Intervention Review

Non-invasive physical treatments for chronic/recurrent headache

  1. Gert Brønfort1,*,
  2. Niels Nilsson2,
  3. Mitchell Haas3,
  4. Roni L Evans1,
  5. Charles H Goldsmith4,
  6. Willem JJ Assendelft5,
  7. Lex M Bouter6

Editorial Group: Cochrane Pain, Palliative and Supportive Care Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 14 NOV 2002

DOI: 10.1002/14651858.CD001878.pub2

Database Title

Additional Information

How to Cite

Brønfort G, Nilsson N, Haas M, Evans RL, Goldsmith CH, Assendelft WJJ, Bouter LM. Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD001878. DOI: 10.1002/14651858.CD001878.pub2.

Author Information

  1. 1

    Northwestern Health Sciences University, Wolfe-Harris Center for Clinical Studies, Bloomington, MN, USA

  2. 2

    Odense University, Center for Biomechanics, Odense M, Denmark

  3. 3

    Western States Chiropractic College, Center for Outcomes Studies, Portland, OR, USA

  4. 4

    McMaster University, Department of Clinical Epidemiology & Biostatistics, Hamilton, Ontario, Canada

  5. 5

    Leiden University Medical Centre, Department of Public Health and Primary Care, Leiden, Netherlands

  6. 6

    Executive Board of VU University Amsterdam, Amsterdam, Netherlands

*Gert Brønfort, Wolfe-Harris Center for Clinical Studies, Northwestern Health Sciences University, 2501 West 84th Street, Bloomington, MN, 55431, USA. gbronfort@nwhealth.edu.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

SEARCH

ARTICLE TOOLS

View Full Article (HTML) Summary (61K)Standard (685K)Full (690K)
 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Non-invasive physical treatments are often used to treat common types of chronic/recurrent headache.

Objectives

To quantify and compare the magnitude of short- and long-term effects of non-invasive physical treatments for chronic/recurrent headaches.

Search methods

We searched the following databases from their inception to November 2002: MEDLINE, EMBASE, BIOSIS, CINAHL, Science Citation Index, Dissertation Abstracts, CENTRAL, and the Specialised Register of the Cochrane Pain, Palliative Care and Supportive Care review group. Selected complementary medicine reference systems were searched as well. We also performed citation tracking and hand searching of potentially relevant journals.

Selection criteria

We included randomized and quasi-randomized controlled trials comparing non-invasive physical treatments for chronic/recurrent headaches to any type of control.

Data collection and analysis

Two independent reviewers abstracted trial information and scored trials for methodological quality. Outcomes data were standardized into percentage point and effect size scores wherever possible. The strength of the evidence of effectiveness was assessed using pre-specified rules.

Main results

Twenty-two studies with a total of 2628 patients (age 12 to 78 years) met the inclusion criteria. Five types of headache were studied: migraine, tension-type, cervicogenic, a mix of migraine and tension-type, and post-traumatic headache. Ten studies had methodological quality scores of 50 or more (out of a possible 100 points), but many limitations were identified. We were unable to pool data because of study heterogeneity.

For the prophylactic treatment of migraine headache, there is evidence that spinal manipulation may be an effective treatment option with a short-term effect similar to that of a commonly used, effective drug (amitriptyline). Other possible treatment options with weaker evidence of effectiveness are pulsating electromagnetic fields and a combination of transcutaneous electrical nerve stimulation [TENS] and electrical neurotransmitter modulation.

For the prophylactic treatment of chronic tension-type headache, amitriptyline is more effective than spinal manipulation during treatment. However, spinal manipulation is superior in the short term after cessation of both treatments. Other possible treatment options with weaker evidence of effectiveness are therapeutic touch; cranial electrotherapy; a combination of TENS and electrical neurotransmitter modulation; and a regimen of auto-massage, TENS, and stretching. For episodic tension-type headache, there is evidence that adding spinal manipulation to massage is not effective.

For the prophylactic treatment of cervicogenic headache, there is evidence that both neck exercise (low-intensity endurance training) and spinal manipulation are effective in the short and long term when compared to no treatment. There is also evidence that spinal manipulation is effective in the short term when compared to massage or placebo spinal manipulation, and weaker evidence when compared to spinal mobilization.

There is weaker evidence that spinal mobilization is more effective in the short term than cold packs in the treatment of post-traumatic headache.

