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A Randomized Controlled Trial

Geoffrey Bove, DC, PhD; Niels Nilsson, DC, MD, PhD

JAMA. 1998;280:1576-1579.

Context.— Episodic tension-type headache is common and is often treated using manual therapies. Few data exist for the efficacy of these interventions.

Objective.— To determine the effects of spinal manipulation therapy on adults with episodic tension-type headache.

Design.— Randomized controlled trial lasting 19 weeks.

Setting.— Outpatient facility of a National Health Service–funded chiropractic research institution in Denmark.

Participants.— Volunteer sample of 26 men and 49 women aged 20 to 59 years who met the diagnostic criteria for episodic tension-type headache as defined by the International Headache Society.

Intervention.— Participants were randomized into 2 groups, 1 receiving soft tissue therapy and spinal manipulation (the manipulation group), and the other receiving soft tissue therapy and a placebo laser treatment (the control group). All participants received 8 treatments over 4 weeks; all treatments were performed by the same chiropractor.

Main Outcome Measures.— Daily hours of headache, pain intensity per episode, and daily analgesic use, as recorded in diaries.

Results.— Based on intent-to-treat analysis, no significant differences between the manipulation and control groups were observed in any of the 3 outcome measures. However, by week 7, each group experienced significant reductions in mean daily headache hours (manipulation group, reduction from 2.8 to 1.5 hours; control group, reduction from 3.4 to 1.9 hours) and mean number of analgesics per day (manipulation group, reduction from 0.66 to 0.38; control group, reduction from 0.82 to 0.59). These changes were maintained through the observation period. Headache pain intensity was unchanged for the duration of the trial.

Conclusion.— As an isolated intervention, spinal manipulation does not seem to have a positive effect on episodic tension-type headache.

From the Center for Biomechanics, Department of Anatomy and Cell Biology, Odense University, Odense, Denmark. Dr Bove is now with the Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass.

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