Spinal manipulation linked to lower butalbital use in tension-type headaches

University Hospitals Cleveland Medical CenterDec 3 2024

A team of researchers led by University Hospitals Connor Whole Health have identified an association between spinal manipulative therapy (SMT) and a reduced likelihood of butalbital prescription and medication overuse headache (MOH) for patients experiencing tension-type headaches (TTH). Their retrospective study, published in Health Science Reports, includes more than 6,200 patients from a national US database spanning 2013 to 2024.

Butalbital, a barbiturate often prescribed for acute TTH relief, is discouraged by guidelines due to its risk of MOH, a debilitating condition with a variety of symptoms including nausea, difficulty concentrating, sleep disturbances, and irritability. SMT is a widely used hands-on treatment that has been shown to reduce headache frequency and intensity in those with TTH. However, no prior studies had examined whether this therapy is associated with reduced reliance on medications like butalbital or development of MOH.

The study compared two cohorts: (1) those who received SMT and (2) matched controls who did not receive SMT. Findings revealed that only 1.7% of SMT patients were prescribed butalbital within two years of follow-up, compared to 3.8% in the non-SMT cohort. Additionally, patients receiving SMT were less likely to develop MOH (0.5% vs. 1.2%).

These results highlight the real-world potential for spinal manipulation to provide benefits to those with TTH beyond reduction of pain intensity."

Robert Trager DC, DIANM, chiropractic physician at UH Connor Whole Health and lead author of the study

"This study underscores the value of nonpharmacologic treatments in delivering safe, guideline-concordant care for headache management," added Dr. Françoise Adan, Chief Whole Health and Well-being Officer at University Hospitals and Director of UH Connor Whole Health.

The researchers call for further studies to corroborate their findings and explore whether these benefits extend to other nonpharmacologic therapies.