title: The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache.
abstract: BACKGROUND
  Migraine headache affects approximately 11 million adults in the United States. Spinal manipulation is a common alternative therapy for headaches, but its efficacy compared with standard medical therapies is unknown.
  
  
  OBJECTIVE
  To measure the relative efficacy of amitriptyline, spinal manipulation and the combination of both therapies for the prophylaxis of migraine headache.
  
  
  METHODS
  A prospective, randomized, parallel-group comparison. After a 4-wk baseline period, patients were randomly assigned to 8 wk of treatment, after which there was a 4-wk follow-up period.
  
  
  METHODS
  Chiropractic college outpatient clinic.
  
  
  METHODS
  A total of 218 patients with the diagnosis of migraine headache.
  
  
  METHODS
  An 8-wk course of therapy with spinal manipulation, amitriptyline or a combination of the two treatments.
  
  
  METHODS
  A headache index score derived from a daily headache pain diary during the last 4 wk of treatment and during the 4-wk follow-up period.
  
  
  RESULTS
  Clinically important improvement was observed in both primary and secondary outcomes in all three study groups over time. The reduction in headache index scores during treatment compared with baseline was 49% for amitriptyline, 40% for spinal manipulation and 41% for the combined group; p = .66. During the posttreatment follow-up period the reduction from baseline was 24% for amitriptyline, 42% for spinal manipulation and 25% for the combined group; p = .05.
  
  
  CONCLUSIONS
  There was no advantage to combining amitriptyline and spinal manipulation for the treatment of migraine headache. Spinal manipulation seemed to be as effective as a well-established and efficacious treatment (amitriptyline), and on the basis of a benign side effects profile, it should be considered a treatment option for patients with frequent migraine headaches.
authors.affiliation: Center for Clinical Studies, Northwestern College of Chiropractic, Bloomington, MN 55431, USA. cnelson@nwchiro.edu
authors.forename: C F
authors.initials: CF
authors.lastname: Nelson
authors.forename: G
authors.initials: G
authors.lastname: Bronfort
authors.forename: R
authors.initials: R
authors.lastname: Evans
authors.forename: P
authors.initials: P
authors.lastname: Boline
authors.forename: C
authors.initials: C
authors.lastname: Goldsmith
authors.forename: A V
authors.initials: AV
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000639:Amitriptyline / Q000627:therapeutic use*; D000700:Analgesics / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy / Q000628:therapy*; D004366:Nonprescription Drugs / Q000627:therapeutic use; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000929:Antidepressive Agents, Tricyclic; D004366:Nonprescription Drugs; D000639:Amitriptyline