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Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence?

By |April 13, 2016|Headache|

Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence?

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SOURCE:   Front Neurol. 2016 (Mar 21); 7: 40 ~ FULL TEXT

Jodan D. Garcia, Stephen Arnold, Kylie Tetley,
Kiel Voight, and Rachael Anne Frank

Department of Physical Therapy,
Georgia State University ,
Atlanta, GA , USA.


Cervical mobilization and manipulation are frequently used to treat patients diagnosed with cervicogenic headache (CEH); however, there is conflicting evidence on the efficacy of these manual therapy techniques. The purpose of this review is to investigate the effects of cervical mobilization and manipulation on pain intensity and headache frequency, compared to traditional physical therapy interventions in patients diagnosed with CEH. A total of 66 relevant studies were originally identified through a review of the literature, and the 25 most suitable articles were fully evaluated via a careful review of the text.

Ultimately, 10 studies met the inclusion criteria:

(1) randomized controlled trial (RCT) or open RCT; the study contained at least two separate groups of subjects that were randomly assigned either to a cervical spine mobilization or manipulation or a group that served as a comparison

(2) subjects must have had a diagnosis of CEH

(3) the treatment group received either spinal mobilization or spinal manipulation, while the control group received another physical therapy intervention or placebo control, and

(4) the study included headache pain and frequency as outcome measurements.

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Do Manual Therapy Techniques Have a Positive Effect on Quality of Life in People With Tension-type Headache?

By |March 2, 2016|Headache|

Do Manual Therapy Techniques Have a Positive Effect on Quality of Life in People With Tension-type Headache? A Randomized Controlled Trial

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SOURCE:   Eur J Phys Rehabil Med. 2016 (Feb 29) [Epub]

Gemma V. Espí-López , Cleofas Rodríguez-Blanco,
Angel Oliva-Pascual-Vaca, Francisco J. Molina-Martínez,
Deborah Falla

Department of Physiotherapy,
University of Valencia,
Valencia, Spain


BACKGROUND:   Controversy exists regarding the effectiveness of manual therapy for the relief of tension-type headache (TTH). However most studies have addressed the impact of therapy on the frequency and intensity of pain. No studies have evaluated the potentially significant effect on the patient’s quality of life.

AIM:   To assess the quality of life of patients suffering from TTH treated for 4 weeks with different manual therapy techniques.

DESIGN:   Factorial, randomized, single-blinded, controlled clinical trial.

SETTING:   Specialized center for the treatment of headache.

POPULATION:   Seventy-six (62 women) patients aged between 18 and 65 years (age: 39.9 ± 10.9) with either episodic or chronic TTH.

METHODS:   Patients were divided into four groups: suboccipital inhibitory pressure; suboccipital spinal manipulation; a combination of the two treatments; control. Quality of life was assessed using the SF-12 questionnaire (considering both the overall score and the different dimensions) at the beginning and end of treatment, and after a one month follow-up.

RESULTS:   Compared to baseline, the suboccipital inhibition treatment group showed a significant improvement in their overall quality of life at the one month follow-up and also showed specific improvement in the dimensions related to moderate physical activities, and in their emotional role. All the treatment groups, but not the control group, showed improvements in their physical role, bodily pain, and social functioning at the one month follow-up. Post treatment and at the one month follow-up, the combined treatment group (suboccipital inhibitory pressure and suboccipital spinal manipulation) showed improved vitality and the two treatment groups that involved manipulation showed improved mental health.

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Upper Cervical and Upper Thoracic Manipulation Versus Mobilization and Exercise in Patients with Cervicogenic Headache

By |February 10, 2016|Headache|

Upper Cervical and Upper Thoracic Manipulation Versus Mobilization and Exercise in Patients with Cervicogenic Headache: A Multi-center Randomized Clinical Trial

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SOURCE:   BMC Musculoskel Disord. 2016 (Feb 6); 17 (1): 64

James R. Dunning, Raymond Butts, Firas Mourad,
Ian Young, Cesar Fernandez-de-las Peñas st. al.

