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Background <p>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 <i>Systematic Reviews</i> recognizes several methodological guidelines and reporting standards, our Letter highlights deviations from best practice methodologies.</p> Main findings <p>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.</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月23日

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

摘要

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.