“I can’t believe how much my head hurts!” I’ve been laid off from work for the last 3 weeks and worried about making my mortgage payment this month – I think the stress is getting out of control! Pain starts in my neck and radiates into my head eventually making my whole head hurt, especially behind my eyes. There are times I feel like my head might explode! I can’t stand loud noises or even normal noise. Over-the-counter medications aren’t touching it and I can’t drive if I take some of the medications my doctor prescribed. I don’t know what to do next.”

This history is classic for the diagnosis of a tension-type of headache (TTH). TTH is the most common type of headache experienced by adults, affecting 10-65% of the population. The impact on daily living by TTH is significant as it disrupts daily activities, quality of life, and work. These types of headaches, according to the International Headache Society (IHS), can last from 30 minutes to 7 days, do not include nausea/vomiting, but may include increased sensitivity to light or noise (rarely both at the same time). The most common frequency is less than 15 TTHs/month.

Medication has been the primary medical form of treatment for TTH and some patients require the regular use of certain medications, even when headaches are not present—as in some cases, it’s too late to start meds once the headache starts. In these cases, amitriptyline has been the most frequently prescribed medication and it’s considered the drug of choice for TTH by many primary care providers. Chiropractic spinal manipulation (CSM) has been reported to be helpful in a number of prior studies. One reported equal benefit to amitriptyline after a six-week course of treatment.

In 2009, researchers from the Canadian Memorial Chiropractic College conducted a study using a new design where TTH sufferers with more than ten headaches per month were randomly assigned to one of four groups four four weeks of treatment: 1) cervical spinal manipulation (CSM) + amitriptyline, 2) CSM + placebo (fake) amitriptyline; 3) sham CSM + real amitriptyline; or 4) sham CSM + placebo amitriptyline. That way, they could determine which of the two treatments or if a combination of both was the most beneficial for this class of patient. Patients kept a headache diary to track headache frequency in the last 28 days of the treatment period. Nineteen participants completed the study and the combined effect carried the most statistically significant result with a close second for CSM alone. A larger sample size was recommended for a more statistically powerful evaluation.

This study is important as CSM by itself was found to be at least as (if not more) effective than amitriptyline alone, which is the medication of choice for TTH. Hence, if CSM or amitriptyline alone are not found to be satisfying, the combination of the two is strongly supported by this study.