Osteopathy for primary headache patients: a systematic review
Open accessAbstract
OBJECTIVE: This systematic review aimed to assess the efficacy, effectiveness, safety, and tolerability of osteopathic manipulative treatment (OMT) in patients with headache. BACKGROUND: Migraine is one of the most common and disabling medical conditions. It affects more than 15% of the general population, causing high global socioeconomic costs, and the currently available treatment options are inadequate. METHODS: We systematically reviewed all available studies investigating the use of OMT in patients with migraine and other forms of headache. RESULTS: The search of literature produced six studies, five of which were eligible for review. The reviewed papers collectively support the notion that patients with migraine can benefit from OMT. OMT could most likely reduce the number of episodes per month as well as drug use. None of the included studies, however, was classified as low risk of bias according to the Cochrane Collaboration's tool for assessing risk of bias. CONCLUSION: The results from this systematic review show a preliminary low level of evidence that OMT is effective in the management of headache. However, studies with more rigorous designs and methodology are needed to strengthen this evidence. Moreover, this review suggests that new manual interventions for the treatment of acute migraine are available and developing.
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In Cerritelli and colleagues, evidence for tension-type headache was reported only when within-group analysis was performed, and intergroup analyses reported conflicting results.
“Similarly, evidence has been reported for the tension-type headache only when within-group analysis was performed; intergroup analyses reported conflicting results.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [31]
The Results section (“Outcomes reported”; page not available) reports a significantly lower headache frequency in the OMT group than in the control group in Rolle et al.’s tension-type headache trial. That between-group finding contradicts the claim that evidence was reported only from within-group analyses. The section also reports nonsignificant between-group results for some outcomes in another trial, so the comparative findings were mixed. (LLM, conf=0.86)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe overall traffic light evidence for the outcomes of each condition in Cerritelli and colleagues was assessed to be red.
“The OTLE for the outcomes of each condition was assessed to be red.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [31]
The Discussion says the evidence for osteopathic treatment of primary headache is preliminary and of low methodological quality. It does not report an overall traffic-light evidence (OTLE) assessment, assign a red rating, or assess outcomes for each condition; the paper concerns primary headache. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn Cerritelli and colleagues, the RCTs were reported to be at high risk of bias, with high-risk domains including care provider blinding (100%), participant blinding (60%), and allocation concealment (20%).
“The RCTs were reported by the authors to be at high RoB [domains at high RoB (% of RCTs): care provider blinding (100%), participant blinding (60%) and allocation concealment (20%)].”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [31]
The Results > Allocation section rates one of five trials at high risk of bias for allocation concealment, supporting 20%. Results > Blinding of participants and personnel reports three trials with unblinded therapists and two with no information—not 100% rated high risk for care-provider blinding. It also does not establish that 60% were rated high risk for participant blinding. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe systematic review by Cerritelli and colleagues included five RCTs with 235 participants, evaluating migraine (two RCTs, 147 participants) and tension-type headache (three RCTs, 88 participants).
“The SR of Cerritelli and colleagues,31 including five RCTs with a total of 235 participants, evaluated two different types of primary headache: migraine (two RCTs, 147 participants) and tension-type headache (three RCTs, 88 participants).”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [31]
The Results describe five included randomized trials involving migraine and tension-type headache. But Results > Sample size and length of study reports 265 participants, not 235; the passages do not establish the claimed 147/88 participant breakdown. (LLM, conf=0.90)
Experimental — accuracy not yet measuredIn Cerritelli and colleagues, the two RCTs evaluating efficacy in migraine reported positive results in favour of OMT (mainly in pain intensity reduction), but intergroup analysis was performed only in one RCT.
“Although the two RCTs evaluating efficacy in migraine reported positive results in favour of OMT (mainly in pain intensity reduction), intergroup analysis was performed only in one RCT.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [31]
The Results > Outcomes reported section (page not provided) describes positive OMT findings in two migraine trials, including improved pain scores, and explicitly compares the treated group with control and sham groups in one trial. It does not say that intergroup analysis was performed in only one of the two trials, so that limitation is not established by our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measured
The lack of solid evidence stems from a small sample size, the presence of conflicting results, and high heterogeneity in participants, outcome measures, interventions, and comparison interventions.
