The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta-Analysis
Open accessAbstract
Background Several small studies have suggested that spinal manipulation may be an effective treatment for reducing migraine pain and disability. We performed a systematic review and meta‐analysis of published randomized clinical trials (RCTs) to evaluate the evidence regarding spinal manipulation as an alternative or integrative therapy in reducing migraine pain and disability. Methods PubMed and the Cochrane Library databases were searched for clinical trials that evaluated spinal manipulation and migraine‐related outcomes through April 2017. Search terms included: migraine, spinal manipulation, manual therapy, chiropractic, and osteopathic. Meta‐analytic methods were employed to estimate the effect sizes (Hedges’ g ) and heterogeneity ( I 2 ) for migraine days, pain, and disability. The methodological quality of retrieved studies was examined following the Cochrane Risk of Bias Tool. Results Our search identified 6 RCTs (pooled n = 677; range of n = 42‐218) eligible for meta‐analysis. Intervention duration ranged from 2 to 6 months; outcomes included measures of migraine days (primary outcome), migraine pain/intensity, and migraine disability. Methodological quality varied across the studies. For example, some studies received high or unclear bias scores for methodological features such as compliance, blinding, and completeness of outcome data. Due to high levels of heterogeneity when all 6 studies were included in the meta‐analysis, the 1 RCT performed only among chronic migraineurs was excluded. Heterogeneity across the remaining studies was low. We observed that spinal manipulation reduced migraine days with an overall small effect size (Hedges’ g = −0.35, 95% CI: −0.53, −0.16, P < .001) as well as migraine pain/intensity. Conclusions Spinal manipulation may be an effective therapeutic technique to reduce migraine days and pain/intensity. However, given the limitations to studies included in this meta‐analysis, we consider these results to be preliminary. Methodologically rigorous, large‐scale RCTs are warranted to better inform the evidence base for spinal manipulation as a treatment for migraine.
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OMT has been shown to be effective in reducing pain and increasing mandibular range of motion.
“the treatment has been shown to be effective in reducing pain and increasing the mandibular range of motion”
From The Effect of Osteopathic Manipulative Treatment Adjunct on Stabilization Splint Treatment in Temporomandibular Joint Anterior Disc Displacement with Reduction Disorder: A Quantitative Analysis, Pilot Study (2025) · cites this paper as [15]
The Results (Effect of spinal manipulation on migraine pain or intensity; page unavailable) report a small reduction in migraine pain, and Study Selection and Characteristics notes that osteopathic physicians performed manipulation in two included studies. The finding concerns spinal manipulation for migraine and is described as preliminary; the paper does not report increased mandibular range of motion. (LLM, conf=0.88)
Experimental — accuracy not yet measuredOMT may have a significant effect on headaches, migraines, and cranial pain.
“Emerging evidence suggests that OMT may have a significant effect on headaches, migraines, and cranial pain [15].”
From The Effect of Osteopathic Manipulative Treatment Adjunct on Stabilization Splint Treatment in Temporomandibular Joint Anterior Disc Displacement with Reduction Disorder: A Quantitative Analysis, Pilot Study (2025) · cites this paper as [15]
The Results section reports reductions in migraine days and migraine pain or intensity with spinal manipulation, and the Conclusion describes the evidence as preliminary. Two included studies used manipulation performed by osteopathic physicians, but the review does not establish an effect for OMT specifically or for headaches and cranial pain beyond migraine. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThere is a lack of quantitative analyses, especially for disc-condyle positions, for temporomandibular disorders.
“there is a lack of quantitative analyses, especially for the disc–condyle positions for TMDs [15,16,17,18,19].”
From The Effect of Osteopathic Manipulative Treatment Adjunct on Stabilization Splint Treatment in Temporomandibular Joint Anterior Disc Displacement with Reduction Disorder: A Quantitative Analysis, Pilot Study (2025) · cites this paper as [15]
The Methods (Data analysis and syntheses; page unavailable) describe quantitative analysis of migraine outcomes, not temporomandibular disorders. Searches for disc–condyle positions and TMD found no passage in our copy addressing whether quantitative analyses of those positions are lacking. (LLM, conf=0.77)
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Cites
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Aklar, A., Bal, B., Taşdelen, N., İnal, H. S., & Ertaş, G. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14082544 · Cited by 2 · see citing works
“Emerging evidence suggests that OMT may have a significant effect on headaches, migraines, and cranial pain [15].”
- Authors
- Rist, P. M., Hernandez, A., Bernstein, C., Kowalski, M., Osypiuk, K., Vining, R., Long, C. R., Goertz, C., Song, R., & Wayne, P. M.
- Affiliations
- Brigham and Women's Hospital (US)
- Palmer College of Chiropractic (US)
- The Spine Institute for Quality Davenport IA USA
- Chungnam National University (KR)
- Corresponding author
- Rist, Pamela M.
- ORCID
- Venue
- Headache: The Journal of Head and Face Pain
- Publisher
- Wiley
- Published
- 2019-03-14
- Volume
- 59
- Issue
- 4
- Pages
- 532-542
- ISSN
- 0017-8748 (ISSN-L)
- 1526-4610
- PMC
- PMC6461372
- OpenAlex
- W2922520567
- Cited by
- 90
- References
- 1
- Citations by year
- 2026: 7 · 2025: 13 · 2024: 14 · 2023: 14 · 2022: 13 · 2021: 18 · 2020: 7 · 2019: 4
- FWCI
- 1.77
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Headache The Journal of Head and Face Pain (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- NCMIC Foundation
- National Institutes of Health (K01HL128791, K24 AT00928L)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Migraine and Headache Studies
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Keywords
- spinal manipulation, migraine, migraine days, migraine disability, manual therapy, chiropractic, osteopathic manipulative treatment, integrative therapy, chronic migraine
- MeSH terms
- Humans, Migraine Disorders, Outcome and Process Assessment, Health Care, Manipulation, Spinal
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