Osteopathy for Headaches

Headaches are among the common medical conditions, with almost everyone experiencing them occasionally. Some people experience frequent, recurring, or chronic headaches. Headache pain ranges from slight discomfort to debilitating pain, and may last for minutes or days to possibly even months and years. Most modern medical treatments for headaches target the pain with medications. In contrast, osteopathy aims to treat the cause of the headache and avoids side effects that often accompany prescription drugs.

How Does Osteopathy Treat Headaches?

Osteopathy has long been associated with the treatment of headaches. In the early 1900s, William Garner Sutherland introduced the concept of cranial osteopathy—the gentle manipulation of the bones of the skull. Sutherland demonstrated that the 22 bones in the head undergo small movements and that restriction of these movements can cause headaches. Today, cranial osteopathy is often referred to as cranial-sacral therapy. Although this therapy is often directed at restoring balance to the entire body, it is particularly relevant to the treatment of headaches.

An osteopathic physician will obtain a complete medical history, conduct a full physical exam, and may order additional tests. These enable the Doctor of Osteopathy (DO) to distinguish between headaches stemming from a common cause, such as muscle tension, and those caused by a rare but serious disease.

Osteopathic treatment for headaches may include one or more of these treatment principles:

• Abortive, to relieve an ongoing headache
• Prophylactic, to reduce the frequency and/or severity of recurrent headaches
• Symptomatic, to relieve headache pain or other symptoms

Osteopathy for headaches usually involves massaging the muscles of the neck and upper spine and/or gentle manipulation of the joints. Osteopathic manipulation techniques for headaches are designed to improve joint mobility, especially in the cervical spine, and to reduce nerve irritation and muscle tension. The goals are to stretch the neck muscles and supporting ligaments, relax muscle spasms, and promote free movement of the musculoskeletal system to improve blood flow and drainage to and from the head and neck. The Doctor of Osteopathy (DO) usually also manipulates the rest of the spine and pelvis to facilitate pain-free movement of the neck and reduce the headache. The DO may advise the patient on posture, exercise and stretching, diet, stress management, techniques for lifting, and workplace ergonomics to prevent future headaches.

What Types of Headaches Can Be Treated with Osteopathy?

Tension headaches are very common, affecting 35 to 40 percent of adults in Western societies. These headaches usually stem from increased muscle tension at the base of the skull or in the neck and shoulders. Osteopathic manipulation techniques can be particularly useful for tension-type headaches caused by stress. They are usually treated by passive or active osteopathic manipulation techniques and relief may be very rapid.

Migraines are severe recurrent headaches that are often accompanied by other symptoms, such as visual disturbances or nausea. They affect about 15 percent of the American population and are often accompanied by neck pain. Osteopathic manipulation techniques for migraines may include:

• High-velocity low-amplitude joint manipulations
• Strain-Counterstrain manipulations
• Deep-tissue massage
• Cranial-sacral therapy

What is Osteopathy?

Osteopathy or Osteopathic Medicine views the musculoskeletal system—the nerves, muscles, and bones that form the structure of the body—as central to disease. Doctors of Osteopathy (DOs) are fully licensed medical doctors who practice general medicine or various specialties. In addition to a traditional medical-school education, DOs are trained in osteopathic manipulation techniques (OMTs). These noninvasive techniques for adjusting and manipulating the muscles, ligaments, and bones are similar to those used by chiropractors. Osteopathy also utilizes gentle hand movements to detect motion and tension throughout the body.

Osteopathic manipulation techniques include:

• Massage
• Gentle release techniques
• Soft tissue and muscle stretching
• Rhythmic, passive joint mobilization
• Joint manipulation

Joint mobilization involves slow or low-velocity movements within or at the limit of the joint’s range of motion. Joint manipulation usually involves high-velocity thrusts to a joint, moving it beyond its restricted range of motion.

Is Osteopathy Effective?

Clinical studies on the effectiveness of osteopathic manipulation techniques for treating headaches have been very limited. Some studies have indicated that manipulative therapy and a low-load exercise regime may reduce the frequency and intensity of cervicogenic headaches, which are headaches originating from the neck. Other studies have found that spinal manipulations are as effective as some medications for relieving both migraines and tension headaches. A recent literature review found evidence that spinal manipulations may be effective for preventing migraine and chronic tension-type headaches. One recent report focused on patients with neck pain and headache lasting at least one month. Those who were treated with joint and muscle mobilization, manipulation, or adjustments combined with exercises reported greater pain relief and increased ability to perform daily activities, as compared with untreated subjects.

Is Osteopathy Safe?

Serious complications from osteopathy are rare. Osteopathic manipulation techniques occasionally result in a temporary increase in pain or a slight headache that usually disappears within one day. Osteopathic manipulations should not be used on patients with broken or dislocated bones, damaged ligaments, bone or joint infection, bone cancer, rheumatoid arthritis of the neck, or osteoporosis. Osteopathy is usually not recommended for patients who have undergone recent joint surgery or are taking blood-thinning medications such as aspirin or warfarin (Coumadin).

Although many headache sufferers have found relief through osteopathy, further research is needed to evaluate its effectiveness in the treatment of various types of headaches.

What Causes Headaches?

Headaches have numerous causes, most of which are not well understood. However headaches most often result from tightness in the muscles and skeleton of the body, especially the neck.

Headache sufferers may have:

• Poor head and upper-back posture
• A sedentary lifestyle
• Tight neck muscles with restricted range of motion
• Muscles that overreact and are slow to relax
• Muscle pain and tenderness

The cervical spine—the seven vertebrae of the neck—contributes to a large percentage of headaches. These are called cervicogenic headaches because they originate in the cervical spine. The nerves in the cervical vertebrae are closely associated with the main nerves in the head that are involved with pain. Tight neck muscles and/or joints that are not moving freely lead to congestion and inflammation that can cause headaches. Tense muscles in the neck and head can also release chemicals that may trigger headaches.

Additional Resources

R. Michael Gallagher, “Headache Pain,” Journal of the American Osteopathic Association, Vol. 105, suppl. 4, pp. 7–11, September 2005.