This systematic review and meta-analysis was aimed at analyzing the effectiveness of craniosacral therapy in improving pain and disability among patients with headache disorders.

PubMed, Physiotherapy Evidence Database, Scopus, Cochrane Library, Web of Science, and Osteopathic Medicine Digital Library databases were searched in March 2023. Two independent reviewers searched the databases and extracted data from randomized clinical trials comparing craniosacral therapy with control or sham interventions. The same reviewers assessed the methodological quality and the risk of bias using the PEDro scale and the Cochrane Collaboration tool, respectively. Grading of recommendations, assessment, development, and evaluations was used to rate the certainty of the evidence. Meta-analyses were conducted using random effects models using RevMan 5.4 software.

The searches retrieved 735 papers, and 4 studies were finally included. The craniosacral therapy provided statistically significant but clinically unimportant change on pain intensity (Mean difference = –1.10; 95% CI: –1.85, –0.35; I2: 44%), and no change on disability or headache effect (Standardized Mean Difference = –0.34; 95% CI –0.70, 0.01; I2: 26%). The certainty of the evidence was downgraded to very low.

The authors concluded that very low certainty of evidence suggests that craniosacral therapy produces clinically unimportant effects on pain intensity, whereas no significant effects were observed in disability or headache effect.

I find it strange that researchers seem so frequently unable to formulate their conclusions clearly. Is it political correctness? Or are they somehow favorably inclined (i.e. biased) towards the treatment that they pretend to critically evaluate?

Let’s look at the facts related to this review:

  • Craniosacral therapy (CST) is utterly implausible.
  • Only 4 RCTs were found.
  • They were of poor quality.
  • They were published mostly by people who want to promote CST.
  • Therefore the overall statistically significant effect is most likely a false-positive result.
  • This means that the conclusion should be much more straight forward.

I suggest something along the following lines:

A critical evaluation of the existing RCTs failed to find convincing evidence that CST is an effective treatment for headache disorders.


4 Responses to Craniosacral Therapy for Headache Disorders: A Systematic Review and Meta-analysis

  • I don’t see the point of including very poor quality studies in a review or meta-analysis. A very short and conclusive paper could be written simply by saying “no good quality evidence was found”. Why do peer reviewers accept such rubbish?

    • Seven hundred and thirty-five papers identified and four usable? This is not a meta-analysis. I think your idea is better.

      It’s a bit like some of the recent COVID meta-analyses, the quality of the research (and/or data fabrication) is often so bad that one cannot really trust the results.

      On the other hand, a good meta-analysis or comprehensive review can help point out systematic problems in a research area.

  • It is bad enough that useless methods are used for a relatively harmless symptomatology that causes a high burden of illness and a high number of absences from work.

    I myself know a young colleague who recently completed her state exams, is the daughter of a so-called alternative practitioner for psychotherapy and herself suffers from bipolar disorder.
    She was helped out of her last depressive phase not by medication but by craniosacral therapy? Really?

    But how do institutions educate?
    The Australian non-profit organisation “Beyond Blue” promotes SCAM like craniosacral therapy in its brochure “A guide to what works for depression”, even though it writes on page 46:

    “Does it work?
    There are reports that craniosacral therapy has been used to
    treat people with depression. However, no scientific study has
    been carried out.”

    🤷 The young colleague L. makes me sad, especially as she herself is affected and sees her vocation as a therapist. I remember the cited survey of German medical colleagues, which proved a connection between the prescription of homeopathic “medicines” and vaccination phobia.

  • Craniosacral Therapy Is Not Medicine
    Steve E Hartman, PhD, James M Norton, PhD
    Physical Therapy, Volume 82, Issue 11, 1 November 2002, Pages 1146–1147,

    To the Editor:

    Although the prescientific thinking emblematic of most “alternative” health care may lead infrequently to fortuitous insights, many of these techniques have been tested, have failed, and should be abandoned.

    For example, we have observed in our laboratory and described in Scientific Review of Alternative Medicine one of the manipulation procedures (craniosacral therapy/cranial osteopathy) used by many physical therapists, occupational therapists, osteopathic physicians, and others. Based on our observations, we have drawn several conclusions.

    We are not characterizing craniosacral therapy as just another approach to health care about which knowledge is incomplete. To the contrary, we believe that craniosacral therapy bears approximately the same relationship to real medicine that astrology bears to astronomy. That is, this approach to “health care” is medical fiction, and it is not appropriate to teach fiction as part of medical or allied health curricula.

    See also:
    craniosacral therapy, The Skeptic’s Dictionary

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