Complementary and Alternative Approaches to Chronic Daily Headache: Part II—Manipulation-Based Therapies and Other CAM Therapies

Abstract

The manipulation-based complementary and alternative medicine (CAM) therapies assessed for headache include acupuncture, acupressure, dry needling, chiropractic manipulation (spinal manipulative and mobilization therapy), massage, craniosacral therapy, and reflexology. Several other complementary therapies discussed include aromatherapy, hydrotherapy, daith piercing, and hyperbaric oxygen administration. The strongest evidence for acupuncture is for chronic migraine, and cost analyses suggest it may have overall cost benefit, but methodologic concerns of the research limit interpretation and generalizability of results. There is some evidence for spinal manipulative therapy for chronic cervicogenic headache or chronic tension-type headache, but most chiropractic studies also have major methodologic limitations. The potential for major adverse events, such as cervical dissection or stroke, limits more widespread recommendation for use. The limited data supporting the use of massage, craniosacral therapy, reflexology, aromatherapy, hydrotherapy, daith piercing, and hyperbaric oxygen treatment for chronic headache conditions precludes any recommendations.