Neck Pain
Neck pain may be accompanied by stiffness, reduced movement, headaches or symptoms in the shoulder or arm. Learn about common causes, assessment and treatment options.
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Chiropractic Treatment for Headaches: What Does the Research Say?
Research into chiropractic and manual therapy for headaches is not all the same. The evidence differs depending on whether the problem is cervicogenic headache, migraine, tension-type headache or associated neck pain.
Research into chiropractic care and manual therapy for headaches has developed considerably over the past two decades.
Some studies show benefits for particular types of headache, particularly cervicogenic headache, while evidence for other conditions such as migraine is less certain.
On this page, we look at what current research actually shows, where the evidence is strongest, where it remains uncertain and what is known about the safety of cervical manipulation.
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Why Does the Type of Headache Matter?
Not all headaches have the same cause, and research findings for one type of headache cannot automatically be applied to another.
A cervicogenic headache is thought to arise from structures in the neck. Migraine, by contrast, is a neurological disorder. Tension-type headache is another distinct primary headache disorder.
This distinction is important when interpreting research into spinal manipulation, mobilisation, exercise and other forms of manual therapy.
The most useful question is therefore not simply “Does chiropractic help headaches?” but rather “Which headache presentations appear most likely to respond to which treatments?”
What Does the Research Show?
Research into chiropractic and manual therapy includes randomised controlled trials, systematic reviews and meta-analyses. The quality of the evidence varies considerably between different headache conditions.
Cervicogenic Headache
Cervicogenic headache is a secondary headache disorder in which pain is associated with structures in the neck. It can be accompanied by reduced neck movement, neck pain and pain that may refer into the head.
This is the area in which the evidence for spinal manipulation and other manual therapies is currently most supportive.
A 2020 systematic review and meta-analysis of seven randomised controlled trials found that spinal manipulative therapy produced small but statistically significant short-term improvements in headache pain intensity, headache frequency and disability when compared with other manual therapies. The authors also noted that high-quality evidence remained limited and that significant long-term effects had not been demonstrated.1
A broader 2022 systematic review and meta-analysis involving 20 studies and 1,439 patients found that manual and exercise therapies could reduce headache intensity and frequency in people with cervicogenic headache. When analysis was restricted to studies with a lower risk of bias, the effects were smaller but remained in favour of manual therapy.2
More recently, a 2025 network meta-analysis including 14 studies and 1,297 people with cervicogenic headache found benefits from several manual therapy approaches. Cervical manipulation ranked highly for short-term pain reduction, while mobilisation techniques also showed benefits for pain and function.3
Overall, current research suggests that spinal manipulation, mobilisation and exercise may have a useful role in the management of appropriately diagnosed cervicogenic headache, particularly in the short term.
What Does the Research Show for Migraine?
Migraine requires a different interpretation because migraine is a neurological disorder rather than simply a problem arising from the neck.
Some people with migraine also experience neck pain or stiffness, but this does not necessarily mean that dysfunction in the neck is the cause of the migraine.
An updated 2024 systematic review and meta-analysis examined six randomised controlled trials involving 645 people with migraine. Five of the trials involved chiropractic spinal manipulation and one involved osteopathic manipulation.4
The review did not establish a convincing benefit of spinal manipulation for migraine intensity, duration or disability. The authors rated the certainty of the evidence as low or very low for several outcomes.
Current research therefore does not allow us to claim that spinal manipulation is an established treatment for migraine itself.
However, this does not mean that someone with migraine cannot also have a separate musculoskeletal problem affecting the neck. Where examination identifies neck pain, stiffness or reduced movement, those symptoms may be assessed and treated on their own merits alongside appropriate migraine management.
Read more about migraine and chiropractic care →
What About Tension-Type Headache?
The evidence for manual treatment of tension-type headache is mixed.
A 2023 systematic review of 15 randomised controlled trials found that physical therapy approaches directed towards the cranio-cervical and mandibular regions were associated with reductions in headache intensity and frequency in the short and medium term. However, the authors noted that there was no standardised physical therapy protocol across the studies.5
A 2022 systematic review and meta-analysis of 15 studies involving 1,131 participants examined manual therapy specifically. It found that some manual therapy approaches produced benefits, but high-velocity low-amplitude manipulation was not superior to no treatment for reducing headache intensity or frequency in the analyses reported.6
This suggests that treatment for tension-type headache should not be reduced to spinal manipulation alone. Other approaches, including mobilisation, soft tissue techniques, exercise and general management strategies, may be relevant depending on the individual.
What About Neck Pain Associated With Headache?
Neck pain is common in people with several different types of headache. In some people it may be part of the headache disorder itself, while in others there may be a separate mechanical or musculoskeletal neck problem.
Research into neck pain is therefore relevant when a patient has headache together with identifiable neck pain or dysfunction.
One frequently cited randomised controlled trial published in the Annals of Internal Medicine compared spinal manipulation, medication and home exercise with advice in 272 adults with acute or subacute non-specific neck pain.7
Spinal manipulation produced better pain outcomes than the medication group at several follow-up points, including 8, 12, 26 and 52 weeks. However, home exercise with advice achieved similar results to spinal manipulation at most time points.
This is important because it suggests that effective conservative management does not necessarily depend on manipulation alone. Exercise, advice and active rehabilitation can be important components of care.
Is Chiropractic Neck Treatment Safe?
Safety is an important question whenever treatment involves the cervical spine.
Most adverse effects reported after cervical manipulation are temporary symptoms such as soreness, stiffness or an increase in pain.
