This week from Dr. Cerami and Utah Sports and Wellness
This osteopathic manipulative therapy trial is the largest ever conducted on migraine adult patients. Patients received 8 treatments over a period of 6 months. These patients were divided into three groups; manipulation, sham manipulation and medication only. For the group assigned to taking drugs-only, there was essentially no reduction in migraine days per month while the group that received manipulative therapy had seen almost a complete elimination of migraine days per month while also reducing drug consumption by 80%. From this data, it appears that manipulative therapy may be considered a clinically valid option for the management of patients with migraines.
To assess the effectiveness of OMT on chronic migraineurs using HIT-6 questionnaire, drug consumption, days of migraine, pain intensity and functional disability. 3-Armed randomized controlled trial setting: all patients admitted in the Department of Neurology of Ancona’s United Hospitals, Italy, with a diagnosis of migraine and without chronic illness, were considered eligible for the study. Patients were randomly divided into three groups: (1) OMT+medication therapy, (2) sham+medication therapy and (3) medication therapy only. Patients received 8 treatments in a study period of 6 months. Changing from baseline HIT-6 score. 105 subjects were included. At the end of the study, ANOVA showed that OMT significantly reduced HIT-6 score (mean change scores OMT-conventional care: -8.74; 95% confidence interval (CI) -12.96 to -4.52; p<0.001 and OMT-sham: -6.62; 95% CI -10.85 to -2.41; p<0.001), drug consumption (OMT-sham: RR=0.22, 95% CI 0.11-0.40; OMT-control: RR=0.20, 95% CI 0.10-0.36), days of migraine (OMT-conventional care: M=-21.06; 95% CI -23.19 to -18.92; p<0.001 and OMT-sham: -17.43; 95% CI -19.57 to -15.29; p<0.001), pain intensity (OMT-sham: RR=0.42, 95% CI 0.24-0.69; OMT-control: RR=0.31, 95% CI 0.19-0.49) and functional disability (p<0.001). These findings suggest that OMT may be considered a valid procedure for the management of migraineurs.
These authors also note:
- The manipulative techniques used in this study included myofascial release, treatment of ligamentous and membrane tensions, treatment of somatic dysfunctions, and treatment to asymmetries and imbalances in the pelvis and cranium.
- Sham therapy mimicked the manipulative care in terms of evaluation and treatment; it used light manual contact to ‘‘treat’’ the subject.
- Both manipulative and sham therapy sessions lasted 30 minutes and were given weekly for the first two sessions, biweekly for the subsequent two, then monthly for the remained four sessions.
- During migraine attacks, high levels of pro-inflammatory substances are released, altering neural autonomic pathways.
- Manipulation influences the autonomic nervous system by producing a parasympathetic effect, and therefore, a “trophotropic tuning state.”
- Manipulation is associated with a “reduction of pro-inflammatory substances.
- At the end of the study period, there was a statistically significant difference on the overall HIT-6 score between the three groups; the manipulation group was statistically improved from control [drug only] and sham group
- “Considering migraine days per month, the three groups differed significantly at the end of the study period.”
- Manipulation “significantly reduced the number of subjects taking medications.”
- “No study participant reported any adverse effects of the [manipulation].”
- “Migraine attacks, use of drugs, pain and disability scores were significantly reduced in the OMT group.”
- “OMT showed a significant improvement in the migraineurs’ quality of life.”
- Interestingly, the “sham group significantly reduced the HIT-6 score compared to the conventional [drug only] care. “The magnitude of the results suggests that the sham procedure may be clinically effective.”