Table 3 Randomized controlled trials (RCTs) of massage therapy, physical therapy and chiropractic spinal manipulative therapy for migraine

Massage therapy

 USA [8]

1998

Chronic migraine for at least 6 months diagnosed by a questionnaire

Mean years with headache 20.7

26 volunteers

Age 24–65

Mean 29.9 years

RCT of 5 weeks duration

5 weeks treatment

Questionnaire pre- and post-treatment for intervention and control group

Assessment on the first and last day of the 5 weeks study

Massage therapy (n = 12)

30 min twice a week focusing on muscle in the neck

control group (n = 12) not receiving treatment

Drop outs (n = 2)

Pain intensity was statistically significantly reduced from pre- to post-treatment in the massage group, while the change was not statistically significant in the control group

The massage group experienced mean pain intensity was reduced 71% from prior to the first massage and after last massage, while the control groups mean pain intensity was unchanged

 New Zealand [9]

2006

Migraineurs diagnosed by questionnaire

48 volunteers

(8M, 40F)

Age 12–60 years

Mean 41.3 years

RCT of 13 weeks duration, i.e.,

4 weeks baseline

6 weeks treatment

3 weeks follow-up

Comparison of baseline, treatment and follow-up

Headache diary recordings

Massage therapy (n = 23)

45 min once every week, focusing on neuromuscular and trigger-point framework of the back, shoulders, neck and head

Control group (n = 23) kept headache diary

Drop outs (n = 4)

Migraine frequency was significantly reduced in the massage group from baseline to treatment (p < 0.01) and baseline to follow-up (p < 0.05), while it was unchanged in the control group

On average migraine frequency was reduced 34% during treatment and 30% during follow-up in the massage group, while similar figures in the control group was 7 and 2%

Physical therapy

 USA [10]

1998

Migraineurs with at least one migraine attack per week or a total of 5 migraine days per month diagnosed by a neurologist

73 women

Age 20–58 years

Mean age 37 years

Study 1

RCT of 13.5 months duration, i.e.,

2 weeks baseline

4 weeks treatment

3,6,12 months follow-up

Comparison of baseline, post-treatment and follow-up

Physical therapy (n = 30)

Two home sessions daily of about 30 min duration each

Relaxation (n = 39)

Muscle relaxation, breathing exercise and thermal bio feedback. Two home sessions daily of about 20–30 duration each

Drop outs (n = 4)

The relaxation group had statistically significantly more persons with 50% reduction or more in headache severity than the physical therapy group (p < 0.001)

13% (n = 4) had 50% reduction or more in mean headache severity in the physical therapy group, i.e., 16% decrease in mean headache severity

51% (n = 20) had 50% reduction or more in mean headache severity in the relaxation group, i.e., 41% decrease in mean headache severity

Follow-up headache recordings at 3, 6 and 12 months on those with 50% reduction or more in mean headache severity

Drop outs at 3, 6 and 12 months follow-up

Physical therapy (n = 1, 1 and 2)

Relaxation (n = 2, 4 and 6)

Treatment effect was maintained in both group at 3, 6 and 12 months

Migraineurs with at least one migraine attack per week or a total of 5 migraine days per month by a neurologist

45 women

Study 2

Participants that did not had a 50% reduction in mean headache severity in study 1 were offered the alternative treatment

Comparison of baseline, post-treatment and follow-up

Physical therapy (n = 11)

Relaxation (n = 19)

Drop outs (n = 15)

55% (6/11) had 50% reduction or more in mean headache severity in physical therapy group, i.e., 30% decrease in mean headache severity

47% (9/19) had 50% reduction or more in mean headache severity in the relaxation group, i.e., 38% decrease in mean headache severity

Follow-up headache recordings at 3, 6 and 12 months

Drop outs at 3, 6 and 12 months follow-up

Physical therapy (n = 2, 3 and 3)

Relaxation (n = 5, 7 and 10)

