Global Advances in Health and Medicine

March 28, 2019

Carolyn Bernstein, MD; Peter M Wayne, PhD; Pamela M Rist, ScD; Kamila Osypiuk, MS; Audrey Hernandez, MS; Matthew Kowalski, DC: From Brigham and Women’s Hospital, Boston; Harvard Medical School.


Migraine, a debilitating condition affecting 38 million people in the United States, stands as a leading cause of disability. Traditional allopathic treatments often come with disabling side effects, prompting a growing interest in nonpharmacologic options. This case series explores an integrated model of care for migraine, seamlessly combining neurological expertise with chiropractic treatment. The collaboration aims to address not only the symptoms but also the underlying dynamics of migraines, recognizing the potential shared pathophysiology with neck pain.

Key Points from the Case Series:

  • Prevalence and Challenges of Migraine:
    • Migraines affect a substantial portion of the population, and while they can be managed, there is no cure. Many medications used for treatment often carry disabling side effects.
  • Patient Preference for Nonpharmacologic Options:
    • Over 75% of migraine patients prefer nonpharmacologic options, including complementary and integrative therapies, reflecting a desire to minimize medication use.
  • Link Between Migraine and Neck Pain:
    • More than 75% of migraine patients report associated neck pain, suggesting a potential link between the two conditions.
  • Shared Pathophysiology of Neck Pain and Migraine:
    • Pathophysiologically, migraine may trigger the trigeminocervical complex, indicating a shared pathophysiology with neck pain.
  • Inadequacy of Traditional Treatments:
    • Traditional treatments for neck pain, including muscle relaxants and physical therapy, are often inadequate in addressing the underlying dynamics reported by individuals with migraines.
  • Rise in Chiropractic Collaboration:
    • In the past decade, there has been a rise in chiropractors working collaboratively with medical practitioners, particularly at integrative medical facilities such as the Harvard Medical School Osher Center for Integrative Medicine.
  • Focus on Musculoskeletal Pain at Harvard Medical School Osher Center:
    • The Osher Clinical Center for Complementary and Integrative Therapies at Brigham and Women’s Hospital, affiliated with Harvard Medical School, places a central focus on musculoskeletal pain, with chiropractic being the most widely used modality.
  • Chiropractic Approach to Migraine:
    • Chiropractors, licensed to administer non-surgical and nonpharmacological therapies, adopt a holistic approach to migraine patients, including spinal manipulative therapy, soft tissue therapies, rehabilitation/exercises, ergonomic advice, lifestyle management, and nutritional counseling.
  • Positive Outcomes in Case Studies:
    • Three migraine patients, initially presenting to a neurologist, experienced significant improvements in pain scores, pain-free days, decreased medication usage, and reduced anxiety/dysthymia through an integrated neurologic and chiropractic care approach.
  • Patient Profiles Suitable for Integration:
    • Patients seeking non-drug approaches, nonresponsive patients requiring multipronged care, and those at a therapeutic plateau benefit from integrated care.
  • Diverse Treatment Approaches in Chiropractic:
    • Chiropractors are trained in a wide range of treatment approaches, including myofascial therapies, lifestyle modifications, and exercise, contributing to the overall well-being of patients.
  • Efficacy of Chiropractic for Musculoskeletal Conditions:
    • Chiropractic has been shown to be efficacious for various musculoskeletal conditions, including neck pain and temporomandibular pain.
  • Therapeutic Benefits of Integrative Approach:
    • All patients reported greater therapeutic benefits with the addition of the integrative approach, emphasizing the positive impact of combining neurological and chiropractic care.
  • Future Directions:
    • The case series concludes by highlighting the promise of and the need to further evaluate integrated models of chiropractic and neurologic care, underscoring the potential for enhanced patient outcomes.

In summary, this case series provides a compelling narrative of successful collaboration between neurologists and chiropractors, offering a glimpse into the potential benefits of an integrated model of care for migraine patients. The study advocates for increased awareness among medical practitioners about the scope and efficacy of chiropractic approaches, ultimately fostering more inclusive and patient-centric healthcare practices.