Expert: Gerald Anzalone, D.C. - 7/9/2007

Question
What evidence is there that chiropractic care can reduce or prevent migraines?  One chiropractor told me that slight anterior head syndrome, with subluxation of the first rib and some compression between vertebrae C5-6 or 6-7 and beginning spurs, are without a doubt causing my headaches. This guy wants to sign me up for a generic treatment plan starting with 3x/week for 14 weeks. Another very hands-on, rather than x-ray and fancy machines, chiropractor told me that she couldn't say but that muscle weakness on one side/overuse on the other could be contributing.  She says come back if I feel a little but not all the way better, but if I don't feel better after the 1st treatment she probably can't help me.  (I also have trouble with SI joint getting "stuck" on one side.)

Answer
Mary,

There is evidence in the literature to support the effectiveness of a variety of manual therapies for headaches in general, and migraines specifically, including chiropractic, acupuncture, and massage therapy. The list is too long to mention here, but you can review a good number of these abstracts for free at PubMed.com, which is sponsored by the National Library of Medicine and the National Institutes of Health.

True migraine headaches may have more than one trigger and may have multiple causes. Like any other therapy or intervention, chiropractic works very well for some people, fairly well for others, and not at all for some. There is no specific "cure" for migraine headaches, and I'm not aware of any evidence to suggest that chiropractic care (or any other manual therapy) can prevent migraine headaches, although there may be anecdotal reports to this effect, which again are highly variable.

Some people require prescription medications to deal with their specific type of headache; for others, dietary changes can be very helpful. Environmental factors and chemical sources may also play a role in the continuation of migraine headaches. Many patients with migraine headaches that I've treated also had recurrent sinus infections that necessitated prescription medication and antibiotics.

Regarding the two chiropractors who offered the opinions you described in your question, I would be highly doubtful of a first rib displacement or subluxation and mid- to lower cervical spinal degenerative changes causing a true migraine headache pattern. Typically, when symptomatic, a first rib displacement compresses the subclavian artery, producing arm and hand numbness or swelling, and degenerative disc and joint changes in the mid- to lower region of the cervical spine may produce neck and arm pain or numbness rather than headache, particularly a migraine headache.

I also would be doubtful of a diagnosis of "muscle weakness" or "muscle overuse" as the cause of a migraine headache. Muscle weakness doesn't produce headaches; muscle overuse could produce a headache, especially if there is referred pain from a trigger point in the musculature, but this is typically one-sided and not of the migraine-type pattern.

Moreover, I think it's ridiculous for anyone to suggest a treatment plan of three visits per week for 14 weeks. My recommendation is for you to consult with a neurologist regarding your headaches, if you haven't already, and try to find a chiropractor who takes an evidence-based and musculoskeletal-based approach to treatment who is willing to initiate a trial course of care to see how you respond (i.e. one treatment per week for a few weeks). You should see results within 4 to 6 weeks if the treatment is helpful. Your chiropractor should be skilled in treating the soft tissues and muscles in addition to the spinal joints.

You would also do well to see a massage therapist who can focus on treating the sore and tender muscles and trigger points, or consider a course of acupuncture, both of which can be helpful for migraines.

In any of these approaches, you shouldn't be expected to sign up for extended care, in my opinion. If you notice positive results with the first few treatments, continue until you feel better. If you notice your condition worsening with treatment, discontinue that treatment and ask your clinician to try a different approach.

I hope that this answers your question.