Chiropractic Therapy for Headaches and Migraines

Chiropractic ​care, which includes a combination of spinal manipulation, active and passive exercises, and massage, is often used for headache management and prevention. While chiropractic treatment is popular, there is limited evidence regarding its effectiveness for most headache types, and there are potential adverse outcomes of spinal manipulation.

Guidelines regarding the use of chiropractic care for headaches have emerged, with a number of research studies underway. The headache types for which chiropractic therapy is often sought out—cervicogenic headaches, migraines, and tension headaches—each respond differently to chiropractic treatment.

For Cervicogenic Headaches

Cervicogenic headaches typically begin with one-sided pain that starts at the back of the head and then moves to the front, often with accompanying same-side shoulder or arm pain. Cervicogenic headaches are believed to stem from an underlying neck problem and may be triggered by an injury.

Chiropractic therapy options for cervicogenic headaches include:

Spinal manipulation:  This is a procedure in which a healthcare provider who is trained in spinal manipulation uses their hands or a device to apply a controlled force to a specific joint of your spine. You may hear a popping sound when the force is applied.

The cervical spine (upper part of the spine in the neck) is the region of focus when spinal manipulation is used for treating cervicogenic headaches.

Most adverse effects are mild and short-lived, but there are also some serious risks associated with spinal manipulation of the upper spine that should be considered, including:

• Stroke
• Bleeding
• Disc herniation
• Nerve compression
• Dissection (tearing of the artery in the back or front of the neck)

Joint mobilization: A type of therapy in which your joints are passively moved for the purpose of improving movement or reducing pain. This treatment targets the cervical spine when used for headaches.

Deep neck flexion exercises: These exercises involve actively moving your muscles and joints under the guidance of a healthcare professional.

An example of a deep neck flexion exercise is one in which you lie flat on the floor before doing a series of chin tucks, followed by nodding your head. These muscle contractions usually last for 10-second intervals followed by 10 seconds of rest for 15 repetitions.

Ultimately, the goal is to stretch the deep neck flexor muscles​ that play an important role in supporting the neck.

For Migraines

Migraines are characterized by headaches, as well as other symptoms, such as dizziness and nausea. There are effective medications that can be used for migraine prevention or for acute migraine episodes. Some procedures, such as pain injections, have also been successful.

Migraine is frequently associated with neck pain, which can make it hard to distinguish between migraine and cervicogenic headache. It is important to see your healthcare provider to investigate underlying causes and determine the best management plan.

Chiropractic therapy options for migraines include:

Neuromuscular massage: Also known as trigger point therapy, this type of massage focuses on trigger points within the back, shoulder, neck, and head to relax muscles, improve blood flow, and even relieve stress. This may ease symptoms by releasing pressure from compressed nerves that send pain signals to the brain.

Multidisciplinary care intervention: This approach, which combines physical therapy exercises, relaxation techniques, stress management, and dietary counseling, has been found to be effective in reducing migraine pain, frequency, duration, and disability.

For Tension Headaches

Episodic tension headaches are very common. They can result from muscle tension due to prolonged tension in the neck, shoulders, or head, and they generally improve with over-the-counter pain medications, such as non-steroidal anti-inflammatories (NSAIDs) or Tylenol (acetaminophen).

Chiropractic treatment, including spinal manipulation, has not been found to be helpful for managing this type of headache. However, chronic tension headaches may improve with a more multidisciplinary approach that includes soft tissue therapy (e.g., trigger point therapy, stretching) and stress management.

Other forms of chiropractic therapy that may be useful include:

Low-load craniocervical mobilization: This involves a gentler force than that used in spinal manipulation. For treatment of headaches, this force is applied to the joints of the neck, allowing for rhythmic movement of the cervical segments. Stretching is also usually part of this intervention.

A Word From Verywell

If you are interested in complementary and alternative (CAM) therapies for your headaches, talk with your healthcare provider. It's likely that a combination of therapies will ease your headache pain—and finding the right combination will require some patience, persistence, and a little trial and error.