Response
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Loretta L. Mueller
Letters to the editor noting “horrific disappointment” about a lack of osteopathic content in an article—especially vis-à-vis the use of osteopathic manipulative treatment (OMT) in migraine headache management—are nothing new.1,2 Unfortunately, this lack reflects a clear deficiency of research in this area.
It is disappointing, as suggested by Dr Fisher, that a search of the PubMed database for published studies on OMT and migraine yields only five articles—none of which contain original research. Systematic literature reviews have concluded that the few published studies on spinal manipulation and headache have had overall poor methodology, namely in the form of small sample sizes, lack of control groups and blinding protocols, and inadequate methodologic descriptions of manipulative procedures.3-5 Thus, the data that Dr Fisher requests regarding OMT mechanisms is simply not available.
In my article in the November 2007 supplement to JAOA—The Journal of the American Osteopathic Association (2007;107[suppl 6]:ES10-ES16), I attempted to whet the appetite of researchers by proposing several mechanisms of action for OMT in migraine management, including reducing nociceptive input into the trigeminal nucleus caudalis. An understanding of basic neuroanatomy was inferred.
In regard to Dr Fisher's comment about the grant supporting the publication of the JAOA supplement, none of the pharmaceutical products mentioned in my article are produced by Purdue Pharma LP. Nor have I had any relationship with Purdue Pharma LP in my headache practice or national lectureships.
1 Wisnioski SW III. “Circle turns round” to “allopathic osteopathy” [letter]. J Am Osteopath Assoc. 2006;106:423-424. Available at: http://www.jaoa.org/cgi/content/full/106/7/423-b. Accessed January 4, 2008.Search in Google Scholar
2 Freitag FG, Biondi DM, Nissan GR, Winner PK. Response [letter]. J Am Osteopath Assoc. 2006;106:424-425. Available at: http://www.jaoa.org/cgi/content/full/106/7/424. Accessed January 4, 2008.Search in Google Scholar
3 Astin JA, Ernst E. The effectiveness of spinal manipulation for the treatment of headache disorders: a systematic review of randomized clinical trials. Cephalalgia. 2002;22:617-623.10.1046/j.1468-2982.2002.00423.xSearch in Google Scholar PubMed
4 Bronfort G, Nilsson N, Haas M, Evans R, Goldsmith CH, Assendelft WJ, et al. Non-invasive physical treatments for chronic/recurrent headache.Cochrane Database Syst Rev. 2004;3:CD001878 .10.1002/14651858.CD001878.pub2Search in Google Scholar PubMed
5 Fernandez-de-las-Penas C, Alonso-Blanco C, San-Roman J, Miangolarra-Page JC. Methodological quality of randomized controlled trials of spinal manipulation and mobilization in tension-type headache, migraine, and cervicogenic headache. J Orthop Sports Phys Ther. 2006;36:160-169.10.2519/jospt.2006.36.3.160Search in Google Scholar PubMed
The American Osteopathic Association
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Articles in the same Issue
- AOA COMMUNICATIONS
- Proposed Amendments to the AOA Bylaws
- LETTERS
- Another Case of Extended-Release Bupropion–Induced Seizure
- Embrace Evidence...With Both Eyes Open
- A.T. Still Would Not Be Proud
- Response
- AOA COMMUNICATIONS
- History Bureau's Essay Competition Now Targets Five Core Principles
- THE SOMATIC CONNECTIONS
- The Somatic Connection
- MEDICAL EDUCATION
- Spirituality and Medicine: Prevalence of Spirituality-in-Medicine Instruction at Osteopathic Medical Schools
- REVIEW ARTICLES
- Current Concepts in Diastolic Heart Failure
- CASE REPORTS
- Paradoxical Response to Levalbuterol
- LETTERS
- Moving Beyond Myths of Substance Use Disorders
- CORRECTIONS
- Correction
