Evidence map›Paper›PMID 30973196›Full record

SynthesisHeadache2019

The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta-Analysis.

Pamela M Rist, Audrey Hernandez, Carolyn Bernstein, Matthew Kowalski, Kamila Osypiuk, Robert Vining, Cynthia R Long, Christine Goertz, Rhayun Song, Peter M Wayne

Registry-linked trialOpen access · greenAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Headache, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06229834 (Chiropractic Care for Episodic Migraine), which is not on this map. Cited by 38 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
38citing papers in PubMed, 5 pooled it
8.2field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06229834 narecruitingnot on this mapstarted 2025, after this paper: background citation

Chiropractic Care for Episodic Migraine

TypeinterventionalSponsorBrigham and Women's HospitalRan2025 to 2027Enrolled60ConditionsEpisodic MigraineArmsChiropractic Care, Headache Health Education
3 · Its place in the literature

Who cites it

38 citing papers in PubMed, 5 syntheses or guidelines pooled it, 96 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Guideline
  4. Pooled it
  5. Pooled it
  6. Trial
  7. Trial
  8. Multimodal chiropractic care for migraine: A pilot randomized controlled trial.Cephalalgia : an international journal of headache · 2021
    Trial
  9. Trial
  10. Trial
  11. Review
  12. Review
  13. When there is little or no research evidence: a clinical decision tool.The Journal of the Canadian Chiropractic Association · 2025
    Article
  14. Article
  15. Migraine resolution in a patient receiving CoxThe Journal of the Canadian Chiropractic Association · 2025
    Article
  16. Hallmarks of primary headache: part 1 - migraine.The journal of headache and pain · 2024
    Review
  17. Review
  18. Article
  19. Is physiotherapy in migraines known to sufferers? A cross-sectional study.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2024
    Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 5 institutions in 2 countries.

Pamela M RistDivision of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.
Audrey HernandezDivision of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.
Carolyn BernsteinOsher Clinic Center, Brigham and Women's Hospital, Boston, MA, USA.
Matthew KowalskiOsher Clinic Center, Brigham and Women's Hospital, Boston, MA, USA.
Kamila OsypiukDivision of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.
Robert ViningPalmer College of Chiropractic, Davenport, IA, USA.
Cynthia R LongPalmer College of Chiropractic, Davenport, IA, USA.
Christine GoertzThe Spine Institute for Quality, Davenport, IA, USA.
Rhayun SongCollege of Nursing, Chungnam National University, Daejeon, South Korea.
Peter M WayneDivision of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.
Harvard University · USBrigham and Women's Hospital · USPalmer College of Chiropractic · USChungnam National University · KRThe Spine Institute · US

Funding

Effects of Vitamin D and Omega-3 on Cerebrovascular DiseaseK01HL128791 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI RIST, PAMELA M. · 2016 to 2020
$858k
Mentoring and research in mind-body and integrative therapiesK24AT009282 · NCCIH · BRIGHAM AND WOMEN'S HOSPITAL · PI WAYNE, PETER MICHAEL · 2017 to 2021
$834k
Inter-Institutional Network for Chiropractic Research (IINCR) through Palmer College FoundationNCCIH NIH HHS K24 AT009282NCMIC FoundationNHLBI NIH HHS K01 HL128791NIH HHS K01HL128791NIH HHS K24 AT00928LOsher Center for Integrative Medicine
6 · The paper itself

Abstract

backgroundSeveral small studies have suggested that spinal manipulation may be an effective treatment for reducing migraine pain and disability. We performed a systematic review and meta-analysis of published randomized clinical trials (RCTs) to evaluate the evidence regarding spinal manipulation as an alternative or integrative therapy in reducing migraine pain and disability.

methodsPubMed and the Cochrane Library databases were searched for clinical trials that evaluated spinal manipulation and migraine-related outcomes through April 2017. Search terms included: migraine, spinal manipulation, manual therapy, chiropractic, and osteopathic. Meta-analytic methods were employed to estimate the effect sizes (Hedges' g) and heterogeneity (I

resultsOur search identified 6 RCTs (pooled n = 677; range of n = 42-218) eligible for meta-analysis. Intervention duration ranged from 2 to 6 months; outcomes included measures of migraine days (primary outcome), migraine pain/intensity, and migraine disability. Methodological quality varied across the studies. For example, some studies received high or unclear bias scores for methodological features such as compliance, blinding, and completeness of outcome data. Due to high levels of heterogeneity when all 6 studies were included in the meta-analysis, the 1 RCT performed only among chronic migraineurs was excluded. Heterogeneity across the remaining studies was low. We observed that spinal manipulation reduced migraine days with an overall small effect size (Hedges' g = -0.35, 95% CI: -0.53, -0.16, P < .001) as well as migraine pain/intensity.

conclusionsSpinal manipulation may be an effective therapeutic technique to reduce migraine days and pain/intensity. However, given the limitations to studies included in this meta-analysis, we consider these results to be preliminary. Methodologically rigorous, large-scale RCTs are warranted to better inform the evidence base for spinal manipulation as a treatment for migraine.

Indexed as

Manipulation, SpinalOutcome and Process Assessment, Health CareHumansMigraine Disordersdisabilitymigrainepainspinal manipulation

Identifiers

PMID30973196
PMCPMC6461372
OpenAlexW2922520567

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.