Alabama Physical Therapy & Acupuncture,
Montgomery, AL, USA


BACKGROUND:   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.

METHODS:   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.

RESULTS:   The 2X4 ANOVA demonstrated that individuals with cervicogenic headache (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).

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Chiropractic Spinal Manipulative Therapy for
Cervicogenic Headache

By |January 9, 2016|Headache|

Chiropractic Spinal Manipulative Therapy for Cervicogenic Headache: A Study Protocol of a Single-blinded Placebo-controlled Randomized Clinical Trial

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SOURCE:   Springerplus. 2015 (Dec 16);   4:   779

Aleksander Chaibi, Jurate Šaltyte Benth,
Peter J. Tuchin, and Michael Bjørn Russell

Head and Neck Research Group,
Research Centre, Akershus University Hospital,
1478 Lørenskog, Norway ;

Institute of Clinical Medicine,
Akershus University Hospital, University of Oslo,
1474 Nordbyhagen, Norway


Cervicogenic headache (CEH) is a secondary headache which affects 1.0-4.6% of the population. Although the costs are unknown, the health consequences are substantial for the individual; especially considering that they often suffers chronicity. Pharmacological management has no or only minor effect on CEH. Thus, we aim to assess the efficacy of chiropractic spinal manipulative therapy (CSMT) for CEH in a single-blinded placebo-controlled randomized clinical trial (RCT). According to the power calculations, we aim to recruit 120 participants to the RCT. Participants will be randomized into one of three groups; CSMT, placebo (sham manipulation) and control (usual non-manual management). The RCT consists of three stages: 1 month run-in, 3 months intervention and follow-up analyses at the end of intervention and 3, 6 and 12 months. Primary end-point is headache frequency, while headache duration, headache intensity, headache index (frequency × duration × intensity) and medicine consumption are secondary end-points. Primary analysis will assess a change in headache frequency from baseline to the end of intervention and to follow-up, where the groups CSMT and placebo and CSMT and control will be compared. Due to two group-comparisons, the results with p values below 0.025 will be considered statistically significant. For all secondary end-points and analyses, the significance level of 0.05 will be used. The results will be presented with the corresponding p values and 95 % confidence intervals. To our knowledge, this is the first prospective manual therapy three-armed single-blinded placebo-controlled RCT to be conducted for CEH. Current RCTs suggest efficacy in headache frequency, duration and intensity. However a firm conclusion requires clinical single-blinded placebo-controlled RCTs with few methodological shortcomings. The present study design adheres to the recommendations for pharmacological RCTs as far as possible and follows the recommended clinical trial guidelines by the International Headache Society.

Trial registration ClinicalTrials.gov identifier: NCT01687881, 2 December 2012.

KEYWORDS:   Cervicogenic headache; Chiropractic; Headache; Manual therapy; Protocol; Randomized controlled trial; Spinal manipulation


From the FULL TEXT Article:

Background

The prevalence of cervicogenic headache (CEH) is low and varies from 1.0 to 4.6 % in the general population, depending on the applied diagnostic criteria, i.e. 1.0 % if 6 and 4.6 % if 5 diagnostic criteria of the Cervicogenic Headache International Study Group are fulfilled, and 2.5 % if the criteria of the International Headache Society (IHS) are applied (Table 1) (Nilsson 1995a; Pareira Monteriro 1995; Sjaastad et al. 1998; Sjaastad and Bakketeig 2008; Headache Classification Subcommittee of the International Headache Society 2013). Headache disorders have substantial health and socio-economic costs (Vos et al. 2012). However, no studies have exclusively investigated the costs for CEH.


