{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T09:54:21Z","timestamp":1753869261383,"version":"3.41.2"},"reference-count":51,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T00:00:00Z","timestamp":1732838400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>Butalbital is an acute headache medication commonly prescribed for tension\u2010type headache (TTH), although discouraged by guidelines due to a risk of medication overuse headache (MOH). Considering spinal manipulative therapy (SMT) may reduce TTH frequency and intensity, we hypothesized adults with TTH receiving chiropractic SMT would be less likely to receive a butalbital prescription over 2 years versus matched controls not receiving SMT. We secondarily compared likelihood of MOH between cohorts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched a United States medical records database of patients attending academic medical centers for adults with TTH, from 2013 to 2024, excluding those diagnosed with other headaches and seen in inpatient\/emergency settings. We divided patients into two cohorts: (1) SMT and (2) non\u2010SMT, using propensity matching to control for demographics and other variables associated with likelihood of butalbital prescription and MOH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three thousand one hundred and sixteen patients remained per cohort after matching. The incidence of butalbital prescription was lower in the SMT cohort compared to the non\u2010SMT cohort (SMT: 1.7%; non\u2010SMT: 3.8%), yielding an RR (95% CI) of 0.46 (0.33\u20130.63; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The incidence of MOH was lower in the SMT cohort versus non\u2010SMT cohort (SMT: 0.5%; non\u2010SMT: 1.2%), yielding an RR (95% CI) of 0.44 (0.25\u20130.80; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Adults receiving chiropractic SMT had a significantly lower likelihood of butalbital prescription and, tentatively, MOH compared to matched controls not receiving SMT. These findings support current guideline recommendations favoring SMT in TTH care, though future studies should replicate and compare these findings with other nonpharmacologic clinicians and interventions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/hsr2.70218","type":"journal-article","created":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T11:40:15Z","timestamp":1732880415000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Spinal Manipulation, Butalbital Prescription, and Medication Overuse Headache in Adults With Tension\u2010Type Headache: Retrospective Cohort Study"],"prefix":"10.1002","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4714-1076","authenticated-orcid":false,"given":"Robert J.","family":"Trager","sequence":"first","affiliation":[{"name":"Connor Whole Health University Hospitals Cleveland Medical Center Cleveland Ohio USA"},{"name":"Department of Family Medicine and Community Health Case Western Reserve University School of Medicine Cleveland Ohio USA"},{"name":"Department of Biostatistics and Bioinformatics Clinical Research Training Program Duke University School of Medicine Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy J.","family":"Williamson","sequence":"additional","affiliation":[{"name":"UCHealth Spine Center University of Colorado Hospital Aurora Colorado USA"},{"name":"Department of Physical Medicine &amp; Rehabilitation, University of Colorado School of Medicine Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pratheek S.","family":"Makineni","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindsay H.","family":"Morris","sequence":"additional","affiliation":[{"name":"Frances Payne Bolton School of Nursing Case Western Reserve University Cleveland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,11,29]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-022-01402-2"},{"issue":"1","key":"e_1_2_12_3_1","article-title":"Aids for Management of Common Headache Disorders in Primary Care","volume":"8","author":"Steiner T. 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