Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial

Abstract

BackgroundAlthough commonly utilized interventions, no studies have directly compared the effectiveness of cervical and thoracic manipulation to mobilization and exercise in individuals with cervicogenic headache (CH). The purpose of this study was to compare the effects of manipulation to mobilization and exercise in individuals with CH.MethodsOne hundred and ten participants (n = 110) with CH were randomized to receive both cervical and thoracic manipulation (n = 58) or mobilization and exercise (n = 52). The primary outcome was headache intensity as measured by the Numeric Pain Rating Scale (NPRS). Secondary outcomes included headache frequency, headache duration, disability as measured by the Neck Disability Index (NDI), medication intake, and the Global Rating of Change (GRC). The treatment period was 4 weeks with follow-up assessment at 1 week, 4 weeks, and 3 months after initial treatment session. The primary aim was examined with a 2-way mixed-model analysis of variance (ANOVA), with treatment group (manipulation versus mobilization and exercise) as the between subjects variable and time (baseline, 1 week, 4 weeks and 3 months) as the within subjects variable.ResultsThe 2X4 ANOVA demonstrated that individuals with CH who received both cervical and thoracic manipulation experienced significantly greater reductions in headache intensity (p < 0.001) and disability (p < 0.001) than those who received mobilization and exercise at a 3-month follow-up. Individuals in the upper cervical and upper thoracic manipulation group also experienced less frequent headaches and shorter duration of headaches at each follow-up period (p < 0.001 for all). Additionally, patient perceived improvement was significantly greater at 1 and 4-week follow-up periods in favor of the manipulation group (p < 0.001).ConclusionsSix to eight sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization and exercise in patients with CH, and the effects were maintained at 3 months.Trial registrationNCT01580280 April 16, 2012.

Non‐pharmacological management of persistent headaches associated with neck pain: A clinical practice guideline from the Ontario protocol for traffic injury management (OPTIMa) collaboration

“…Clinicians may consider manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine limited to a maximum of 10 sessions over six weeks. This recommendation is based on three low risk of bias RCTs suggesting that (a) spinal manipulation combined with light massage and moist heat (8 or 16 treatments over 8 weeks) is more effective than light massage and moist heat alone in improving headache pain, headache frequency and headache‐induced disability (Haas, Schneider, & Vavrek, ; Haas, Spegman, Peterson, Aickin, & Vavrek, ); (b) spinal manipulation and mobilization (8–12 visits over 6 weeks) are more effective than no intervention in improving headache‐related outcomes and neck symptoms (Jull et al, ); and (c) spinal manipulation (6–8 sessions over 4 weeks) is more effective than multimodal care (spinal mobilization and craniocervical flexion exercise) (Dunning et al, ).…”

Effectiveness of Thoracic Manipulation on the Treatment of Patients With Mechanical Non-Specific Neck Pain

“…Cervical Thrust Manipulation is an effective form of manual therapy that can alleviate pain and improve cervical range of motion [17,[26][27][28][29][30], but it can also lead to rare but severe complications related to vertebral artery injury [31][32][33][34][35][36]. To avoid this potential risk, indirect techniques aimed at the thoracic spine such as Thoracic manipulation Thrust (TM) are often used by therapists in the management of mechanical non-specific neck pain [37].…”

Headache, neck manipulation and stroke: the atlanto‐axial triad

“…Headaches have been identified as the third most common cause of years lost because of disability . There are a number of published studies advocating manipulation of the upper cervical spine as a treatment for cervicogenic or neck‐related headache, often without adequate consideration of the danger of such treatment. While upper neck manipulation might sometimes be an effective treatment for neck‐related headache, care must be taken to avoid upper cervical manipulative techniques that may pose a risk of stroke by damaging vertebral and internal carotid arteries.…”