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Spinal manipulative therapy (SMT) may reduce the need for butalbital prescriptions and lower the risk of medication overuse headache (MOH) in patients with tension-type headaches (TTH), according to a retrospective study published in Health Science Reports. The research, led by University Hospitals Connor Whole Health, analyzed data from over 6,200 patients and highlights SMT as a promising nonpharmacologic treatment option for headache management.
Lower Butalbital Use and MOH Risk with SMT
The study compared two groups of patients: those who received SMT and a matched control group who did not. Within two years of follow-up, only 1.7% of patients in the SMT group were prescribed butalbital, compared to 3.8% in the non-SMT group. Similarly, the likelihood of developing MOH was lower among SMT recipients (0.5%) than controls (1.2%).
These findings provide real-world evidence of SMT's potential benefits beyond reducing pain intensity. "These results highlight the real-world potential for spinal manipulation to provide benefits to those with TTH beyond reduction of pain intensity," noted Robert Trager, DC, DIANM, chiropractic physician and lead author of the study.
Expanding Nonpharmacologic Treatments
Tension-type headaches are among the most common headache disorders, frequently prompting the use of medications like butalbital for symptom relief. However, butalbital use is discouraged in treatment guidelines due to its association with MOH, which can cause nausea, cognitive difficulty, and sleep disturbances.
By demonstrating SMT's role in reducing the need for butalbital and preventing MOH, this study reinforces the importance of nonpharmacologic therapies in headache management. "This study underscores the value of nonpharmacologic treatments in delivering safe, guideline-concordant care for headache management," said Dr. Françoise Adan, Chief Whole Health and Well-being Officer at University Hospitals.
The researchers emphasized the need for further studies to validate these results and explore whether other nonpharmacologic treatments might yield similar benefits.