The relative high number of drop outs makes it difficult to judge the treatment effect at follow-up, but it seems that the effect lasted in the physical therapy group, while it was quite fluctuating in the relaxation group

Chiropractic spinal manipulative therapy (CSMT)

 Australia [11]

1978

Migraineurs diagnosed by a neurologist

At least 4 migraine attacks within 2 months

85 volunteers

(33M, 52F)

Age 12–55 years

Mean age 41 years

RCT of 6 months duration, i.e.,

2 months baseline

2 months treatment

2 months follow-up

Comparison of baseline, post-treatment and follow-up

Headache diary recording

All received a maximum of 2 treatments per week

Cervical manipulation by chiropractor (n = 30) (11M, 19F)

Cervical manipulation by physician or physiotherapist (n = 27) (14M, 13F)

Cervical mobilization by physiotherapist or physician (n = 28) (8M, 20F)

Drop outs (n = 3)

No statistically significant difference were found between the three groups

The mean reduction in attack frequency, intensity and duration pre- and post treatment were 40, 43 and 36% in the first cervical manipulation group, 13, 12 and 8% in the second cervical manipulation group and 34, 15 and 20% in the cervical mobilization group. No statistically significant effect differences were found between the three groups

 Australia [12]

1980

See above

9.7 mean migraine attacks within 2 months

84 volunteers

Follow-up at 20 months post trial (see above) by a questionnaire

All received a questionnaire

Drop outs (n = 11)

The mean reduction in attack frequency from pre trial to 20 months post trial follow-up was 58, 29 and 54% in the cervical manipulation by chiropractor, cervical manipulation group by physiotherapist or physician and the cervical mobilization group by physiotherapist or physician

 USA [13]

1998

Migraineurs with at least 4 headache days per month for at least 1 year

diagnosed by chiropractor

218 volunteers

(46M, 172F)

Age 18–65 years

Mean age 38 years

A RCT of 4 months duration, i.e.,

1 month baseline

2 months treatment

1 month follow-up

Comparison of baseline, post-treatment and follow-up

Headache diary recording

CSMT (n = 77) by diversified technique. A total of 14 treatments over a 8 weeks period

Amitriptyline (n = 70). Initial dose 25 mg/day was increased weekly by 25 up to 100 mg/day. Patients were seen three times during the 2 months period.

Combined CSMT and Amitriptyline (n = 71)

Drop outs (n = 59)

Mean intensity was reduced from baseline to last 4 weeks treatment and from baseline to 4 weeks post-treatment by 40 and 42% in the CSMT group, 49 and 24% in the amitriptyline group and 41 and 25% in the combined CSMT and amitriptyline group

Mean frequency was reduced from baseline to last 4 weeks treatment and from baseline to 4 weeks post-treatment by 32 and 33% in the CSMT group, 48 and 22% in the amitriptyline group and 39 and 22% in the combined CSMT and amitriptyline group

 Australia [14]

2000

Migraineurs diagnosed by a questionnaire followed by diagnoses by chiropractor

At least one migraine attack per month

Mean migraine attack were 7.2 per months

127 volunteers

(39M, 86F, 2?)

Age 10–70 years

Mean age 39 years

A RCT of 6 months duration, i.e.,

2 months baseline

2 months treatment

2 months follow-up

Comparison of baseline, post-treatment and follow-up

Headache diary recording

CSMT (n = 83) (25M, 59F)

2 months of diversified technique, maximum of 16 sessions

Control group (n = 40) (14M, 27F)

Detuned interferential therapy

Drop outs (n = 4)

The average response was statistically significantly better in the CSMT than the control group regarding migraine frequency (p < 0.005), duration (p < 0.01), disability (p < 0.05), and reduction in medication use (p < 0.001)

The frequency and duration was reduced from baseline to follow-up by 35 and 40% in the CSMT group, and 17 and 20% in the control group