image: UH Cleveland Medical Center
Credit: University Hospitals
CLEVELAND – A team of researchers led by University Hospitals Connor Whole Health have identified an association between spinal manipulative therapy (SMT) and a reduced likelihood of butalbital prescription and medication overuse headache (MOH) for patients experiencing tension-type headaches (TTH). Their retrospective study, published in Health Science Reports, includes more than 6,200 patients from a national US database spanning 2013 to 2024.
Butalbital, a barbiturate often prescribed for acute TTH relief, is discouraged by guidelines due to its risk of MOH, a debilitating condition with a variety of symptoms including nausea, difficulty concentrating, sleep disturbances, and irritability. SMT is a widely used hands-on treatment that has been shown to reduce headache frequency and intensity in those with TTH. However, no prior studies had examined whether this therapy is associated with reduced reliance on medications like butalbital or development of MOH.
The study compared two cohorts: (1) those who received SMT and (2) matched controls who did not receive SMT. Findings revealed that only 1.7% of SMT patients were prescribed butalbital within two years of follow-up, compared to 3.8% in the non-SMT cohort. Additionally, patients receiving SMT were less likely to develop MOH (0.5% vs. 1.2%).
“These results highlight the real-world potential for spinal manipulation to provide benefits to those with TTH beyond reduction of pain intensity” said Robert Trager DC, DIANM, chiropractic physician at UH Connor Whole Health and lead author of the study.
“This study underscores the value of nonpharmacologic treatments in delivering safe, guideline-concordant care for headache management,” added Dr. Françoise Adan, Chief Whole Health and Well-being Officer at University Hospitals and Director of UH Connor Whole Health.
The researchers call for further studies to corroborate their findings and explore whether these benefits extend to other nonpharmacologic therapies.
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About University Hospitals / Cleveland, Ohio
Founded in 1866, University Hospitals serves the needs of patients through an integrated network of 21 hospitals (including five joint ventures), more than 50 health centers and outpatient facilities, and over 200 physician offices in 16 counties throughout northern Ohio. The system’s flagship quaternary care, academic medical center, University Hospitals Cleveland Medical Center, is affiliated with Case Western Reserve University School of Medicine, Northeast Ohio Medical University, Oxford University, the Technion Israel Institute of Technology and National Taiwan University College of Medicine. The main campus also includes the UH Rainbow Babies & Children's Hospital, ranked among the top children’s hospitals in the nation; UH MacDonald Women's Hospital, Ohio's only hospital for women; and UH Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center. UH is home to some of the most prestigious clinical and research programs in the nation, with more than 3,000 active clinical trials and research studies underway. UH Cleveland Medical Center is perennially among the highest performers in national ranking surveys, including “America’s Best Hospitals” from U.S. News & World Report. UH is also home to 19 Clinical Care Delivery and Research Institutes. UH is one of the largest employers in Northeast Ohio with more than 30,000 employees. Follow UH on LinkedIn, Facebook and Twitter. For more information, visit UHhospitals.org.
Journal
Health Science Reports