“The lack of solid evidence stems from a small sample size,26 28–32 the presence of conflicting results24 30 31 and a high heterogeneity in participants,25 31 outcomes measures,31 32 interventions25–27 31 and comparison interventions.25–27 32”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [31]
The Results (Description of heterogeneity) report wide variation in participants, outcomes, interventions, and comparison interventions. The Results (Sample size and length of study) report 265 participants across five trials, and the Discussion describes the evidence as preliminary and of low methodological quality. The passages do not identify conflicting results as a reason for the lack of solid evidence. (LLM, conf=0.85)
Experimental — accuracy not yet measuredEight systematic reviews performed an appropriate literature search.
“Eight SRs performed an appropriate literature search,25–32”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [31]
All systematic reviews evaluated the risk of bias of the included studies.
“All SRs24–32 evaluated the RoB of the included studies”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [31]
In Cerritelli and colleagues, due to high heterogeneity (different types of primary headaches, different outcome measures, and variable length of follow-up), a meta-analysis was not conducted by the authors.
“Due to high heterogeneity (different types of primary headaches, different outcome measures and variable length of follow-up), a meta-analysis was not conducted by the authors.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [31]
In Cerritelli and colleagues, adverse events evaluated in two RCTs did not occur.
“Adverse events, evaluated in two RCTs, did not occur.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [31]
According to the critical domain established in Shea et al, seven systematic reviews were rated low quality and two were rated critically low quality.
“According to the critical domain established in Shea et al,12 seven25–29 31 32 and two SRs 24 30 were rated as low and critically low quality, respectively.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [31]
In the overview, seven systematic reviews evaluated adverse events, and from these reviews, no severe incident involving musculoskeletal, neurological, visceral, or paediatric disorders occurred after OMT.
“In our overview, we found that seven SRs25–28 30–32 evaluated adverse events, and from these SRs, it emerges that no severe incident involving musculoskeletal, neurological, visceral or paediatric disorders occurred after OMT.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [31]
Eight systematic reviews accounted for the risk of bias when interpreting and discussing the results of the systematic review.
“Eight SRs25–32 accounted for the RoB when interpreting and discussing the results of the SR.”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [31]
Domain 15 (publication bias assessment) was rated as not applicable for all systematic reviews due to lack of a meta-analysis or inclusion in the meta-analysis of fewer than 10 trials.
“Finally, domain 15 (publication bias assessment) was rated as not applicable for all the SRs due to lack of a meta-analysis24 30–32 or the inclusion in the meta-analysis of fewer than 10 trials.25–29”
From Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews (2022) · cites this paper as [31]
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Reply to the letter sent by Ceballos-Laitaa et al
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ІНСТРУМЕНТИ ОЦІНКИ ХРОНІЧНОГО ТАЗОВОГО БОЛЮ У ЖІНОК
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- Authors
- Cerritelli, F., Lacorte, E., Ruffini, N., & Vanacore, N.
- Affiliations
- University of Chieti-Pescara (IT)
- Istituto Superiore di Sanità (IT)
- Corresponding author
- Cerritelli, Francesco
- Venue
- Journal of Pain Research
- Publisher
- Informa UK Limited
- Published
- 2017-03
- Volume
- Volume 10
- Pages
- 601-611
- ISSN
- 1178-7090 (ISSN-L)
- PMC
- PMC5359118
- OpenAlex
- W2600936024
- Cited by
- 70
- References
- 37
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 9 · 2023: 6 · 2022: 9 · 2021: 13 · 2020: 13 · 2019: 3 · 2018: 2 · 2017: 2
- FWCI
- 0.83
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Pain Research (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Migraine and Headache Studies
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- osteopathic manipulative treatment, migraine, primary headache, headache treatment, manual therapy, drug use reduction, treatment efficacy and safety
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