A critical review of manual therapy use for headache disorders: prevalence, profiles, motivations, communication and self- reported effectiveness

DOI: https://doi.org/10.1186/s12883-017-0835-0

Abstract-Summary The aim of this paper is to evaluate research studies on the prevalence of patient use of manual therapies for the treatment of headache and the key factors associated with this patient population.

This critical review of the peer-reviewed literature identified 35 papers reporting findings from new empirical research regarding the prevalence, profiles, motiva- tions, communication and self-reported effectiveness of manual therapy use amongst those with headache disorders.

While available data was limited and studies had considerable methodological limitations, the use of manual therapy appears to be the most common non-medical treatment utilized for the management of common recurrent headaches.

There is a need for more rigorous public health and health services research in order to assess the role, safety, utilization and financial costs associated with manual therapy treatment for headache.

Extended: The aim of this study is to report from the peer-reviewed literature; 1) the prevalence of MT use for the treatment of common recurrent headaches and 2) factors associated with this use across several key themes.

There is a number of non-drug approaches also utilized for the prevention of

headaches.

One general population study provides findings for the self-reported effective- ness for chiropractic and physiotherapy at 25.6 and 25.1% respectively for those with primary chronic headache and 38 and 38% respectively for those with second- ary chronic headache [511].

Background Preventative drug treatments for tension-type headaches can include analgesics, NSAIDs, muscle relaxants and botulinum toxin as well as anticonvulsants and antidepressants.

While preventative drug treatments are successful for a significant proportion of sufferers, headache disorders are still reported as under-diagnosed and under-treated

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within medical settings [512, 513] with other studies reporting sufferers can cease continuing with preventative headache medications long-term [514, 515].

The use of physical therapies is significant, with one recent global survey report- ing physical therapy as the most frequently used ‘alternative or complementary treatment’ for headache disorders across many countries [516].

Recent systematic reviews of randomized clinical trials of MT for the prevention of migraine report a number of significant methodological short-comings and the need for more high quality research before any firm conclusions can be made [517, 518].

Recent reviews of MT trials for tension-type headache and cervicogenic head- ache are cautious in reporting positive outcomes and the strong need for further robust research [519, 520].

Methods The aim of this study is to report from the peer-reviewed literature; 1) the preva- lence of MT use for the treatment of common recurrent headaches and 2) factors associated with this use across several key themes.

A comprehensive search of peer-reviewed articles published in English between 2000 and 2015 reporting new empirical research findings of key aspects of MT use among patients with migraine and non-migraine headache disorders was undertaken. Due to the focus of the review, literature reporting randomized control trials and similar clinical research designs were excluded as were articles identified as letters, correspondence, editorials, case reports and commentaries.

All identified articles were screened and only those reporting new empirical find-

ings on MT use for headache in adults were included in the review.

Articles identified and selected for the review were research manuscripts mostly

within epidemiological and health economics studies.

Results The combined prevalence rate of MT use across all MT professions for those with migraine ranged from 1.0 to 57.0% (mean: 15.9%) within the general population; ranged from 2.7 to 56.4% (mean: 18.4%) within headache- clinic patient popula- tions and was reported as 1.7% in one MT patient population.

While patient socio-demographic profiles were not reported within headache populations that were exclusively using MT, several studies report these findings where MT users made up a significant percentage of the non- medical headache treatments utilized by the study population (range 40% – 86%: mean 63%).

Several studies within headache-clinic populations report patient motivations for the use of complementary and alternative headache treatments where MT users made up a significant proportion of the study population (range 40–86%: mean 63%) [521–524].

Discussion Limited information suggests that a pluralistic approach toward the use of medical and non-medical headache treatments such as MT is common.

Information limited to Italy, suggests referral from GPs for MT headache treat- ment can be common in some regions, while this is less likely to widespread given

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the issue of patient non-disclosure to medical doctors regarding the use of this treat- ment in other studies.

Further to this is the need for more research to understand the healthcare utiliza- tion pathways associated with those patients who use MT in their headache management.

Data on the prevalence of MT use for headache was limited particularly within individual MT provider populations when compared to data found within the gen- eral population and headache-clinic populations.

The prevalence of MT use for headache was reported most within chiropractic patient population studies, however information was limited on the types of headache.

Conclusion Beyond clinical research, more high quality public health and health services research is needed to measure and examine a number of issues of significance to the delivery and use of MT’s within headache management.

Acknowledgement A machine generated summary based on the work of Moore, Craig S.; Sibbritt, David W.; Adams, Jon. 2017 in BMC Neurology.

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