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

Although 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 ex...

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Published in:	BMC musculoskeletal disorders Vol. 17; no. 64; p. 64
Main Authors:	Dunning, James R, Butts, Raymond, Mourad, Firas, Young, Ian, Fernandez-de-Las Peñas, Cesar, Hagins, Marshall, Stanislawski, Thomas, Donley, Jonathan, Buck, Dustin, Hooks, Todd R, Cleland, Joshua A
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 06-02-2016 BioMed Central
Subjects:	Adult Cervical Vertebrae Clinical trials Exercise Exercise Therapy - methods Female Follow-Up Studies Headache Headaches Health aspects Humans Male Manipulation, Spinal - methods Manipulative therapy Medical screening Middle Aged Musculoskeletal diseases Neck pain Neck Pain - diagnosis Neck Pain - epidemiology Neck Pain - therapy Patients Physical therapists Physical therapy Post-Traumatic Headache - diagnosis Post-Traumatic Headache - epidemiology Post-Traumatic Headache - therapy Range of motion Risk factors Spinal manipulation Thoracic Vertebrae Treatment Outcome
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Summary:	Although 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. One 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. The 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). Six 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. NCT01580280 April 16, 2012.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-News-2 ObjectType-Feature-3 content type line 23
ISSN:	1471-2474 1471-2474
DOI:	10.1186/s12891-016-0912-3