Dose Response for Chiropractic Care of Chronic Cervicogenic Headache and Associated Neck Pain: A Randomized Pilot Study
Received 5 June 2003; received in revised form 9 September 2003
Objective
To acquire information for designing a large clinical trial and determining its feasibility and to make preliminary estimates of the relationship between headache outcomes and the number of visits to a chiropractor.
Design
Randomized, controlled trial.
Setting
Private practice in a college outpatient clinic and in the community.
Subjects
Twenty-four adults with chronic cervicogenic headache.
Methods
Patients were randomly allocated to 1, 3, or 4 visits per week for 3 weeks. All patients received high-velocity low-amplitude spinal manipulation. Doctor of Chiropractics could apply up to 2 physical modalities at each visit from among heat and soft tissue therapy. They could also recommend modification of daily activities and rehabilitative exercises. Outcomes included 100-point Modified Von Korff pain and disability scales, and headaches in last 4 weeks.
Results
Only 1 participant was insufficiently compliant with treatment (3 of 12 visits), and 1 patient was lost to follow-up. There was substantial benefit in pain relief for 9 and 12 treatments compared with 3 visits. At 4 weeks, the advantage was 13.8 (P = .135) for 3 visits per week and 18.7 (P = .041) for 4 visits per week. At the 12-week follow-up, the advantage was 19.4 (P = .035) for 3 visits per week and 18.1 (P = .048) for 4 visits per week.
Conclusion
A large clinical trial on the relationship between pain relief and the number of chiropractic treatments is feasible. Findings give preliminary support for the benefit of larger doses, 9 to 12 treatments, of chiropractic care for the treatment of cervicogenic headache.
aCenter for Outcome Studies, Western States Chiropractic College, Portland, OR
bCenter for Health Research, Kaiser Permanente Northwest, Portland, OR
cNational College of Naturopathic Medicine, Portland, OR
dDivisions of Chiropractic and Clinical Sciences, Western States Chiropractic College, Portland, OR
Mitchell Haas, DC, Center for Outcome Studies, Western States Chiropractic College, 2900 NE 132nd Avenue, Portland, OR 97230
Funded by a grant from The Oregon Craniofacial Complementary and Alternative Medicine Center, National Center for Complementary and Alternative Medicine/National Institutes of Health (under P50 AT00076).
ABSTRACT