Multimodal chiropractic care for migraine: A pilot randomized controlled trial.

The short version

This pilot randomized controlled trial with 61 adult women explored whether adding multimodal chiropractic care to enhanced usual care could feasibly be delivered to people with episodic migraine, and whether it might reduce how often migraines occurred. Multimodal chiropractic care combines several hands-on techniques — spinal manipulation (adjusting joint movement in the spine), joint mobilization, soft-tissue release, and posture correction — rather than spinal manipulation alone, the approach most prior migraine trials tested. Enhanced usual care meant continuing regular medical treatment plus migraine education materials and regular phone check-ins, giving both groups comparable attention from the study team. Participants were women ages 21 to 55 (average 36) having 4 to 13 migraine days a month, randomly assigned to receive up to 10 individualized chiropractic sessions over 14 weeks (29 women) or enhanced usual care alone (32 women). Chiropractors tailored treatment to each person's diagnosis — myofascial pain, spinal misalignment, or jaw dysfunction — drawing from a fixed menu of techniques. Migraine frequency, severity, and disability were tracked through daily logs and standardized questionnaires: the Migraine Disability Assessment (MIDAS), the Headache Impact Test (HIT-6), and a migraine-specific quality-of-life scale, completed at 14 and 18 weeks. Recruitment and safety looked encouraging: of 422 people screened, 61 enrolled over 20 months, 93% completed migraine logs, and no serious side effects occurred, though only 83% of chiropractic-group participants attended enough sessions to meet the study's own adherence goal (versus a target of 85%), so feasibility criteria were narrowly missed. Migraine days dropped substantially more with chiropractic care added, a difference of about 2 fewer migraine days per month than usual care alone (95% confidence interval -3.46 to -0.37, meaning the true benefit is likely real but its exact size is uncertain), and this advantage held up a month after treatment ended. Disability and headache-impact scores (MIDAS and HIT-6) improved significantly more with chiropractic care too. However, migraine severity, duration, medication use, and quality-of-life scores did not differ significantly between groups, and musculoskeletal stiffness was reported more often by the chiropractic group (21% versus 6%). For migraine sufferers seeking non-drug options, these results are promising but preliminary: the size of the migraine-day reduction was similar to what topiramate, propranolol, and erenumab achieve against placebo in prior research. Because participants and chiropractors knew who was receiving treatment, and the chiropractic group received more attention overall, some of the benefit could reflect that extra contact rather than the techniques themselves. The sample was small, all female, and drawn from one clinic, so a larger, multi-site trial is needed before multimodal chiropractic care can be recommended as proven migraine therapy.

Key findings

• In this pilot study of 61 women with episodic migraine (recurring migraines that come and go, as opposed to daily chronic migraine), adding 14 weeks of multimodal chiropractic care, a combination of spinal adjustments, joint mobilization, and soft-tissue techniques, to usual medical care reduced migraine days by about two more per month than usual care alone.
• The study also found significant improvements in migraine-related disability, measured by the MIDAS questionnaire (Migraine Disability Assessment, which scores how much migraines limit daily activities), and in headache impact, measured by the HIT-6 (Headache Impact Test).
• No serious side effects occurred, though some participants in the chiropractic group experienced temporary muscle stiffness or a short-term increase in migraine symptoms.
• Because this was a small pilot study without blinding (participants and chiropractors knew who was receiving treatment), the results should be considered preliminary rather than proof that chiropractic care works for migraine.
• The researchers concluded these findings support running a larger, fully powered trial to confirm whether multimodal chiropractic care truly reduces migraine frequency.

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