Migraine is one of the leading causes of disability worldwide, and some people turn to spinal manipulation — high-velocity “adjustments” of the neck and spine — hoping to reduce their attacks. This review pooled the best trials to date to answer a clear question: does spinal manipulation actually work for migraine, and is it safe?
The authors combined six randomised controlled trials involving 645 people with migraine, comparing spinal manipulation (with or without usual care) against placebo, drug therapy or usual care. They used the GRADE system to judge how trustworthy the evidence was, and specifically looked at pain intensity, migraine days, duration, disability, quality of life and side effects.
This review looked at spinal manipulation — the high-velocity, low-amplitude thrust technique (the kind that often produces a “pop”). That is not the same as the gentle joint mobilisation and soft-tissue work used in myotherapy and physiotherapy, which the review deliberately excluded.
After eight weeks, the hobble was removed for a month so the animals could move normally again — testing whether simply restoring movement was enough to recover fascia mobility.
The overall picture was that spinal manipulation offered little or no reliable benefit for migraine, on very weak evidence, while carrying a measurable risk of side effects.
Pooling all six trials, manipulation had no significant effect on how severe migraines were, and the evidence was rated very low certainty.
Manipulation showed no significant effect on how long migraines lasted or on emotional quality of life.
There were small reductions in migraine days per month and in disability, but the effects were very small and, again, of very low certainty.
People receiving manipulation had roughly double the risk of adverse events versus controls — and rare but serious harms (artery injury, stroke) have been linked to neck manipulation.
The honest, responsible message here is that no one should be sold high-velocity neck manipulation as a migraine cure. Migraine is a complex neurological condition that is primarily managed medically, and this review shows manipulation doesn’t reliably change it.
That doesn’t make hands-on care irrelevant. Gentle manual therapy and soft-tissue work — which are different from the thrust manipulation studied here — can help with the neck tension, muscle tightness and stress that often accompany headache, and can sit alongside medical migraine management as supportive, comfort-focused care with realistic expectations.
Supports steering clear of high-velocity manipulation as a migraine “treatment,” and instead coordinating with medical management while using gentle, evidence-informed approaches for associated neck dysfunction.
A reminder to set honest expectations — soft-tissue and gentle mobilisation may ease accompanying neck and shoulder tension, but are not a proven cure for migraine itself.
Massage can offer comfort and stress relief for people living with migraine, framed as supportive care rather than a treatment that stops attacks.
Limited direct relevance; the main takeaway is caution about aggressive cervical techniques where the evidence and safety profile don’t support them.
The review is only as strong as the trials in it, and those were mostly small, methodologically flawed, and clinically varied — which is why the certainty of evidence was rated very low for every outcome. Only a handful reported side effects at all, so the true safety picture is incomplete. The authors are also clear that this concerns spinal manipulation specifically, not gentle mobilisation or soft-tissue therapy, and that larger, more rigorous, independent trials are needed.
Read fairly, the message isn’t “manual therapy is useless for headache” — it’s “high-velocity spinal manipulation is not a proven or risk-free migraine treatment,” which is important for honest patient care.
Pooling six trials with 645 people, this updated meta-analysis found spinal manipulation had no reliable effect on migraine intensity, duration or quality of life, at most a tiny and very uncertain effect on migraine days and disability, and a roughly doubled risk of side effects. The evidence was very low certainty throughout, and the authors conclude manipulation is not an evidence-based migraine treatment.
For myotherapists, physiotherapists and remedial massage therapists, the takeaway is to avoid overselling manual therapy for migraine, distinguish gentle hands-on care from high-velocity manipulation, and support migraine sufferers alongside appropriate medical management.
Spinal Manipulations for Migraine: An Updated Systematic Review and Meta-Analysis of Randomized Clinical Trials and Posadzki P, Klimek AT, Ernst E. Systematic Reviews, 2024; 13: 296.