A 2024 systematic review and meta-analysis examined adverse events reported in 14 randomised controlled trials involving cervical high-velocity, low-amplitude manipulation. It found no statistically significant increase in adverse events compared with control interventions. All adverse events reported in these trials were classified as mild, and no moderate or serious adverse events were reported.8
However, the authors emphasised an important limitation: randomised controlled trials are generally too small to detect very rare serious complications.
Serious adverse events involving the cervical spine have been described in the medical literature. A 2025 systematic review identified 334 published cases of serious adverse events following a range of physical procedures directed towards the neck. Most were vascular events, and manipulation was involved in the majority of reported cases.9
Case reports cannot establish how often these events occur or prove that treatment caused the event, but they show why careful history-taking, clinical assessment, recognition of warning symptoms, patient selection and informed consent are important.
The evidence therefore supports a balanced interpretation: serious complications appear to be uncommon, but cervical manipulation should not be considered completely risk-free.
Does Chiropractic Treatment Always Mean Neck Manipulation?
No. Chiropractic care can include a range of approaches depending on the patient and the clinical findings.
These may include:
- Spinal manipulation where appropriate
- Joint mobilisation
- Soft tissue treatment
- Exercise and rehabilitation
- Advice about activity and self-management
- Referral or further investigation where appropriate
Manipulation is therefore one possible treatment option rather than something that must be used for every patient with headache or neck pain.
How Does Manual Treatment Compare With Medication?
Comparisons between manual treatment and medication need to be interpreted carefully because different studies investigate different conditions, medications and treatment programmes.
The 2012 Bronfort trial in people with acute and subacute neck pain found that spinal manipulation performed better than the medication group for pain at several follow-up points. Home exercise with advice also performed well and produced outcomes similar to spinal manipulation at most time points.7
This study should not be interpreted as proving that chiropractic treatment is universally safer or more effective than painkillers, or that the same results apply to migraine.
For migraine and tension-type headache, medication remains part of recognised medical management. NICE guidance recommends appropriate acute medication for both migraine and tension-type headache, depending on the individual patient and their medical circumstances.10
The more useful conclusion is that conservative physical treatment can sometimes provide an alternative or additional approach for appropriately selected musculoskeletal conditions, particularly where neck pain or cervicogenic headache is present.
Why Do Different Studies Reach Different Conclusions?
Research into manual therapy is difficult for several reasons.
Different studies may use different diagnostic criteria, different types of manipulation or mobilisation, different treatment frequencies and different comparison groups.
It is also difficult to blind patients and clinicians fully to physical treatments, which can increase the risk of bias.
Systematic reviews therefore often find considerable variation between studies and may rate the overall certainty of the evidence as low or moderate even when individual trials report positive results.
This is why we prefer to look at the overall body of evidence rather than relying on a single favourable study.
What Does This Mean for Patients?
The research does not support treating every headache in the same way.
Cervicogenic headache currently has the most supportive evidence for manual therapy and spinal manipulation, particularly for short-term improvement.
Tension-type headache may respond to some physical therapy and manual therapy approaches, although the evidence does not support manipulation as a consistently superior treatment.
Migraine is a neurological disorder, and current research has not established spinal manipulation as an effective treatment for migraine itself.
However, people with migraine may also have separate neck pain or musculoskeletal problems that can be assessed and managed appropriately.
The starting point should therefore be an accurate clinical assessment rather than assuming that every headache has the same cause or requires the same treatment.
Research References
- Fernandez M, Moore C, Tan J, et al. Spinal manipulation for the management of cervicogenic headache: a systematic review and meta-analysis. European Journal of Pain. 2020;24:1687–1702.
- Bini P, Hohenschurz-Schmidt D, Masullo V, et al. The effectiveness of manual and exercise therapy on headache intensity and frequency among patients with cervicogenic headache: a systematic review and meta-analysis. Chiropractic & Manual Therapies. 2022.
- Xu et al. Comparative safety and efficacy of manual therapy interventions for cervicogenic headache: a systematic review and network meta-analysis. Frontiers in Neurology. 2025.
- Posadzki P, Klimek AT, Ernst E. Spinal manipulations for migraine: an updated systematic review and meta-analysis of randomized clinical trials. Systematic Reviews. 2024;13:296.
- Repiso-Guardeño A, Moreno-Morales N, Armenta-Pendón MA, et al. Physical Therapy in Tension-Type Headache: A Systematic Review of Randomized Controlled Trials. International Journal of Environmental Research and Public Health. 2023;20:4466.
- Kamonseki DH, et al. Effectiveness of manual therapy in patients with tension-type headache: a systematic review and meta-analysis. Disability and Rehabilitation. 2022.
- Bronfort G, Evans R, Anderson AV, et al. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Annals of Internal Medicine. 2012;156:1–10.
- Pankrath N, Nilsson S, Ballenberger N. Adverse Events After Cervical Spinal Manipulation – A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Pain Physician. 2024;27:185–201.
- Leung B, Treleaven J, Dinsdale A, Marsh L, Thomas L. Serious adverse events associated with conservative physical procedures directed towards the cervical spine: A systematic review. Journal of Bodywork and Movement Therapies. 2025;41:56–77.
- National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management. NICE guideline CG150. Updated 2025.
Want to Discuss Whether Chiropractic Care May Be Appropriate for Your Headaches?
If headaches are affecting your everyday life, we can assess your symptoms, including any associated neck pain or stiffness, and explain whether chiropractic care may have an appropriate role.