Objective: The purpose of this study was to characterize expectations, attitudes, and experiences of individuals with migraine who were randomly assigned to receive chiropractic care delivered within a randomized controlled trial in a hospital-based integrative care center.

Methods: This qualitative substudy was conducted as a part of a 2-arm pilot pragmatic randomized controlled trial investigating a multimodal model of chiropractic care for women with episodic migraine (4-13 migraines per month). Women were randomly assigned to chiropractic care (10 sessions over 14 weeks) plus enhanced usual care vs enhanced usual care alone. Semistructured interviews were conducted at baseline and 14-week follow-up with 15 randomly selected participants from the 29 participants randomized to the chiropractic group. Qualitative analysis was performed by 2 independent reviewers using a constant comparative method of analysis for generating grounded theory.

Results: Integrating baseline and follow-up interviews, 3 themes emerged: over the course of treatment with chiropractic care, participants became more aware of the role of musculoskeletal tension, pain, and posture in triggering migraine; participants revised their prior conceptions of chiropractic care beyond spinal manipulation; and participants viewed the chiropractor-patient relationship as an essential and valuable component to effectively managing their migraines.

Conclusion: In this qualitative study, women with episodic migraine after receiving comprehensive chiropractic care described chiropractic as a multimodal intervention where they learned about musculoskeletal contributions to migraine, discovered new ways to affect their symptoms, and developed a collaborative patient-practitioner relationship. The results of this study provide insights into perceptions of chiropractic care among women with migraine and suggestions for future trials.

Author keywords: Migraine Disorders; Chiropractic; Female; Integrative Medicine; Qualitative Research; Complementary Therapies

Author affiliations: JPC, KO, PMW: Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts; Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts; CB: Osher Clinical Center, Brigham and Women's Hospital, Chestnut Hill, Massachusetts; John Graham Headache Center, Department of Neurology, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts; KK: School of Special Education, School Psychology & Early Childhood Studies, University of Florida, Gainesville, Florida; PMR: Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; MK: Osher Clinical Center, Brigham and Women's Hospital, Chestnut Hill, Massachusetts.

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