SPINAL MANIPULATION FOR THE MANAGEMENT OF CERVICOGENIC HEADACHE: A SYSTEMATIC REVIEW AND META-ANALYSIS
 
   

Spinal Manipulation for the Management of Cervicogenic Headache:
A Systematic Review and Meta-analysis

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:
   Frankp@chiro.org
 
   

FROM:   European Journal of Pain 2020 (Oct); 24 (9): 1687–1702 ~ FULL TEXT

Matthew Fernandez, Craig Moore, Jinghan Tan, Derrick Lian, Jeremy Nguyen, Andrew Bacon, Brie Christie, Isabella Shen, Thomas Waldie, Danielle Simonet, André Bussières

Macquarie University,
Sydney, Australia.

Chiropractic Academy for Research Leadership (CARL),
Sydney, Australia.


FROM:   ACA's Hands Down Better page

Headaches and Chiropractic


February 18, 2022

If you have a headache, you’re not alone. Many people suffer from headaches — some are occasional, some frequent, some are dull and throbbing, and some cause debilitating pain and nausea.

What do you do when you suffer from a pounding headache? Do you grit your teeth and carry on? Lie down? Take pain medication and hope it goes away? There is an alternative.

Research shows that spinal manipulation therapy (SMT) – a centerpiece of chiropractic care – may be an effective treatment option for cervicogenic headaches, which are tension headaches and headaches that originate in the neck. Pain medications have limited effects on these types of headaches, so attention has turned to the use of non-drug options. This scientific review of research [1] published in 2020 determined that SMT could be considered an effective treatment for tension headaches because it provides “superior, small, short-term effects for pain intensity, frequency and disability when compared with other manual therapies.” The authors recommend additional studies to better understand the findings.

What’s already known about this topic?

  • Previous systematic reviews have shown that SMT might be a beneficial modality for reducing pain and disability associated with cervicogenic headache (CGHA).

What does this study add?

  • This meta-analysis reports the estimate of the size of the effects for SMT compared to other manual therapies for CGHA.

  • These findings may help clinicians to better understand the treatment effects of SMT alone for CGHA.

  • Such findings may assist with the shared decision-making process regarding treatment options for this common headache disorder.


Background:   Spinal manipulative therapy (SMT) is frequently used to manage cervicogenic headache (CGHA). No meta-analysis has investigated the effectiveness of SMT exclusively for CGHA.

Objective:   To evaluate the effectiveness of SMT for CGHA.

Databases and data treatment   : Five databases identified randomized controlled trials comparing SMT with other manual therapies. The PEDro scale assessed the risk-of-bias. Pain and disability data were extracted and converted to a common scale. A random effects model was used for several follow-up periods. GRADE described the quality of evidence.

Results:   Seven trials were eligible. At short-term follow-up, there was a significant, small effect favouring SMT for pain intensity (mean difference [MD] –10.88 [95% CI, –17.94, –3.82]) and small effects for pain frequency (standardized mean difference [SMD] –0.35 [95% CI, –0.66, –0.04]). There was no effect for pain duration (SMD – 0.08 [95% CI, –0.47, 0.32]). There was a significant, small effect favouring SMT for disability (MD – 13.31 [95% CI, –18.07, –8.56]). At intermediate follow-up, there was no significant effects for pain intensity (MD – 9.77 [–24.21 to 4.68]) and a significant, small effect favouring SMT for pain frequency (SMD – 0.32 [–0.63 to – 0.00]). At long-term follow-up, there was no significant effects for pain intensity (MD – 0.76 [–5.89 to 4.37]) and for pain frequency (SMD – 0.37 [–0.84 to 0.10]).

Conclusion:   For CGHA, SMT provides small, superior short-term benefits for pain intensity, frequency and disability, but not pain duration, however, high-quality evidence in this field is lacking. The long-term impact is not significant.

Significance:   Cervicogenic Headache (CGHA) is a common headache disorder. SMT can be considered an effective treatment modality, with this review suggesting it providing superior, small, short-term effects for pain intensity, frequency and disability when compared with other manual therapies. These findings may help clinicians in practice better understand the treatment effects of SMT alone for CGHA.

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