• C F Nelson, G Bronfort, R Evans, P Boline, C Goldsmith, and A V Anderson.
• Center for Clinical Studies, Northwestern College of Chiropractic, Bloomington, MN 55431, USA. cnelson@nwchiro.edu
• J Manipulative Physiol Ther. 1998 Oct 1; 21 (8): 511-9.

BackgroundMigraine headache affects approximately 11 million adults in the United States. Spinal manipulation is a common alternative therapy for headaches, but its efficacy compared with standard medical therapies is unknown.ObjectiveTo measure the relative efficacy of amitriptyline, spinal manipulation and the combination of both therapies for the prophylaxis of migraine headache.DesignA prospective, randomized, parallel-group comparison. After a 4-wk baseline period, patients were randomly assigned to 8 wk of treatment, after which there was a 4-wk follow-up period.SettingChiropractic college outpatient clinic.ParticipantsA total of 218 patients with the diagnosis of migraine headache.InterventionsAn 8-wk course of therapy with spinal manipulation, amitriptyline or a combination of the two treatments.Main Outcome MeasuresA headache index score derived from a daily headache pain diary during the last 4 wk of treatment and during the 4-wk follow-up period.ResultsClinically important improvement was observed in both primary and secondary outcomes in all three study groups over time. The reduction in headache index scores during treatment compared with baseline was 49% for amitriptyline, 40% for spinal manipulation and 41% for the combined group; p = .66. During the posttreatment follow-up period the reduction from baseline was 24% for amitriptyline, 42% for spinal manipulation and 25% for the combined group; p = .05.ConclusionThere was no advantage to combining amitriptyline and spinal manipulation for the treatment of migraine headache. Spinal manipulation seemed to be as effective as a well-established and efficacious treatment (amitriptyline), and on the basis of a benign side effects profile, it should be considered a treatment option for patients with frequent migraine headaches.

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