool discriminates well between chronic migraine, episodic migraine and non-migraine patients. As a brief tool, the HIT-6 is easy to score and interpret, and can be readily integrated into clinical practice, or clinical studies of migraine patients. It may offer clinicians a practical and easy-to implement tool to assist them with evaluating treatment effectiveness by obtaining input directly from the patient on aspects other than just the frequency of headache days.”

KEY POINTS FROM THIS STUDY

1) “This manipulative therapy trial is the largest ever conducted on migraine adult patients.” These authors assessed the effectiveness of manipulative treatment on 105 chronic migraine patients using:

• Headache Impact Test (HIT-6) questionnaire [main outcome measure]

• Drug consumption

• Days of migraine

• Pain intensity

• Functional disability

2) This is a randomized controlled trial. Patients received 8 treatments over a period of 6 months. Patients were randomly divided into three groups:

 

• Manipulation + medication therapy n=35

•• The manipulative techniques used in this study included myofascial release, treatment of ligamentous and membrane tensions, treatment of somatic dysfunctions, and treatment to asymmetries and imbalances in the pelvis and cranium.

• Sham manipulation + medication therapy n=35

•• The sham group received a false manipulation, in addition to drug care.

•• Sham therapy mimicked the manipulative care in terms of evaluation and treatment; it used light manual contact to ‘‘treat’’ the subject.

•• Both manipulative and sham therapy sessions lasted 30 minutes and were given weekly for the first two sessions, biweekly for the subsequent two, then monthly for the remained four sessions.

• Medication only n=35

3) “Migraine attacks are usually characterized by a unilateral and pulsating severe headache, lasting 4—72 hours, and are often associated with nausea, phono- and photophobia.”

4) “Migraine is a serious public health concern of considerable consequences to both the migraineur and society.”

5) The overall migraine prevalence in Europe is 10—15% of the population.

6) These authors make the following points pertaining to the etiology of migraine:

• In 20% of migraineurs, the attacks are anticipated by transient neurological

symptoms, the aura.

• Migraine has a genetic etiology in about 50% of cases.

• Migraine etiology also has multifactorial epigenetic mechanisms.

• During a migraine attack, high levels of inflammatory cytokines are released causing neurogenic inflammation of the meninges and transmitting pain signals to the trigeminovascular system and autonomic nervous system nuclei.

7) Criteria considered for manipulative evaluation and treatment were:

• Alteration of tissue consistency

• Asymmetry

• Range of motion restriction

• Tenderness

8) During migraine attacks, high levels of pro-inflammatory substances are released, altering neural autonomic pathways.

9) Manipulation influences the autonomic nervous system by producing a parasympathetic effect, and therefore, a “trophotropic tuning state.”

10) Manipulation is associated with a “reduction of pro-inflammatory substances.”

11) Manipulation in migraineurs could reduce the release of pro-inflammatory substances that have an effect on the autonomic nervous system function. “As a consequence, a cascade of biological and neurological events, potentially based on a rebalance of the abnormal activation of the habituation/sensitization mechanism, even between attacks, could occur resulting in an overall improvement of clinical outcomes.”

12) Manipulation “significantly reduced the frequency of migraine.”

13) At the end of the study period, there was a statistically significant difference on the overall HIT-6 score between the three groups; the manipulation group was statistically improved from control [drug only] and sham group.

14) “Considering migraine days per month, the three groups differed significantly at the end of the study period.”

15) Manipulation “significantly reduced the number of subjects taking medications.”

16) “No study participant reported any adverse effects of the [manipulation].”

17) “Migraine attacks, use of drugs, pain and disability scores were significantly reduced in the OMT group.”

18) “OMT showed a significant improvement in the migraineurs’ quality of life.”

19) Interestingly, the “sham group significantly reduced the HIT-6 score compared to the conventional [drug only] care. “The magnitude of the results suggests that the sham procedure may be clinically effective.” [Important]

20) The sham treatment used soft touch, which will induce responses at different levels of the central nervous system, reducing pain and improving well-being.

21) “The use of osteopathy [manipulative therapy] as an adjuvant therapy for migraine patients may reduce the use of drugs and optimize the clinical

management of the patients.”

22) “The present study showed significant differences between OMT group compared to drug and sham groups, suggesting that OMT may be considered a clinically valid procedure for the management of patients with migraine.”

COMMENTS

It is important to look at the numbers in the table and the graph in this Review. Again, it is noteworthy that sham manipulation is superior to drug-only treatment for migraine. Note that manipulation essentially eliminated migraine days per month, pain, disability, and reduced drug consumption by 80%. Note that for the group assigned to taking drugs-only, there was essentially no reduction in migraine days per month, pain, disability, and no reduction in drug consumption.

Our interpretation of this data is that it appears that manipulation is actually addressing the causative pathophysiology of migraine headache; in contrast, it appears that taking drugs is nothing more than temporary pain control with no benefit to the causative pathophysiological of migraine headache. We remain perplexed as to why any healthcare delivery system would favor drugs for migraine (and many other pain syndromes) over mechanical therapy.  $  ??? 😊