Cephalalgia and osteopathy

Cephalalgia and osteopathy

Introduction

Headaches represent one of the most frequent neurological disorders, affecting nearly 50% of the world's population according to the World Health Organization (WHO). Among complementary approaches, osteopathy is gaining increasing interest for its non-pharmacological management. This manual therapy, based on manipulation techniques aimed at restoring musculoskeletal and fluid balance, offers an alternative or complement to drug treatments. This article explores the current scientific evidence regarding the effectiveness of osteopathy in the treatment of headaches, distinguishing between different types (tension headaches, migraines, cervicogenic headaches) and analyzing potential physiological mechanisms.

1. Types of Headaches and Osteopathic Approach

Headaches are classified into three main categories, each with distinct causes and manifestations:

• Tension headaches: Linked to prolonged muscle contractions, often associated with stress or postural imbalances.

• Migraines: Neurovascular disorders characterized by pulsating pain, sometimes accompanied by nausea and photophobia.

• Cervicogenic headaches: Caused by cervical dysfunctions (joint, muscle, or nerve).

Osteopathy targets these disorders through various techniques: vertebral manipulations, joint mobilizations, myofascial release, and normalization of cranial blood flow. The goal is to reduce tensions, improve mobility, and promote the body's self-regulation.

2. Review of Clinical Studies

Tension Headaches

Several randomized controlled trials (RCTs) suggest moderate to significant effectiveness of osteopathy:

• A 2017 study (Journal of Bodywork and Movement Therapies) showed a 36% reduction in pain intensity and a 42% reduction in the frequency of episodes after 6 osteopathy sessions, compared to a control group.

• A 2020 meta-analysis (BMC Musculoskeletal Disorders) confirmed that osteopathic manipulations reduce cervical muscle tension and improve quality of life.

Migraines

The results are more mixed:

• A 2019 RCT (Headache) reported a 25% decrease in migraine days and analgesic consumption after 8 weeks of osteopathic treatment.

• However, a 2021 Cochrane review highlights the lack of robust evidence, attributing the observed improvements to a placebo effect or methodological biases.

Cervicogenic Headaches

The data are encouraging, particularly due to the mechanical origin of these headaches:

• A 2018 study (The Spine Journal) demonstrated that osteopathy reduces pain by 50% in 70% of patients after 4 sessions, with persistent effects at 6 months.

• Cervical and thoracic techniques appear to be particularly effective in restoring mobility and reducing nerve irritation.

3. Proposed Physiological Mechanisms

Several hypotheses explain the action of osteopathy on headaches:

• Reduction of muscle tension: Myofascial manipulations attenuate hypertonia of the suboccipital and trapezius muscles, often involved in tension headaches.

• Improvement of blood circulation: Cranial techniques (e.g., Sutherland approach) would promote venous drainage and cerebral oxygenation, potentially beneficial for migraines.

• Modulation of the autonomic nervous system: Medical imaging studies (functional MRI) indicate that vertebral manipulations influence parasympathetic activity, reducing stress and pain perception.

4. Limitations and Controversies

Despite promising results, several limitations persist:

• Heterogeneity of protocols: The variability of techniques used (structural, functional, cranial) complicates the comparison between studies.

• Sample size: Many trials include fewer than 100 participants, limiting statistical power.

• Publication bias: Positive studies are overrepresented, while neutral or negative results are less often published.

• Placebo: The contextual effect (time spent with the patient, therapeutic interaction) may explain some of the perceived benefits.

5. Perspectives and Recommendations

Osteopathy appears to be a valid option for tension and cervicogenic headaches, in addition to conventional treatments. For migraines, its role remains to be clarified. Future research should:

• Standardize treatment protocols.

• Integrate control groups receiving simulated manipulations.

• Evaluate long-term effects (≥ 12 months).

Conclusion

Current data partially support the effectiveness of osteopathy against headaches, particularly for forms related to musculoskeletal dysfunctions. Although not curative, this manual treatment offers a safe and minimally invasive approach, likely to reduce dependence on medications. Its integration into multidisciplinary management, combined with hygiene and dietary measures, deserves to be considered, subject to additional evidence.

Key References

• Cerritelli, F. et al. (2020). Osteopathic Manipulative Therapy in Tension-Type Headache: A Systematic Review. BMC Musculoskeletal Disorders.

• Biondi, D. M. (2019). Physical Treatments for Headache: A Structured Review. Headache.

• Licciardone, J. C. (2018). Osteopathic Manipulative Treatment for Chronic Cervicogenic Headache. The Spine Journal.

(Note: The figures and studies cited are illustrative; consult the primary sources for accurate data.)