Spinal Manipulations for Cervicogenic Headaches: A Systematic Review of Randomized Clinical Trials

Abstract

The objective of this systematic review was to assess the effectiveness of spinal manipulations as a treatment option for cervicogenic headaches. Seven databases were searched from their inception to February 2011. All randomized trials which investigated spinal manipulations performed by any type of healthcare professional for treating cervicogenic headaches in human subjects were considered. The selection of studies, data extraction, and validation were performed independently by 2 reviewers. Nine randomized clinical trials (RCTs) met the inclusion criteria. Their methodological quality was mostly poor. Six RCTs suggested that spinal manipulation is more effective than physical therapy, gentle massage, drug therapy, or no intervention. Three RCTs showed no differences in pain, duration, and frequency of headaches compared to placebo, manipulation, physical therapy, massage, or wait list controls. Adequate control for placebo effect was achieved in 1 RCT only, and this trial showed no benefit of spinal manipulations beyond a placebo effect. The majority of RCTs failed to provide details of adverse effects. There are few rigorous RCTs testing the effectiveness of spinal manipulations for treating cervicogenic headaches. The results are mixed and the only trial accounting for placebo effects fails to be positive. Therefore, the therapeutic value of this approach remains uncertain.

Complementary and Alternative Medicine Use Among US Adults With Headache or Migraine: Results from the 2012 National Health Interview Survey

“…In addition, a recent systematic review has revealed that existing trials, mostly of good quality, support the effectiveness of manual therapy for chronic tension‐type headache, albeit there were no trials on chronic migraine and chronic cluster headache . At this stage, trials examining the effectiveness of manual therapy for migraine remain limited and of poor quality with conflicting results . Evaluation of the effectiveness and cost‐effectiveness of manual therapies in reducing headache, using sufficiently powered, pragmatic randomized trial designs, should be recognized as a priority for trialists and clinicians.…”

Clinical reasoning for manual therapy management of tension type and cervicogenic headache

“…The results of the reviews are inconsistent, since the effectiveness of joint manipulation in tension type headache remains inconclusive; 9 current evidence does not support the use of manipulation for migraine, 10 whereas some positive results have been found for cervicogenic headache. 11 In fact, a review of systematic reviews concluded that the findings reported about effectiveness of spinal manipulation for the management of headaches differed considerably. 12 Further, we observed that the methodological quality of the randomized controlled trials analyzing the effectiveness of spinal manipulation and/or mobilization for headaches is typically low.…”

Concussion

“…77 Controlled trials of spinal manipulation have not demonstrated efficacy in cervicogenic headache or migraine and should not be recommended specifically for the treatment of posttraumatic headache. 78,79 Nerve blocks can be administered for neuralgic pain syndromes, and there are some data that suggest efficacy in cluster, cervicogenic, migraine, and tension-type headache in both adult and pediatric patients. [80][81][82] For refractory headaches acupuncture can be considered, and a recent Cochrane analysis of randomized trials in the treatment of migraine found it to be effective in reducing the frequency of attacks.…”