Critical limitations compromise the conclusions of a recent meta-analysis regarding spinal manipulation and migraine: a commentary

Robert J Trager; Marc A Bronson; Clinton J Daniels; Stephen M Perle

doi:10.1186/s13643-025-02849-5

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Critical limitations compromise the conclusions of a recent meta-analysis regarding spinal manipulation and migraine: a commentary

Journal article

Open access

Peer reviewed

Critical limitations compromise the conclusions of a recent meta-analysis regarding spinal manipulation and migraine: a commentary

Robert J Trager, Marc A Bronson, Clinton J Daniels and Stephen M Perle

Systematic reviews, Vol.14(1), 200

2025

DOI: https://doi.org/10.1186/s13643-025-02849-5

PMID: 41131621

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Abstract

Humans

Manipulation, Spinal

Meta-Analysis as Topic

Migraine Disorders - therapy

Randomized Controlled Trials as Topic

Reproducibility of Results

Systematic Reviews as Topic

A recent meta-analysis by Posadzki et al. synthesized randomized controlled trials to evaluate the effectiveness and safety of spinal manipulative therapy (SMT) for migraines. Considering Systematic Reviews recognizes several methodological guidelines and reporting standards, our Letter highlights deviations from best practice methodologies. We detail issues with the search strategy, application of selection criteria, inclusion of data, and outcome reporting and analysis. We partially replicated the authors' search across three of their seven databases, which identified 1845 more articles than they reported. Finally, the authors' interpretations appear to conflate mild and transient adverse effects with serious ones and minimize potentially meaningful benefits of SMT. The methodological limitations in the meta-analysis by Posadzki et al. raise concerns about its reliability and reproducibility. Accordingly, we advise against relying on this study to guide clinical decision-making. Clinicians, patients, and stakeholders should interpret its conclusions cautiously when evaluating the appropriateness of SMT for migraine management.

Details

Title: Critical limitations compromise the conclusions of a recent meta-analysis regarding spinal manipulation and migraine: a commentary
Authors/Creators: Robert J Trager - Case Western Reserve University
Marc A Bronson - Merck Canada Inc. (Canada)
Clinton J Daniels - VA Puget Sound Health Care System
Stephen M Perle - School of Allied Health, Murdoch University, Murdoch, WA, Australia
Publication Details: Systematic reviews, Vol.14(1), 200
Publisher: BioMed Central Ltd unless otherwise stated. Part of Springer Nature.
Number of pages: 3
Identifiers: 991005829249007891
Murdoch Affiliation: School of Allied Health
Language: English
Resource Type: Journal article

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Collaboration types: Domestic collaboration; International collaboration
Citation topics: 1 Clinical & Life Sciences; 1.247 Migraines & Headaches; 1.247.461 Migraine Mechanisms
Web Of Science research areas: Rehabilitation
ESI research areas: Clinical Medicine