Efficacy of osteopathic manipulative treatment in reducing monthly migraine days: a meta-analysis

CONTEXT: Migraine is a highly prevalent and disabling neurological condition affecting approximately 12 % of adults in the United States, with substantial personal and economic burdens. Nonpharmacologic therapies, including osteopathic manipulative treatment (OMT), are increasingly utilized as adjunctive or alternative management strategies, yet the evidence base for OMT efficacy in migraine remains variable and incompletely synthesized. OBJECTIVES: The objective of this study was to evaluate the efficacy of OMT in reducing monthly migraine days compared to control interventions in adult patients through a systematic review and meta-analysis of randomized controlled trials. METHODS: A comprehensive literature search was conducted across PubMed, Scopus, NIH Library, and Wiley Library through December 2024. Studies were included if they enrolled adult migraine patients, evaluated OMT for a minimum of 5 weeks, included a control group, and reported monthly migraine day outcomes. Five randomized controlled trials (n=258) met all of the inclusion criteria. Effect sizes were standardized to the mean difference in monthly migraine days; a fixed-effect model was applied to pool the results across studies. RESULTS: =99.8 %), reflecting substantial differences in patient populations, OMT techniques, treatment duration, and outcome assessment methodology. CONCLUSIONS: OMT is associated with a statistically significant reduction in monthly migraine days and may serve as a clinically meaningful adjunct to standard pharmacologic migraine management. The extreme heterogeneity across trials limits the generalizability of pooled estimates and underscores the need for standardized protocols, rigorous blinding, and harmonized outcome definitions in future research.