Author Names
Núñez-Cabaleiro, P., Leirós-Rodríguez, R.
Reviewer Name
Hannah Koch, SPT
Reviewer Affiliation(s)
Duke University
Paper Abstract
Objective: The aim of this study was to identify the manual therapy (MT) methods and techniques that have been evaluated for the treatment of cervicogenic headache (CH) and their effectiveness. Background: MT seems to be one of the options with the greatest potential for the treatment of CH, but the techniques to be applied are varied and there is no consensus on which are the most indicated. Methods: A systematic search in Scopus, Medline, PubMed, Cinahl, PEDro, and Web of Science with the terms: secondary headache disorders, physical therapy modalities, musculoskeletal manipulations, cervicogenic headache, manual therapy, and physical therapy. We included articles published from 2015 to the present that studied interventions with MT techniques in patients with CH. Two reviewers independently screened 365 articles for demographic information, characteristics of study design, study-specific intervention, and results. The Oxford 2011 Levels of Evidence and the Jadad scale were used. Results: Of a total of 14 articles selected, 11 were randomized control trials and three were quasi-experimental studies. The techniques studied were: spinal manipulative therapy, Mulligan’s Sustained Natural Apophyseal Glides, muscle techniques, and translatory vertebral mobilization. In the short-term, the Jones technique on the trapezius and ischemic compression on the sternocleidomastoid achieved immediate improvements, whereas adding spinal manipulative therapy to the treatment can maintain long-term results. Conclusions: The manual therapy techniques could be effective in the treatment of patients with CH. The combined use of MT techniques improved the results compared with using them separately. This review has methodological limitations, such as the inclusion of quasi-experimental studies and studies with small sample sizes that reduced the generalizability of the results obtained.
NIH Risk of Bias Tool
Quality Assessment of Systematic Reviews and Meta-Analyses
- Is the review based on a focused question that is adequately formulated and described?
- Yes
- Were eligibility criteria for included and excluded studies predefined and specified?
- Yes
- Did the literature search strategy use a comprehensive, systematic approach?
- Yes
- Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
- Yes
- Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
- Were the included studies listed along with important characteristics and results of each study?
- Yes
- Was publication bias assessed?
- Cannot Determine, Not Reported, Not Applicable
- Was heterogeneity assessed? (This question applies only to meta-analyses.)
- Cannot Determine, Not Reported, Not Applicable
Key Finding #1
Manual therapy can be beneficial in the treatment of patients with cervicogenic headaches. The techniques that may improve cervicogenic related symptomatology includes spinal manipulation, Mulligan’s SNAGs, ischemic trigger point compression, suboccipital musculature relaxation, Jones technique, and vertebral translatory mobilization.
Key Finding #2
Of manual therapy techniques that may be utilized for the treatment of cervicogenic headaches, spinal manipulation therapy appears to be most beneficial for long term reduction of symptoms.
Key Finding #3
For immediate, but short lasting results, the employment of the Jones technique on the trapezius and ischemic compression on the sternocleidomastoid is applicable.
Please provide your summary of the paper
This paper reviewed the literature regarding manual therapy treatment effectiveness in cervicogenic headache. Key findings of this systematic review indicate that manual therapies are effective treatment options for individuals seeking relief from cervicogenic headaches. Of the available therapies, spinal manipulation therapies are the most effective in long term reduction of symptom intensity. However, for patients desiring a quick relief, the Jones technique of the trapezius and ischemic compression on the sternocleidomastoid may be desirable. Significant improvements were seen after four treatment sessions with these techniques. Overall, there are a variety of effective manual treatment options that physical therapist’s have the ability to choose from based on therapist skill acquisition and patient preference. More research is indicated to further analyze potential differences in manual therapy techniques. This study compiled data from 14 studies; additional research investigating the relationship between cervicogenic headaches and manual therapy is indicated to improve patient outcomes. Additionally, the current research lacks the longevity to fully appreciate the long term effects manual therapy may have on cervicogenic headaches.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
Key findings of this systematic review indicate that manual therapies are effective treatment options for individuals seeking relief from cervicogenic headaches. Of the available therapies, spinal manipulation therapies are the most effective in long term reduction of symptoms. However, for patients desiring an immediate relief, the Jones technique of the trapezius and ischemic compression on the sternocleidomastoid may be desirable. The reduction of symptoms is observed in a large variety of manual techniques, allowing the physical therapist the opportunity to utilize a therapy that is within their own personal scope. If a physical therapy does not possess any manual therapy techniques within their own personal scope, it is important for them to seek out opportunities for skill acquisition. With 2.2-4.1% of the population having cervicogenic headaches, it is imperative that physical therapists possess the necessary skills to employ manual therapy techniques to improve patient outcomes. This paper should encourage physical therapists to seek opportunities to become competent in manual therapy techniques. Ultimately, this review demonstrates that cervicogenic headache outcomes are not overly dependent on the specific manual therapy technique utilized. Instead, employment of any manual therapy techniques should yield better outcomes. This encourages physical therapists to integrate these methods to their plan of care.
