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

Trager, Robert, Bronson, Marc, Daniels, Clinton and Perle, Stephen (2025) Critical limitations compromise the conclusions of a recent meta-analysis regarding spinal manipulation and migraine: a commentary. Systematic Reviews, 14. ISSN 2046-4053

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Abstract

Background 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. Main findings 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. Conclusion 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.

Item Type:	Article
Schools:	Other
Depositing User:	Bridget Roberts
Date Deposited:	22 May 2026 12:23
Last Modified:	22 May 2026 12:23
URI:	https://hsu.repository.guildhe.ac.uk/id/eprint/649

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