MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Osteopathy is a difficult subject. In the US, osteopaths are (almost) identical with doctors who have studied conventional medicine and hardly practice any manipulative techniques at all. Elsewhere, osteopaths are alternative healthcare providers specialising in what they like to call ‘osteopathic manipulative therapy’ (OMT). As though this is not confusing enough, osteopaths are doing similar things as chiropractors but are adamant that they are a distinct profession. Despite these assertions, I have seen little to clearly differentiate the two – with one exception perhaps: osteopaths tend to use techniques that are less frequently associated with severe harm.

Despite this confusion, or maybe because of it, we need to ask: DOES OMT WORK?

A recent study was aimed at assessing the effectiveness of OMT on chronic migraineurs using HIT-6 questionnaire, drug consumption, days of migraine, pain intensity and functional disability. All patients admitted to the Department of Neurology of Ancona’s United Hospitals, Italy, with a diagnosis of migraine and without chronic illness, were considered eligible for this 3-armed RCT.

Patients were randomly divided into three (1) OMT+medication therapy, (2) sham+medication therapy and (3) medication therapy only and received 8 treatments during 6 months. Changes in the HIT-6 score were considered as the main outcome measure.

A total of 105 subjects were included. At the end of the study, OMT significantly reduced HIT-6 score, drug consumption, days of migraine, pain intensity and functional disability.

The investigators concluded that these findings suggest that OMT may be considered a valid procedure for the management of migraineurs.

Similar results have been reported elsewhere:

One trial, for instance, concluded: “This study affirms the effects of OMT on migraine headache in regard to decreased pain intensity and the reduction of number of days with migraine as well as working disability, and partly on improvement of HRQoL. Future studies with a larger sample size should reproduce the results with a control group receiving placebo treatment in a long-term follow-up.”

Convinced? No, I am not.

Why? Because the studies that do exist seem a little too good to be true; because they are few and far between, because the few studies tend to be flimsy and have been published in dodgy journals, because they lack independent replications, and because critical reviews seem to conclude that OMT is nowhere near as promising as some osteopaths would like us to believe: “Further studies of improved quality are necessary to more firmly establish the place of physical modalities in the treatment of primary headache disorders. With the exception of high velocity chiropractic manipulation of the neck, the treatments are unlikely to be physically dangerous, although the financial costs and lost treatment opportunity by prescribing potentially ineffective treatment may not be insignificant. In the absence of clear evidence regarding their role in treatment, physicians and patients are advised to make cautious and individualized judgments about the utility of physical treatments for headache management; in most cases, the use of these modalities should complement rather than supplant better-validated forms of therapy.”

6 Responses to Osteopathy for migraine?

  • In the US, osteopaths regard themselves as ‘equivalent to MDs (doctors)’ and style themselves ‘Doctor’.
    Why they are not proud enough of their profession to style themselves as, say, ‘Os (for ‘osteopath’) Smith’ is for them to explain. Andrew Taylor Still clearly had ideas above his station and appropriated the title that his father had used.

    In the UK there is only one standard good enough to entitle practice as a ‘Registered Medical Practitioner’ – and that is a qualification registerable with the GMC.
    Other folks can style themselves ‘Dr’ if that rings their bell, but must not commit fraud by misrepresentation if doing so.

  • That’s an odd argument. At least in the US, we tend to call *every* person who has earned a doctorate “Doctor,” whether it’s a Ph. D. in Accounting or a V. M. D. Why should any doctoral recipient have to explain themselves when using the title they earned?

    • It all depends on the context. An accountant with a PhD is unlikely to be representing him/herself as a medical doctor. However, where an advertiser is, say, making health claims, the use of the title Dr is likely to be interpreted by a member of the public as meaning a medical doctor. The advertising rules are set by the Advertising Standards Authority and their guidance on the use of the term Dr is here.

      Also, there may also be problems with various regulations such as the Consumer Protection from Unfair Trading Regulations 2008 if someone is using the title whilst not a registered medical professional.

  • You were questioning the use of “Doctor” by a D.O. in his work. Where does advertising fit into your notion that a D.O., in the U.S., should not call himself “Doctor” for… some strange reason? Even though “Doctor” is how we properly address someone with a doctorate?

    People with doctorates but not M.D.s do refer to themselves as “Doctor” in medical settings. Psychologists with Ph.D.’s, dentists, physical therapists, etc do not have M.D.’s but often use “Doctor.”

    And since, again, your strange comment was regarding a D.O. in the U.S. going by “Doctor”… they *are* licensed medical professionals.

    I’m all for slamming people who deserve it. But you’re going off a bit half-cocked and unloaded here, and it’s a bit hard to understand. You are mocking a group of doctors for using the appropriate title for their position. It’s somewhat irrational. If you want to mock American ostepaths in general–I’m not sure why you would[*], but hey–do you have an actual reason with logical backing?


    [*] quoting Dr. Ernst in his 2nd sentence above: “In the US, osteopaths are (almost) identical with doctors who have studied conventional medicine and hardly practice any manipulative techniques at all.” Not sure why that makes them a target.

  • A big part of osteopathy is improving the function of someones spine, improving posture, loosening tight muscles etc.

    If someone is getting headaches, has awful posture, sits at a computer all day with bad posture, gets migraines or tension headaches then surely it’s a good thing to get this corrected?

    There are so many patients with these exact problems and when they are corrected the headaches go away! What is wrong and so unbelievable with this?

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