Authors' conclusions

A few non-invasive physical treatments may be effective as prophylactic treatments for chronic/recurrent headaches. Based on trial results, these treatments appear to be associated with little risk of serious adverse effects. The clinical effectiveness and cost-effectiveness of non-invasive physical treatments require further research using scientifically rigorous methods. The heterogeneity of the studies included in this review means that the results of a few additional high-quality trials in the future could easily change the conclusions of our review.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Non-invasive physical treatments for chronic/recurrent headaches

Various physical treatments are often used instead of, or in addition to, medications to treat headaches. Evidence from controlled trials suggests that several non-invasive physical treatments may help prevent chronic/recurrent headaches. Spinal manipulation may be effective for migraine and chronic tension-type headache. Both spinal manipulation and neck exercises may be effective for cervicogenic headache. Weaker evidence suggests that other treatments may also be effective: pulsating electromagnetic fields and transcutaneous electrical nerve stimulation (TENS) for migraine, and therapeutic touch, cranial electrotherapy, TENS, and a combination of self-massage/TENS/stretching for tension-type headache. Although none of these treatments has conclusive evidence for effectiveness, all appear to be associated with little risk of serious adverse effects.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

慢性/反覆性頭痛之非侵犯性物理治療

非侵犯性物理治療常常被使用在治療常見的慢性/反覆性頭痛。

目標

為了量化和比較以非侵犯性物理治療於慢性/反覆性頭痛短期及長期的效果。

搜尋策略

我們搜尋了直到2002年11月的資料庫，包含MEDLINE, EMBASE, BIOSIS, CINAHL, Science Citation Index, Dissertation Abstracts, CENTRAL, and the Specialised Register of the Cochrane Pain, Palliative Care and Supportive Care review group。其中也選擇了部分輔助醫療參考資料系統。同時有包括了對於可能的相關文獻也使用引用追蹤與人工搜尋。

選擇標準

我們的研究包括了針對慢性/反覆性頭痛非侵犯性物理治療之隨機與半隨機控制(各種形式的控制組)試驗。

資料收集與分析

兩個獨立的檢閱者摘要出試驗資訊及對試驗方法的品質評分。只要可能的話，研究結果被標準化成百分點及效應分數。證據效力的強度以事先訂定的規則評估。

主要結論

總共2628個病人(年齡從12至78歲)於22個研究中納入研究。有五種型式的頭痛被研究：偏頭痛、張力型頭痛、頸部成因型、偏頭痛及張力型混和性頭痛、創傷後頭痛。十個研究方法的品質計分大於50分(可能超出100分)，但有很多的限制存在。由於研究的異質性，我們無法把數據綜整處理。針對偏頭痛的預防性治療，有一些證據顯示脊椎推拿的動作可以是一種有效的治療選擇，其短期的效果就像是常用的有效藥物amitriptyline一樣。其他治療選項效果屬於較差的證據等級者，還有脈衝性電磁場及合併經皮電神經刺激(TENS)和電神經傳導調節。針對慢性張力型頭痛的預防性治療，治療期間amitriptyline相對於脊椎推拿是更為有效的。然而，在治療停止後，脊椎推拿在短期來說是較有效的。其他治療選項效果屬於較差的證據等級者包含治療性觸摸、顱部電治療、合併經皮電神經刺激(TENS)及電神經傳導調節，及自我按摩、經皮電神經刺激(TENS)、伸展運動的合併療法。針對陣發性慢性張力型頭痛，有證據顯示自我按摩加上脊椎推拿是沒有效果的。針對頸部成因型頭痛的預防性治療，有證據顯示頸部運動(低強度耐力訓練)和脊椎推拿兩者相對於沒有治療，在短期及長期來說都是比較有效的。也有證據顯示當與按摩或者是脊椎推拿的安慰劑組比較，脊椎推拿在短期是較有效的；以及微弱的證據顯示和脊椎活動比較也是較有效的。有較弱的證據顯示，治療創傷後頭痛，在短期的效果來說脊椎活動是比冰敷更有效的。

作者結論

一些非侵犯性的物理性治療也許像針對慢性、反覆性頭痛一樣有效。基於試驗的結果，這些治療似乎關聯著小風險的嚴重有害影響。非侵犯性物理性治療的臨床成效及成本效益需要使用合乎科學地更精確的方法作更進一步的研究。這些研究的異質性包含這一個回顧意旨在未來一些額外的高品質試驗可能很容易的就改變我們回顧的結論。

翻譯人

本摘要由三軍總醫院林斈府翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

一些非侵犯性物理性治療也許有助於預防慢性/反覆性頭痛。不同的物理治療常常用來代替或輔助藥物治療。從對照試驗的證據中顯示一些非侵犯性物理治療也許有助於預防慢性/反覆性頭痛。對於偏頭痛和慢性張力型頭痛，脊椎推拿也許有效。對於頸部成因型頭痛，脊椎推拿和頸部運動兩者也許都有效。較弱的證據建議其他的治療也許有效：對於偏頭痛使用陣發性電磁場及經皮電神經刺激(TENS)治療；針對張力型頭痛使用治療性觸摸、顱部電治療、經皮電神經刺激(TENS)，和合併自我按摩/經皮電神經刺激/伸展運動。雖然這些治療沒有一個是確實被證實有效，但所有治療都與嚴重副作用的發生無關。

View Full Article (HTML) Summary (61K)Standard (685K)Full (690K)