Can a Chiropractor Help Treat Headaches and Migraines?

Certain chiropractic techniques are thought to help ease chronic headaches and migraines. This is especially true with migraines in which neck pain and other musculoskeletal problems are reported by up to 75% of patients.

Growing evidence suggests that incorporating chiropractic care—including spinal manipulation and mobilization—into standard medical treatments can yield better control of certain types of headaches.

Even so, there are risks associated with spinal manipulation, and the treatment of migraines and headaches by a chiropractor is still regarded as a complementary therapy rather than the standard of care.

Chiropractic Treatment of Migraine Headaches

Much of the research exploring the chiropractic treatment of headaches is devoted to migraines. Some studies, in fact, suggest that around 87% of migraine sufferers report seeing a chiropractor to treat headache pain.

A migraine is a neurological condition characterized by recurrent severe headaches, usually on one side of the head. An attack is often accompanied by symptoms like nausea, vomiting, visual disturbances, and increased sensitivity to sound and light.

Another symptom less commonly reported is neck pain, which some experts suggest occurs far more frequently than even nausea.

According to a 2019 study in Global Advances in Health and Medicine, around 75% of people with migraine report neck pain, stiffness, and tension, often preceding the actual headache.

While it is unclear how neck pain and migraines are connected, some treatment centers (like the Osher Clinical Center at Brigham and Women’s Hospital in Boston) have begun to integrate chiropractic care into their treatment model to address musculoskeletal issues related to migraines.

Some of the chiropractic treatments that have proved useful for this include:

• Soft tissue release: A manual technique using stretching and deep pressure to break up rigid muscle tissues, relax muscle tension, and move fluids trapped in the tissues
• Myofascial release: A type of gentle massage, also known as trigger point therapy, that releases tightness and pain in myofascial tissues (connective tissues that cover and support muscles)
• Spinal manipulation therapy: Also known as an "adjustment," it involves the application of forceful thrusts to spinal joints to improve movement or function
• Spinal mobilization: A technique similar to spinal manipulation that doesn't involve thrusts but instead uses controlled movements performed within a joint's natural range of motion

The treatment plan will usually involve home-based stretches and self-mobilization techniques to support in-office treatments.

Although the evidence supporting chiropractic treatments is based largely on case studies, some individuals have reported a significant reduction in migraine intensity and frequency.

A 2019 review of studies in the journal Headache concluded that spinal manipulation used for an average of two to six months may be effective in reducing migraine days and pain intensity.

Even so, it is not clear how spinal manipulation helps. Some experts suggest that it may reduce spinal inflammation which can set off a migraine attack or that it may stimulate a part of the nervous system called the descending pain inhibitory system. More research is needed.

Cervicogenic Headaches

Cervicogenic headaches stem from an underlying neck problem and are often triggered by an injury to the cervical spine of the neck. The headaches typically start with one-sided pain at the back of the head that gradually moves to the front, often with same-sided shoulder or arm pain.

Cervicogenic headaches are among the least common headaches which usually don't improve with pain medications. Physical therapy is commonly recommended and usually affords the best results. Nerve blocks administered by a healthcare provider can also provide temporary relief.

Increasingly, chiropractic care—specifically cervical spinal manipulation therapy (SMT)—is being integrated into the treatment plan for cervicogenic headaches.

Cervical SMT involves a technique described as high-velocity, low-amplitude (HVLA) in which rapid force is applied over a small rotational area.

Cervical SMT is typically done when the patient is lying on their back. After supporting the spinal joint with one hand, the chiropractic will tilt the head to its end range of motion before applying HVLA. Variations of the procedure can also performed with the patient lying face down.

A 2020 review of studies in the European Journal of Pain reported that cervical SMT provides "superior short-term relief" in the intensity and frequency of cervicogenic headaches but does nothing to reduce the duration of pain episodes.

As with migraine headaches, it is unclear how spinal manipulation helps, though some experts suggest that activation of the descending pain inhibitory system plays a role. Even so, there is little evidence that SMT is more effective than physical therapy in managing cervicogenic headaches.

Tension Headaches

Tension headaches are the most common type of headache associated with stress and muscle tension in the neck, head, or scalp. Tension headaches cause dull, non-throbbing pain that can feel like a vise around your head or cause all-over head pain worsening at the scalp, temples, or back of the neck.

Unlike cervicogenic headaches, tension headaches can often be effectively treated with over-the-counter pain relievers like Tylenol (acetaminophen) or non-steroidal anti-inflammatories (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen).

Chiropractic treatment has not proven to be useful in managing this type of headache. With that said, some experts suggest that chronic tension headaches may improve with a multidisciplinary approach involving stress management, head and neck massage, neck stretching exercises, and myofascial trigger point therapy.

Possible Risks

While chiropractic techniques like spinal manipulation are being increasingly embraced for the treatment of certain headaches, the American Medical Association does not endorse the practice overall and has fought legislation expanding Medicare coverage for chiropractic treatments.

The concern is mainly centered around the potential harm caused by spinal manipulations.

While the risk of injury is low if performed by a duly licensed chiropractor, spinal adjustments can or rare occasions lead to complications such as:

• Herniated spinal discs
• Spinal nerve compression, leading to chronic pain or the loss of sensory or motor function
• Vertebrobasilar stroke (VBS), a type of stroke caused by damage to spinal arteries

Because of these risks, SMT should not be pursued if you have osteoporosis, spinal cancer, chronic nerve pain, or a known abnormality in the upper neck. People at an increased risk of stroke should also avoid spinal manipulation.

If suffering from migraines or chronic headaches, it is best to see a healthcare provider first before considering chiropractic treatment. A coordinated approach typically yields the best results.

Summary

Chiropractic treatments like spinal manipulation are increasingly being explored for the treatment of migraines and cervicogenic headaches. While some studies suggest that spinal manipulation can reduce the frequency and/or severity of headache episodes, the procedure poses certain risks and should only be performed by a licensed chiropractor.