Pragmatic application of manipulation versus mobilization to the upper segments of the cervical spine plus exercise for treatment of cervicogenic headache: a randomized clinical trial

Abstract

Background: The effectiveness of manipulation versus mobilization for the management of spinal conditions, including cervicogenic headache, is conflicting. However, a pragmatic approach comparing manipulation to mobilization has not been examined in a patient population with cervicogenic headache. Objectives: To evaluate the effectiveness of manipulation compared to mobilization applied in a pragmatic fashion for patients with cervicogenic headache. Methods: Forty-five (26 females) patients with cervicogenic headache (mean age 47.8 ± SD 16.9 years) were randomly assigned to receive either pragmatically selected manipulation or mobilization. Outcomes were measured at baseline, the second visit, discharge, and 1-month follow-up and included the Neck Disability Index (NDI), Numeric Pain Rating Scale (NPRS), the Headache Impact Test (HIT-6), the Global Rating of Change (GRC), the Patient Acceptable Symptoms Scale (PASS). The primary aim (effects of treatment on disability and pain were examined with a mixed-model analysis of variance (ANOVA), with treatment group (manipulation versus mobilization) as the between subjects variable and time (baseline, 48 hours, discharge and follow-up) as the within subjects variable. Results: The interaction for the mixed model ANOVA was not statistically significant for NDI (p = 0.91), NPRS (p = 0.81), or HIT (p = 0.89). There was no significant difference between groups for the GRC or PASS. Discussion and Conclusion: The results suggest that manipulation has similar effects on disability, pain, GRC, and cervical range of motion as mobilization when applied in a pragmatic fashion for patients with cervicogenic headaches. Clinicaltrials.gov: NCT03919630

The effectiveness of manual and exercise therapy on headache intensity and frequency among patients with cervicogenic headache: a systematic review and meta-analysis

“…The RoB analysis showed high inter-rater reliability (Cohen’s Kappa = 0.87). Overall RoB was low in eight trials [ 53 , 55 , 56 , 60 , 61 , 66 – 68 ], unsure in six trials [ 51 , 58 , 62 – 64 , 69 ], and high in six trials [ 52 , 54 , 57 , 59 , 65 , 70 ] for the primary and secondary outcome measures. Further detail regarding the RoB of individual studies is found in Table 2 .…”

“…Among the included trials, the majority analyzed manual therapy in isolation: six focussed on spinal manipulation [ 52 , 53 , 55 , 56 , 61 , 68 ], two on trigger point therapy [ 51 , 58 ], two on spinal mobilization [ 57 , 60 ], and one study each on kinesio-taping [ 54 ] and dry needling [ 62 ]. Seven trials used a combination of manual and exercise therapy [ 59 , 63 , 64 , 66 , 67 , 69 , 70 ], and two used exercise therapy alone [ 59 , 65 ]. Ten studies used “other interventions” in their control groups (e.g.…”

“…3 patients dropped out after the second follow up due to worsening of their symptoms Yang and Kang [ 65 ] Not reported Youssef and Shanb [ 66 ] Not reported Abdel et al [ 67 ] Not reported Dunning et al [ 68 ] No severe or serious adverse effects. 60% of participants in the dry needling group experienced localized soreness, and 24% localized ecchymosis, resolved withing 48 h. 4% experienced drowsiness or nausea, resolved within several hours Lerner-Lentz et al [ 69 ] Not reported Moustafa et al [ 70 ] No severe or serious adverse effects …”

“…A combination of spinal manipulation and electrical dry needling was found more effective than spinal mobilization and cranio-cervical exercises at short and long-term [ 68 ]. Important clinical changes were also found in favor of spinal manipulation (with or without exercise therapy] for headache frequency and intensity in two high and unsure-RoB trials (n = 245) [ 59 , 69 ] at short and long term.…”

“…MCIDs reached for NDI (MD = 11.1 at 4 weeks) Dunning et al [ 68 ] Spinal manipulation and electrical dry needling (74) Spinal mobilization and scapular and cranio-cervical exercise (68) HD (hours in the past week), Disability (NDI), Global Rating of Change (GROC), Medication intake Between-group P < 0.001 for HD at all timepoints, for GRC and Medication intake at 3 months. MCIDs reached for NDI (MD = 14.4 at 4 weeks and 16.9 at 3 months) and between-group P < 0.001 at all timepoints Lerner-Lentz et al [ 69 ] Spinal manipulation, cranio-cervical and scapular exercise (21) Spinal mobilization and scapular and cranio-cervical exercise (24) Disability (NDI), Headache Impact Test (HIT-6), Globale Rate of Change (GRC), Patient Acceptable Symptoms Scale (PASS) MCIDs reached for NDI in both groups (MD = 13.9 for manipulation and MD = 12.8 for mobilization group at 1 month). Within-group P < 0.05 at all timepoionts for all groups for all secondary outcomes.…”