duke evidence report released

Des Moines, Iowa—In 1996, the Agency for Health Care Policy and Research (AHCPR) was scheduled to produce a set of clinical practice guidelines on available treatment alternatives for headache in much the same way as the agency had previously done for its historic low-back pain Clinical Guidelines released late in 1994. This headache project was based on the systematic evaluation of the literature which existed at that time by a multidisciplinary panel of experts. Due to largely political circumstances, however, their efforts never came to fruition: their work was never released as a guideline but was instead transformed with modifications and budget cuts into a set of evidence reports on only migraine headache by the staff at the Center for Clinical Health Policy Research at Duke University.

The Foundation for Chiropractic Education and Research (FCER) is proud to announce at this time that, due to our own efforts and with funding from the National Chiropractic Mutual Insurance Company (NCMIC*), evidence reports have now been updated on both cervicogenic and tension-type headaches. This new report, titled Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache, is now available to you exclusively from FCER and essentially updates and releases much of the information on treatment alternatives for both tension-type and cervicogenic headache which had been suppressed earlier. For documenting both the quality and strength of research findings pertaining to chiropractic and headache, this report represents an invaluable addition to both your library and clinical practice. It does so from the point of view of an impartial government agency—the objectivity and credibility of which would be expected to have the greatest public impact.

Among the many treatment alternatives supported by evidence, chiropractic is buoyed by substantial evidence in this report as to its efficacy in the management of both tension-type and cervicogenic headaches:

  • Compared to amitriptyline use, chiropractic is shown to produce slightly lesser effects during the treatment period but markedly superior results afterward in the treatment of tension-type headache.
  • Compared to various soft tissue procedures, a course of manipulation treatments (diversified and/or toggle-recoil techniques, depending on the level of the palpated segmental dysfunction) is shown to produce sustained improvement in headache frequency and severity in the treatment ofcervicogenic headache.
  • Compared to various soft tissue procedures, there was no evidence to indicate that a course of manipulation treatments (diversified and/or toggle-recoil techniques, depending on the level of the palpated segmental dysfunction) produced further improvement in headache frequency and severity in the treatment of episodic tension-type headache. This particular study’s findings have important implications in choosing alternatives in contact procedures in managing different types of headache patients.

This new undertaking mandated the staff at the Duke Center to screen citations from the literature, abstract the data into evidence tables, analyze the quality and magnitude of results from these studies, and draft an evidence report with peer review from a panel of 19 reviewers, including both researchers and clinicians in chiropractic.

Starting with over 2,500 citations from such sources as MEDLINE, MANTIS, CRAC, CINAHL, PsychoINFO, the Cochrane Controlled Trials Register, and additional articles obtained by referral, the panel obtained bibliographies of both physical and behavioral options for treating headache which were either prospective, controlled trials aimed at either relief from or prevention of attacks of tension-type or cervicogenic headache. Among the physical interventions reviewed in this report:
  • Acupuncture
  • Cervical spinal manipulation
  • Low-force techniques (such as cranial sacral therapy, massage [including trigger point releases])
  • Mobilization
  • Stretching
  • Heat therapy
  • Ultrasound
  • Transcutaneous electrical nerve stimulation (TENS)
  • Exercise (including postural exercises)
Among the behavioral interventions reviewed are:

  • Relaxation
  • Biofeedback
  • Cognitive-behavioral (stress management) therapy
  • Hypnosis
Even though further research is desirable—and mandatory—this report clearly positions chiropractic as a viable treatment alternative that lacks the detrimental and sometimes fatal side effects of conventional treatment options for managing tension and cervicogenic headache patients. Compared to other physical treatment methods (including physiotherapy, acupuncture, and electrical stimulation), the evidence supporting chiropractic appears to be more robust. Consequently, you will find this report to be an invaluable resource for documenting your practice for your colleagues, practitioners in other health care professions, the public, and third-party payers.