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Duke Evidence Report
Released
For
Immediate Release: February 6, 2001
Contact:
Robin R. Merrifield
1304
Perry Ave. Bremerton WA 98310
Phone:
360-478-2716 or 800-343-0549
Fax:
360-478-0834
E-mail:
FCERedit@aol.com
Des Moines, Iowa— In 1996, the Agency for Health Care Policy and
Research (AHCPR) was scheduled to produce a set of clinical practice
guidelines on available treatment alternatives for headache in much the
same way as the agency had previously done for its historic low-back pain
Clinical Guidelines released late in 1994. This headache project was based
on the systematic evaluation of the literature which existed at that time
by a multidisciplinary panel of experts. Due to largely political
circumstances, however, their efforts never came to fruition: their work
was never released as a guideline but was instead transformed with
modifications and budget cuts into a set of evidence reports on only
migraine headache by the staff at the Center for Clinical Health Policy
Research at Duke University.
The Foundation for Chiropractic Education and Research (FCER) is proud
to announce at this time that, due to our own efforts and with funding
from the National Chiropractic Mutual Insurance Company (NCMIC*),
evidence reports have now been updated on both cervicogenic and
tension-type headaches. This new report, titled Evidence Report:
Behavioral and Physical Treatments for Tension-type and Cervicogenic
Headache, is now available to you exclusively from FCER and
essentially updates and releases much of the information on treatment
alternatives for both tension-type and cervicogenic headache which had
been suppressed earlier. For documenting both the quality and strength
of research findings pertaining to chiropractic and headache, this report
represents an invaluable addition to both your library and clinical
practice. It does so from the point of view of an impartial government
agency—the objectivity and credibility of which would be expected to
have the greatest public impact.
Among the many treatment alternatives supported by evidence,
chiropractic is buoyed by substantial evidence in this report as to its
efficacy in the management of both tension-type and cervicogenic
headaches:
- Compared to amitriptyline use, chiropractic is shown to produce
slightly lesser effects during the treatment period but markedly
superior results afterward in the treatment of tension-type
headache.
- Compared to various soft tissue procedures, a course of manipulation
treatments (diversified and/or toggle-recoil techniques, depending on
the level of the palpated segmental dysfunction) is shown to produce
sustained improvement in headache frequency and severity in the
treatment of cervicogenic headache.
- Compared to various soft tissue procedures, there was no evidence to
indicate that a course of manipulation treatments (diversified and/or
toggle-recoil techniques, depending on the level of the palpated
segmental dysfunction) produced further improvement in headache
frequency and severity in the treatment of episodic tension-type
headache. This particular study’s findings have important
implications in choosing alternatives in contact procedures in
managing different types of headache patients.
This new undertaking mandated the staff at the Duke Center to screen
citations from the literature, abstract the data into evidence tables,
analyze the quality and magnitude of results from these studies, and draft
an evidence report with peer review from a panel of 19 reviewers,
including both researchers and clinicians in chiropractic.
Starting with over 2,500 citations from such sources as MEDLINE,
MANTIS, CRAC, CINAHL, PsychoINFO, the Cochrane Controlled Trials Register,
and additional articles obtained by referral, the panel obtained
bibliographies of both physical and behavioral options for treating
headache which were either prospective, controlled trials aimed at either
relief from or prevention of attacks of tension-type or cervicogenic
headache. Among the physical interventions reviewed in this report:
- Acupuncture
-
Cervical spinal
manipulation
-
Low-force
techniques (such as cranial sacral therapy, massage [including trigger
point releases])
- Mobilization
- Stretching
- Heat therapy
- Ultrasound
- Transcutaneous electrical nerve stimulation (TENS)
- Exercise (including postural exercises)
Among the behavioral interventions reviewed are:
- Relaxation
- Biofeedback
- Cognitive-behavioral (stress management) therapy
- Hypnosis
Even though further research is desirable—and mandatory—this report
clearly positions chiropractic as a viable treatment alternative that
lacks the detrimental and sometimes fatal side effects of conventional
treatment options for managing tension and cervicogenic headache patients.
Compared to other physical treatment methods (including physiotherapy,
acupuncture, and electrical stimulation), the evidence supporting
chiropractic appears to be more robust. Consequently, you will find
this report to be an invaluable resource for documenting your practice for
your colleagues, practitioners in other health care professions, the
public, and third-party payers.
Evidence Report: Behavioral and Physical Treatments for Tension-type
and Cervicogenic Headache is available exclusively from FCER. You may
order your copy over the Internet at
HERE,
or call FCER at 800-622-6309. The cost is $39 for non-FCER members, $35
for current members (plus shipping and handling). The Executive Summary of
this report is available as a free download
HERE.
Add this groundbreaking and definitive report to your library today!
Since 1944, the Foundation for Chiropractic Education and Research
(FCER) has endeavored to fund and support scientifically sound research to
evaluate chiropractic health care. In order to protect the integrity of
the research that it funds, FCER maintains a 501 c (3) status as an
independent research foundation.
* NCMIC Insurance Company is the largest chiropractic malpractice
insurance company, established in 1946 and providing coverage for more
than 28,500 Doctor of Chiropractic. NCMIC is dedicated to advancing the
chiropractic profession by providing funding for research, educational
scholarships, and other services to enhance the success of the
practitioner of chiropractic. NCMIC Insurance Company can be reached at
(800) 247-8043, or visit the company’s website at
http://www.ncmic.com.
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