Spinal manipulation associated with reduced butalbital use for tension headaches

A team of researchers led by University Hospitals Connor Whole Health has found a link between spinal manipulative therapy (SMT) and a reduced likelihood of butalbital prescription and medication overuse headache (MOH) in patients with tension-type headache (TTH). Their retrospective study, published in Health science reportsincludes more than 6,200 patients from a national US database for the period 2013 to 2024.

Butalbital, a barbiturate commonly prescribed for acute TTH relief, is discouraged in the guidelines due to the risk of MOH, a debilitating condition with a variety of symptoms including nausea, difficulty concentrating, sleep disturbances, and irritability. SMT is a widely used practical treatment that has been shown to reduce the frequency and intensity of headaches in patients with TTH. However, no previous studies have examined whether this therapy is associated with reduced dependence on medications such as butalbital or the development of MOH.

The study compared two cohorts: (1) those who received SMT and (2) matched control groups who did not receive SMT. Results showed 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 potential of spinal manipulation to provide benefits to people with TTH beyond reducing pain intensity.”

Robert Trager DC, DIANM, a chiropractor at UH Connor Whole Health and lead author of the study

“This study highlights the value of non-pharmacological treatments in providing safe, guideline-compliant treatment for headache management,” added Dr. Françoise Adan, Chief Whole Health and Wellbeing Officer at University Hospitals and Director of UH Connor Whole Health, added.

The researchers call for further studies to support their findings and examine whether these benefits translate to other non-pharmacological therapies.