Could osteopathy be used to treat headaches and migraine?

• Osteopathy is a medical practice that involves physical manipulation of the bones and tissues performed by an osteopathic physician.
• A recent study reviewing previous research suggests that osteopathy could benefit individuals with musculoskeletal disorders, such as low back or neck pain.
• The findings provide insights into how other musculoskeletal pains may be treated differently, such as certain types of headaches and migraine.
• The researchers caution that most of the studies conducted so far have methodological limitations, and more research is needed before these benefits of osteopathy can be affirmed.

Evidence from five clinical trials suggests that osteopathic manipulative treatment (OMT) might effectively reduce pain and improve functional status in people with musculoskeletal conditions, according to a recent study published in BMJ Open. The findings also show that OMT can be a safe intervention for the treatment of headaches, but further research is needed to confirm its effectiveness.

The study’s co-author, Dr. Donatella Bagagiolo, director of the Research Department at Scuola Superiore di Osteopatia Italiana, Italy, spoke with Medical News Today.

“Currently, only a few studies have investigated the efficacy and safety of OMT in the management of the headache. However, they suggest that OMT could be a positive and safe intervention approach that can reduce pain episodes and related disability in adults with headaches,” said Dr. Bagagiolo.

Need for alternative treatments

Severe headaches and migraine were estimated to affect 15.9% of adults in the United States in 2018. Chronic headaches or other headache disorders can interfere with daily functioning and negatively impact well-being.

Primary headaches are chronic headaches that are not caused by another condition. There are multiple types of primary headaches, with tension-type headaches, migraine, and cluster headaches being some of the most common types.

Treatments for primary headaches include medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and triptans. Due to the potential adverse effects of NSAIDs and triptans on heart and kidney function, individuals with cardiovascular or renal conditions are advised to avoid these medications.

Thus, there is a need for non-pharmacological alternatives, such as osteopathy, to treat headaches in individuals who are unable to tolerate medications or do not wish to take medications.

Osteopathic treatment

Osteopathic manipulative treatment involves the manual application of force or pressure to detect and treat health conditions by an osteopathic physician. OMT is commonly used for back pain and other skeletomuscular conditions.

A central tenet of osteopathy is that the body’s structure and function are interrelated. Consistently, structural imbalances in the muscles, bones, tissues, and joints are associated with disease symptoms. OMT involves manipulating muscles, joints, bones, and tissues to normalize these imbalances in the structure and function of the body.

In the present study, the authors reviewed previous research to conclude that OMT has promise for treating musculoskeletal disorders such as lower back pain, chronic neck pain, and chronic non-cancer pain. The study also summarized evidence from a systematic review, which suggests that OMT could be potentially used to treat headaches.

Evidence on headaches

The aforementioned systematic review analyzed five randomized clinical trials examining the efficacy of OMT in treating primary headaches. The review included three clinical trials for tension-type headaches and the remaining two for migraine.

The clinical trials showed that osteopathic treatment resulted in a reduction in pain intensity and the frequency of headaches. Two clinical trials also showed that OMT reduced the use of medications and disability due to headaches or migraine.

However, most improvements in variables such as pain frequency in patients receiving OMT in these clinical trials were in comparison with their levels at baseline. Except for one clinical trial, there was conflicting data comparing pain intensity or other variables in the osteopathic treatment group with the control group.

Moreover, only two studies used a control group involving sham treatment mimicking features of actual osteopathic treatment. There was also considerable variation in the type, duration, and frequency of OMT and the specific types of headaches treated.

Overall, the authors of the systematic review noted that the evidence supporting the effectiveness of osteopathic manipulation for treating headaches was limited and of low quality.

Thus, more research is needed to address these shortcomings. Dr. Bagagiolo said, “Further studies are needed to support the benefit of osteopathic treatment, and more effort is needed to describe in adequate detail each phase of the intervention, including how and when they are administered.”

Lucas Bohlen, a researcher at the Osteopathic Research Institute at the Osteopathie Schule Deutschland in Germany, provided a similar assessment.

“Preliminary and low-level evidence demonstrates that osteopathic manipulative treatment reduces pain intensity, frequency, and disability in patients with migraine and tension-type headaches,” Bohlen told MNT.

“However, the generalizability of these findings is limited due to the high risk of bias and heterogeneity (of population, outcome, and intervention characteristics). Hence, further rigorously designed randomized controlled trials are needed to draw any conclusive statements,” he added.

Potential Mechanisms

The mechanisms underlying the potential effects of OMT on headaches are not well-understood, and there are multiple hypotheses about these mechanisms.

Headaches such as migraine are associated with an increase in the release of proinflammatory molecules, and osteopathic treatment could reduce inflammation to relieve headaches.

Studies suggest that headaches and migraine may involve dysfunction of the autonomic nervous system, which regulates breathing and heart rate that are not under voluntary control. The autonomic nervous system consists of the sympathetic and parasympathetic nervous systems with opposite functions. The sympathetic nervous system is involved in the “fight or flight” response during stress, whereas the parasympathetic nervous system promotes processes associated with relaxation.

OMT could help stimulate the vagus nerve, a part of the parasympathetic nervous system, to normalize the function of the autonomic nervous system and improve blood flow to the brain. OMT could also facilitate fluid drainage to remove waste products from the brain.

The vagus nerve is also involved in the modulation of painful stimuli, and evidence suggests that stimulation of the vagus nerve can help alleviate symptoms of migraine and cluster headaches.

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