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University Headache Center, Moorestown, NJ, Associate Professor, Department of Family Medicine, University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine, Stratford

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.

References
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.

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.

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.[Medline]

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 .[Medline]

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.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Mueller, L. L. PubMed Articles by Mueller, L. L.