脊柱推拿对偏头痛疼痛和残疾的影响：系统评价和荟萃分析。
The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta-Analysis.
机构信息
Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.
Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.
出版信息
Headache. 2019 Apr;59(4):532-542. doi: 10.1111/head.13501. Epub 2019 Mar 14.
BACKGROUND
Several small studies have suggested that spinal manipulation may be an effective treatment for reducing migraine pain and disability. We performed a systematic review and meta-analysis of published randomized clinical trials (RCTs) to evaluate the evidence regarding spinal manipulation as an alternative or integrative therapy in reducing migraine pain and disability.
METHODS
PubMed and the Cochrane Library databases were searched for clinical trials that evaluated spinal manipulation and migraine-related outcomes through April 2017. Search terms included: migraine, spinal manipulation, manual therapy, chiropractic, and osteopathic. Meta-analytic methods were employed to estimate the effect sizes (Hedges' g) and heterogeneity (I ) for migraine days, pain, and disability. The methodological quality of retrieved studies was examined following the Cochrane Risk of Bias Tool.
RESULTS
Our search identified 6 RCTs (pooled n = 677; range of n = 42-218) eligible for meta-analysis. Intervention duration ranged from 2 to 6 months; outcomes included measures of migraine days (primary outcome), migraine pain/intensity, and migraine disability. Methodological quality varied across the studies. For example, some studies received high or unclear bias scores for methodological features such as compliance, blinding, and completeness of outcome data. Due to high levels of heterogeneity when all 6 studies were included in the meta-analysis, the 1 RCT performed only among chronic migraineurs was excluded. Heterogeneity across the remaining studies was low. We observed that spinal manipulation reduced migraine days with an overall small effect size (Hedges' g = -0.35, 95% CI: -0.53, -0.16, P < .001) as well as migraine pain/intensity.
CONCLUSIONS
Spinal manipulation may be an effective therapeutic technique to reduce migraine days and pain/intensity. However, given the limitations to studies included in this meta-analysis, we consider these results to be preliminary. Methodologically rigorous, large-scale RCTs are warranted to better inform the evidence base for spinal manipulation as a treatment for migraine.
背景
一些小型研究表明，脊柱推拿可能是一种有效治疗方法，可以减轻偏头痛的疼痛和残疾。我们进行了系统评价和荟萃分析，以评估发表的随机临床试验（RCT）的证据，评估脊柱推拿作为替代或综合疗法在减轻偏头痛疼痛和残疾方面的效果。
方法
我们检索了 PubMed 和 Cochrane 图书馆数据库，以查找评估脊柱推拿和偏头痛相关结果的临床试验，检索时间截至 2017 年 4 月。检索词包括：偏头痛、脊柱推拿、手法治疗、脊椎按摩疗法和整骨疗法。采用荟萃分析方法估计偏头痛天数、疼痛和残疾的效应大小（Hedges'g）和异质性（I）。根据 Cochrane 偏倚风险工具评估检索研究的方法学质量。
结果
我们的搜索确定了 6 项 RCT（汇总 n=677；范围 n=42-218）符合荟萃分析的条件。干预持续时间从 2 到 6 个月不等；结果包括偏头痛天数（主要结果）、偏头痛疼痛/强度和偏头痛残疾的测量。研究的方法学质量存在差异。例如，一些研究在依从性、盲法和结局数据完整性等方法学特征方面获得了高或不明确的偏倚评分。由于在纳入荟萃分析的 6 项研究中存在高度异质性，因此排除了仅在慢性偏头痛患者中进行的 1 项 RCT。其余研究之间的异质性较低。我们观察到，脊柱推拿可减少偏头痛天数，总体效应量较小（Hedges'g=-0.35，95%置信区间：-0.53，-0.16，P<.001），偏头痛疼痛/强度也降低。
结论
脊柱推拿可能是一种有效的治疗技术，可以减少偏头痛天数和疼痛/强度。然而，鉴于纳入荟萃分析的研究存在局限性，我们认为这些结果只是初步的。需要进行严格的、大规模的 RCT，以更好地为脊柱推拿作为偏头痛治疗方法提供循证依据。
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