Table 1. Diagnostic criteria for cervicogenic headache by the Cervicogenic Headache International Study Group


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Efficacy of Manual and Manipulative Therapy in the Perception of Pain and Cervical Motion in Patients with Tension-type Headache: A Randomized, Controlled Clinical Trial

By |March 21, 2015|Headache, Spinal Manipulation|

Efficacy of Manual and Manipulative Therapy in the Perception of Pain and Cervical Motion in Patients with Tension-type Headache: A Randomized, Controlled Clinical Trial

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SOURCE:   J Chiropr Med. 2014 (Mar);   13 (1):   4—13

Espí-López Gemma V., PhD, PT, and Gómez-Conesa Antonia, PhD, PT

Professor, Physiotherapy Department,
University of Valencia, Spain


OBJECTIVE:   The purpose of this study was to evaluate the efficacy of manipulative and manual therapy treatments with regard to pain perception and neck mobility in patients with tension-type headache.

METHODS:   A randomized clinical trial was conducted on 84 adults diagnosed with tension-type headache. Eighty-four subjects were enrolled in this study: 68 women and 16 men. Mean age was 39.76 years, ranging from 18 to 65 years. A total of 57.1% were diagnosed with chronic tension-type headache and 42.9% with tension-type headache. Participants were divided into 3 treatment groups (manual therapy, manipulative therapy, a combination of manual and manipulative therapy) and a control group. Four treatment sessions were administered during 4 weeks, with posttreatment assessment and follow-up at 1 month. Cervical ranges of motion pain perception, and frequency and intensity of headaches were assessed.

RESULTS:   All 3 treatment groups showed significant improvements in the different dimensions of pain perception. Manual therapy and manipulative treatment improved some cervical ranges of motion. Headache frequency was reduced with manipulative treatment (P < .008). Combined treatment reported improvement after the treatment (P < .000) and at follow-up (P < .002). Pain intensity improved after the treatment and at follow-up with manipulative therapy (P < .01) and combined treatment (P < .01).

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Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache

By |January 26, 2014|Chiropractic Care, Evidence-based Medicine, Headache|

Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache

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SOURCE:  Duke University Evidence-based Practice Center

Douglas C. McCrory, MD, MHSc, Donald B. Penzien, PhD,
Vic Hasselblad, PhD. Rebecca N. Gray, DPhil

Duke University Evidence-based Practice Center
Center for Clinical Health Policy Research
2200 W. Main Street, Suite 230
Durham, NC 27705


EXECUTIVE SUMMARY

Background

Tension-type headache and cervicogenic headache are two of the most common non-migraine headaches. Population-based studies suggest that a large proportion of adults experience mild and infrequent (once per month or less) tension-type headaches, and that the one-year prevalence of more frequent headaches (more than once per month) is 20%-30%; a smaller percentage of the population (roughly 3%) has been estimated to have chronic tension-type headache (180 days per year). Estimates of the prevalence of cervicogenic headache have varied considerably, due in large part to disagreements about the precise definition of the condition. A recent population-based study, which used the diagnostic criteria of the International Headache Society (IHS), found that 17.8% of subjects with frequent headache (5 days per month) fulfilled the criteria for cervicogenic headache; this was equivalent to a prevalence of 2.5% in the larger population. This agrees with an earlier clinic-based study which found that 14% of headache patients treated had cervicogenic headache.

The impact of tension-type headache on individuals and society appears to be significant. According to one population-based study, regular activities were limited during 38% of tension-type headache attacks, and 4% of respondents indicated that their headaches affected their attendance at work. Eighty-nine percent of tension-type headache sufferers reported that their headaches had negatively affected their relationships with friends, colleagues, and family. Little is known about the personal and societal impact of cervicogenic headache.

Nearly all patients with tension-type headache have used medications at one time or another to treat their headaches. But pharmacological treatments are not suitable for all patients, nor are they universally effective. Drug treatments may also produce undesired side effects. Partly for these reasons, significant interest has developed among both patients and health care providers in alternative treatments for tension-type headache, including behavioral and physical interventions. Cervicogenic headache, when diagnosed as such, is commonly treated with non-pharmacological interventions, especially physical treatments.

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