title: Evidence-based guidelines for the chiropractic treatment of adults with headache.
abstract: OBJECTIVE
  The purpose of this manuscript is to provide evidence-informed practice recommendations for the chiropractic treatment of headache in adults.
  
  
  METHODS
  Systematic literature searches of controlled clinical trials published through August 2009 relevant to chiropractic practice were conducted using the databases MEDLINE; EMBASE; Allied and Complementary Medicine; the Cumulative Index to Nursing and Allied Health Literature; Manual, Alternative, and Natural Therapy Index System; Alt HealthWatch; Index to Chiropractic Literature; and the Cochrane Library. The number, quality, and consistency of findings were considered to assign an overall strength of evidence (strong, moderate, limited, or conflicting) and to formulate practice recommendations.
  
  
  RESULTS
  Twenty-one articles met inclusion criteria and were used to develop recommendations. Evidence did not exceed a moderate level. For migraine, spinal manipulation and multimodal multidisciplinary interventions including massage are recommended for management of patients with episodic or chronic migraine. For tension-type headache, spinal manipulation cannot be recommended for the management of episodic tension-type headache. A recommendation cannot be made for or against the use of spinal manipulation for patients with chronic tension-type headache. Low-load craniocervical mobilization may be beneficial for longer term management of patients with episodic or chronic tension-type headaches. For cervicogenic headache, spinal manipulation is recommended. Joint mobilization or deep neck flexor exercises may improve symptoms. There is no consistently additive benefit of combining joint mobilization and deep neck flexor exercises for patients with cervicogenic headache. Adverse events were not addressed in most clinical trials; and if they were, there were none or they were minor.
  
  
  CONCLUSIONS
  Evidence suggests that chiropractic care, including spinal manipulation, improves migraine and cervicogenic headaches. The type, frequency, dosage, and duration of treatment(s) should be based on guideline recommendations, clinical experience, and findings. Evidence for the use of spinal manipulation as an isolated intervention for patients with tension-type headache remains equivocal.
authors.affiliation: Guidelines Development Committee Chair and Chiropractor, Private Practice, Clarenville, Newfoundland and Labrador, Canada. rbryans@nfld.net
authors.forename: Roland
authors.initials: R
authors.lastname: Bryans
authors.forename: Martin
authors.initials: M
authors.lastname: Descarreaux
authors.forename: Mireille
authors.initials: M
authors.lastname: Duranleau
authors.forename: Henri
authors.initials: H
authors.lastname: Marcoux
authors.forename: Brock
authors.initials: B
authors.lastname: Potter
authors.forename: Rick
authors.initials: R
authors.lastname: Ruegg
authors.forename: Lynn
authors.initials: L
authors.lastname: Shaw
authors.forename: Robert
authors.initials: R
authors.lastname: Watkin
authors.forename: Eleanor
authors.initials: E
authors.lastname: White
mesh_terms: D000328:Adult; D019317:Evidence-Based Medicine; D006261:Headache / Q000628:therapy*; D006801:Humans; D026882:Manipulation, Chiropractic / Q000009:adverse effects; D008881:Migraine Disorders / Q000628:therapy; D051298:Post-Traumatic Headache / Q000628:therapy; D012449:Safety; D018781:Tension-Type Headache / Q000628:therapy