Effectiveness of manual therapy in the treatment of cervicogenic headache: A systematic review

Abstract

Objective:The aim of this study was to identify the manual therapy (MT) methods and techniques that have been evaluated for the treatment of cervicogenic headache (CH) and their effectiveness.Background: MT seems to be one of the options with the greatest potential for the treatment of CH, but the techniques to be applied are varied and there is no consensus on which are the most indicated. Methods: A systematic search in Scopus, Medline, PubMed, Cinahl, PEDro, and Web of Science with the terms: secondary headache disorders, physical therapy modalities, musculoskeletal manipulations, cervicogenic headache, manual therapy, and physical therapy. We included articles published from 2015 to the present that studied interventions with MT techniques in patients with CH. Two reviewers independently screened 365 articles for demographic information, characteristics of study design, study-specific intervention, and results. The Oxford 2011 Levels of Evidence and the Jadad scale were used.Results: Of a total of 14 articles selected, 11 were randomized control trials and three were quasi-experimental studies. The techniques studied were: spinal manipulative therapy, Mulligan's Sustained Natural Apophyseal Glides, muscle techniques, and translatory vertebral mobilization. In the short-term, the Jones technique on the trapezius and ischemic compression on the sternocleidomastoid achieved immediate improvements, whereas adding spinal manipulative therapy to the treatment can maintain long-term results. Conclusions:The manual therapy techniques could be effective in the treatment of patients with CH. The combined use of MT techniques improved the results compared with using them separately. This review has methodological limitations, such as the inclusion of quasi-experimental studies and studies with small sample sizes that reduced the generalizability of the results obtained.

Association between Cervical Muscle Weakness and Functional Limitations due to Headache in Doctors

“…Interestingly, headaches can emerge from cervical discomfort even in asymptomatic individuals, particularly when cervical muscles like the levator scapulae, sternocleidomastoid (SCM), trapezius, and paraspinal muscles are weakened or fatigued. This connection between headaches and neck muscle issues underscores the importance of addressing these factors for effective treatment (8,9). Cervical muscles with structural and functional anomalies are less capable of generating and maintaining the necessary torque for optimal functioning.…”

Clinical efficacy of the mulligan maneuver for cervicogenic headache: a randomized controlled trial

“…A systematic review have demonstrated the efficacy of the Mulligan maneuvre for CEH on clinical pain scales and cervical range of motion after treatment 12 . However, they do not take into account the fact that chronic pain results in feelings of anxiety or depression in patients.…”

Individual endogenous pain modulation profiles within a multidimensional context of people with cervicogenic headache – A retrospective exploratory study

“…Cervicogenic headache (CeH) is a type of referred pain which originates from cervical structures innervated by C1–C3 spinal afferents ( Bogduk and Govind, 2009 ). Both anatomical lesions as well as musculoskeletal dysfunctions of the upper-cervical spine could be sources of CeH ( Bogduk and Govind, 2009 ; Núñez-Cabaleiro and Leirós-Rodríguez, 2022 ). Such upper-cervical musculoskeletal dysfunctions are commonly targeted by physiotherapists, manual therapists, chiropractors, and osteopaths ( Biondi, 2005 ; Bryans et al, 2011 ; Luedtke et al, 2016a , Luedtke et al, 2016b ; Núñez-Cabaleiro and Leirós-Rodríguez, 2022 ).…”

“…Both anatomical lesions as well as musculoskeletal dysfunctions of the upper-cervical spine could be sources of CeH ( Bogduk and Govind, 2009 ; Núñez-Cabaleiro and Leirós-Rodríguez, 2022 ). Such upper-cervical musculoskeletal dysfunctions are commonly targeted by physiotherapists, manual therapists, chiropractors, and osteopaths ( Biondi, 2005 ; Bryans et al, 2011 ; Luedtke et al, 2016a , Luedtke et al, 2016b ; Núñez-Cabaleiro and Leirós-Rodríguez, 2022 ). Nevertheless, despite the well-known pathophysiology of CeH, the number of non-responders amounts to 25%, and self-reported effectiveness of manual therapy is only rated as 36% ( Ossendorf et al, 2009 ; Liebert et al, 2013 ; Moore et al, 2017 ).…”